Guidelines on Non-pharmacology Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 WUJie , WANGYi ,  WANGZhi-wen

School of Nursing, Peking University, Beijing 100191, China;

Corresponding?author：

WANGZhi-wen, Email: wzwjing@sina.com

Keywords：

Dementia; Behavioral and psychological symptoms; Guideline; Systematic review; AGREE Ⅱ

DOI：

10.7507/1672-2531.20160202

Video：

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Objective To systematically review the methodological quality of evidence-based guidelines on non-pharmacology management of behavioral and psychological symptoms of dementia, so as to provide references for taking caring for the dementia with behavioral and psychological symptoms. Methods Guidelines concerning non-pharmacology treatment of behavioral and psychological symptoms were searched from websites of guideline development, websites of medical association and literature databases from inception to May 31st 2016. The methodological quality of included guidelines were evaluated according to the AGREE Ⅱ instrument, and the differences and similarities between recommendations of included guidelines were compared. Results A total of 544 literatures were identified and 6 of them were included. All the included guidelines were from abroad. The average scores of guidelines in six domains of AGREE Ⅱ were:scope and purpose 88.89%, stakeholder involvement 65.74%, rigor of development 63.72%, clarity of presentations 86.11%, applicability 50.69%, and independence 37.50%. The overall qualities of the included guidelines were grade B. The recommendations of the included guidelines were almost consistent. Recommended non-pharmacology management of behavioral and psychological symptoms of dementia included leisure and recreation activity, reminiscence therapy, behavioral therapy, training of caregivers, physical environment modification, animal-assisted therapy, massage, physical activity and patient-centered approach. Conclusion The overall quality of included guidelines is relatively high. More efforts are needed to improve the applicability and independence of guidelines. There is still no local guideline concerning non-pharmacology recommendations on behavioral and psychological symptoms of dementia in China. It is suggested to develop guideline that is suitable for Chinese condition as soon as possible.

Citation： WUJie, WANGYi, WANGZhi-wen. Guidelines on Non-pharmacology Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2016, 16(11): 1338-1344. doi: 10.7507/1672-2531.20160202 Copy

