Research on treating neuropsychiatric symptoms of advanced dementia with non-pharmacological strategies, 1998-2008: a systematic literature review.
Research on treating neuropsychiatric symptoms of advanced dementia with non-pharmacological strategies, 1998-2008: a systematic literature review.
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DOI：
10.1017/s1041610209990196
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发表时间：
2009-10
影响因子：
7
通讯作者：
Rabins PV
中科院分区：
文献类型：
--
作者：
Kverno KS;Black BS;Nolan MT;Rabins PV
晚期痴呆症的特点是严重的认知和功能障碍，导致几乎完全依赖自我照顾。神经精神症状（NPS）在晚期痴呆症中很常见，降低了生活质量并增加了护理负担。卫生保健提供者面临的挑战是找到安全有效的治疗方法。非药物干预为药物治疗提供了更安全的替代方案，但对其疗效知之甚少。本综述评估了非药物干预治疗晚期痴呆患者NPS的已发表文献。对1998年至2008年间发表的非药物干预研究进行了文献检索，这些研究测量了诊断为晚期痴呆的个体的NPS结果。最初严格的纳入标准要求所有研究参与者都患有严重或非常严重的痴呆症，但这一范围后来扩大到包括中度严重到非常严重的阶段。在215项干预研究中，有21项（9.8%）专门针对中度至重度痴呆症患者的治疗。这些研究提供了有限的、中等到高质量的证据，证明了感官聚焦策略的使用，包括香气、首选或现场音乐，以及多感官刺激。以情绪为导向的方法，如模拟在场，可能对保留语言互动能力的个人更有效。大多数与痴呆症相关的NPS干预研究都集中在轻度到中度认知障碍的个体上。有严重认知障碍的个体不一定对NPS治疗有同样的反应。未来的研究应专门设计，以进一步探索非药物治疗对晚期痴呆患者的阶段性疗效。特别需要进一步研究的领域包括基于运动的疗法，动手（触摸）疗法，以及可以在个人护理过程中提供的干预措施。当干预措施被量身定制以平衡个体唤醒模式时，效果似乎最好。
Advanced dementia is characterized by severe cognitive and functional impairments that lead to almost total dependency in self-care. Neuropsychiatric symptoms (NPS) are common in advanced dementia, diminishing quality of life and increasing the care burden. The challenge for health care providers is to find safe and effective treatments. Non-pharmacological interventions offer the potential for safer alternatives to pharmacotherapy, but little is known about their efficacy. This review evaluates the published literature on non-pharmacological interventions for treating NPS in advanced dementia. A literature search was undertaken to find non-pharmacological intervention studies published between 1998 and 2008 that measured NPS outcomes in individuals diagnosed with advanced dementia. Strict inclusion criteria initially required that all study participants have severe or very severe dementia, but this range was later broadened to include moderately severe to very severe stages. Out of 215 intervention studies, 21 (9.8%) specifically focused on treatments for individuals with moderately severe to very severe dementia. The studies provide limited moderate to high quality evidence for the use of sensory-focused strategies, including aroma, preferred or live music, and multi-sensory stimulation. Emotion-oriented approaches, such as simulated presence may be more effective for individuals with preserved verbal interactive capacity. Most studies of interventions for dementia-related NPS have focused on individuals with mild to moderate cognitive impairment. Individuals with severe cognitive impairment do not necessarily respond to NPS treatments in the same manner. Future studies should be specifically designed to further explore the stage-specific efficacy of non-pharmacological therapies for patients with advanced dementia. Areas of particular need for further research include movement-based therapies, hands-on (touch) therapies, and interventions that can be provided during personal care routines. Interventions appear to work best when they are tailored to balance individual arousal patterns.