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2.	李昂, 殷淑琴, 徐勇, 等. 2010~2030年中國老年期癡呆的預測.中國老年學雜志, 2015, 35(13):3708-3711.
3.	Finkel SI. Introduction to behavioral and psychological symptoms of dementia (BPSD). Int J Geriat Psychiatry, 2000, 15:S2-S4.
4.	Li XL, Hu N, Tan MS, et al. Behavioral and psychological symptoms in Alzheimer's disease. Biomed Res Int, 2014, 9(10):1-9.
5.	van der Linde RM, Dening T, Matthews FE, et al. Grouping of behavioural and psychological symptoms of dementia. Int J Geriatr Psychiatry, 2014, 29(6):562-568.
6.	Petrovic M, Hurt C, Collins D, et al. Clustering of behavioural and psychological symptoms in dementia (BPSD):a European Alzheimer's Disease Consortium (EADC) study. Acta Clin Belg, 2007, 62(6):426-432.
7.	Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Front Neurol, 2012, 3:73.
8.	Azermai M. Dealing with behavioral and psychological symptoms of dementia:a general overview. Psychol Res Behav Manag, 2015, 8:181-185.
9.	Feast A, Moniz-Cook E, Stoner C, et al. A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being. Int Psychogeriatr, 2016:1-14.
10.	Brodaty H, Connors MH, Xu J, et al. Predictors of institutionalization in dementia:a three year longitudinal study. J Alzheimers Dis, 2014, 40(1):221-226.
11.	Tochimoto S, Kitamura M, Hino S, et al. Predictors of home discharge among patients hospitalized for behavioural and psychological symptoms of dementia. Psychogeriatrics, 2015, 11(5):413-419.
12.	Liu S, Jin Y, Shi Z, et al. The effects of behavioral and psychological symptoms on caregiver burden in frontotemporal dementia, Lewy body dementia, and Alzheimer's disease:clinical experience in China. Aging Ment Health, 2016:1-7.
13.	Herrmann N, Lanct?t KL, Sambrook R, et al. The contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psychiatry, 2006, 21(10):972-978.
14.	盛樹力.老年性癡呆及相關性疾病.北京:科學技術文獻出版社, 2008:76-77.
15.	Locca JF, Büla CJ, Zumbach S, et al. Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes:Development of practice recommendations in a Swiss canton. J Am Med Dir Assoc, 2008, 9(6):439-448.
16.	趙春剛.老年癡呆癥患者精神行為癥狀治療的臨床研究.中國醫藥指南, 2014, 12(13):234-235.
17.	鄧世雄, 陳麗華.失智癥整合照護.臺北:華騰文化股份有限公司, 2011.
18.	National Health and Medical Research Council. Clinical practice guidelines and principles of care for people with dementia.[2016-04-18]. Available at:https://www.nhmrc.gov.au/.
19.	American Psychological Association. Treatment of Patients With Alzheimer's Disease and Other Dementias.[2016-04-18]. Available at:http://www.psychiatryonline.com/pracGuide/pracGuideChapToc3.aspx.
20.	Hersch EC, Falzgraf S. Management of the behavioral and psychological symptoms of dementia. Clin Interv Aging, 2007, 2(4):611-621.
21.	Institute of Medicine (US) Committee on Clinical Practice Guidelines. Guidelines for Clinical Practice:From development to use. Washington, D.C.:National Academy Press, 1992.
22.	蔡樺楊.基于臨床病例和層次分析法的中醫臨床實踐指南應用評價研究.廣州:廣州中醫藥大學, 2015.
23.	Brouwers MC, Kho ME, Browman GP, et al. AGREE II:Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J, 2010, 182(8):839-842.
24.	余紅梅, 羅艷虹, 薩建, 等.組內相關系數及其軟件實現.中國衛生統計, 2011, 28(5):497-500.
25.	National Institute for Health and Clinical Excellence. Supporting people with dementia and their carers in health and social care.[2016-05-18]. Available at:https://www.nice.org.uk/guidance/cg42.
26.	Ministry of Health Singapore. Clinical practice guideline:Dementia.[2016-04-18]. Available at:http://www.moh.gov.sg/cpg.
27.	Scottish Intercollegiate Guidelines Network. Management of patients with dementia.[2016-04-18]. Available at:http://www.sign.ac.uk/pdf/sign86.pdf.
28.	Registered Nurses Association of Ontario. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression.[2016-04-18]. Available at:http://rnao.ca/bpg/guidelines/caregiving-strategies-older-adults-delirium-dementia-and-depression.
29.	Shiffman RN, Shekelle P, Overhage JM, et al. Standardized reporting of clinical practice guidelines:A proposal from the conference on guideline standardization. Ann Intern Med, 2003, 139(6):493-498.
30.	賈建平.中國癡呆與認知障礙診治指南.北京:人民衛生出版社, 2010.

1. Prince M, Wimo A, Guerchet M, et al. World Alzheimer Report 2015. The global impact of dementia. An analysis of prevalence, incidence, cost and trends. London:Alzheimer's Disease International, 2015.
2. 李昂, 殷淑琴, 徐勇, 等. 2010~2030年中國老年期癡呆的預測.中國老年學雜志, 2015, 35(13):3708-3711.
3. Finkel SI. Introduction to behavioral and psychological symptoms of dementia (BPSD). Int J Geriat Psychiatry, 2000, 15:S2-S4.
4. Li XL, Hu N, Tan MS, et al. Behavioral and psychological symptoms in Alzheimer's disease. Biomed Res Int, 2014, 9(10):1-9.
5. van der Linde RM, Dening T, Matthews FE, et al. Grouping of behavioural and psychological symptoms of dementia. Int J Geriatr Psychiatry, 2014, 29(6):562-568.
6. Petrovic M, Hurt C, Collins D, et al. Clustering of behavioural and psychological symptoms in dementia (BPSD):a European Alzheimer's Disease Consortium (EADC) study. Acta Clin Belg, 2007, 62(6):426-432.
7. Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Front Neurol, 2012, 3:73.
8. Azermai M. Dealing with behavioral and psychological symptoms of dementia:a general overview. Psychol Res Behav Manag, 2015, 8:181-185.
9. Feast A, Moniz-Cook E, Stoner C, et al. A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being. Int Psychogeriatr, 2016:1-14.
10. Brodaty H, Connors MH, Xu J, et al. Predictors of institutionalization in dementia:a three year longitudinal study. J Alzheimers Dis, 2014, 40(1):221-226.
11. Tochimoto S, Kitamura M, Hino S, et al. Predictors of home discharge among patients hospitalized for behavioural and psychological symptoms of dementia. Psychogeriatrics, 2015, 11(5):413-419.
12. Liu S, Jin Y, Shi Z, et al. The effects of behavioral and psychological symptoms on caregiver burden in frontotemporal dementia, Lewy body dementia, and Alzheimer's disease:clinical experience in China. Aging Ment Health, 2016:1-7.
13. Herrmann N, Lanct?t KL, Sambrook R, et al. The contribution of neuropsychiatric symptoms to the cost of dementia care. Int J Geriatr Psychiatry, 2006, 21(10):972-978.
14. 盛樹力.老年性癡呆及相關性疾病.北京:科學技術文獻出版社, 2008:76-77.
15. Locca JF, Büla CJ, Zumbach S, et al. Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes:Development of practice recommendations in a Swiss canton. J Am Med Dir Assoc, 2008, 9(6):439-448.
16. 趙春剛.老年癡呆癥患者精神行為癥狀治療的臨床研究.中國醫藥指南, 2014, 12(13):234-235.
17. 鄧世雄, 陳麗華.失智癥整合照護.臺北:華騰文化股份有限公司, 2011.
18. National Health and Medical Research Council. Clinical practice guidelines and principles of care for people with dementia.[2016-04-18]. Available at:https://www.nhmrc.gov.au/.
19. American Psychological Association. Treatment of Patients With Alzheimer's Disease and Other Dementias.[2016-04-18]. Available at:http://www.psychiatryonline.com/pracGuide/pracGuideChapToc3.aspx.
20. Hersch EC, Falzgraf S. Management of the behavioral and psychological symptoms of dementia. Clin Interv Aging, 2007, 2(4):611-621.
21. Institute of Medicine (US) Committee on Clinical Practice Guidelines. Guidelines for Clinical Practice:From development to use. Washington, D.C.:National Academy Press, 1992.
22. 蔡樺楊.基于臨床病例和層次分析法的中醫臨床實踐指南應用評價研究.廣州:廣州中醫藥大學, 2015.
23. Brouwers MC, Kho ME, Browman GP, et al. AGREE II:Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J, 2010, 182(8):839-842.
24. 余紅梅, 羅艷虹, 薩建, 等.組內相關系數及其軟件實現.中國衛生統計, 2011, 28(5):497-500.
25. National Institute for Health and Clinical Excellence. Supporting people with dementia and their carers in health and social care.[2016-05-18]. Available at:https://www.nice.org.uk/guidance/cg42.
26. Ministry of Health Singapore. Clinical practice guideline:Dementia.[2016-04-18]. Available at:http://www.moh.gov.sg/cpg.
27. Scottish Intercollegiate Guidelines Network. Management of patients with dementia.[2016-04-18]. Available at:http://www.sign.ac.uk/pdf/sign86.pdf.
28. Registered Nurses Association of Ontario. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression.[2016-04-18]. Available at:http://rnao.ca/bpg/guidelines/caregiving-strategies-older-adults-delirium-dementia-and-depression.
29. Shiffman RN, Shekelle P, Overhage JM, et al. Standardized reporting of clinical practice guidelines:A proposal from the conference on guideline standardization. Ann Intern Med, 2003, 139(6):493-498.
30. 賈建平.中國癡呆與認知障礙診治指南.北京:人民衛生出版社, 2010.

Chinese Journal of Evidence-Based Medicine

Guidelines on Non-pharmacology Management of Behavioral and Psychological Symptoms of Dementia: A Systematic Review

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