Abstract
Interventions for people living with dementia: updates from 2024 Lancet Commission
Alzheimer's & dementia, v 20(S4)
Dec 2024
PMID: 39782387
Abstract
Background
The progressive nature of dementia and the complex needs means that people living with dementia require tailored approaches to address their changing care needs over time. These include physical multimorbidity, psychological, behavioural, and cognitive symptoms and possible risks arising from these and helping family caregivers. However, provision of these interventions is highly variable between and within countries, partly due to uncertainty about their efficacy and scarce resources. In the 2024 update of the Lancet Commission we aimed to summarise published evidence about the effect of non‐pharmacological interventions for people with dementia and their carers on cognition, neuropsychiatric symptoms and other person‐centred outcomes.
Method
We reviewed and summarised evidence according to expert consensus opinion.
Result
There is moderate‐quality evidence from a Cochrane review of 25 studies for effect of cognitive stimulation therapy on cognition; 1.99 (1.24‐2.74) Mini‐Mental State Examination points higher compared to control groups, and clinically relevant improvements in communication and social interaction. Multicomponent interventions for family carers reduce family carer depression, burden, or stress and are cost‐effective but remote delivery of these interventions was not better than care as usual. A meta‐analysis of 7 studies of tailored activity programmes for people with dementia found a moderate effect on improving quality of life (standardised ES Cohen’s d 0.79, 0.39–1.18; 7 studies, n = 160), decreasing neuropsychiatric symptoms (0.62; 0.40–0.83) and decreasing carer burden (0.68, 0.29–1.07) but there is little evidence on cost‐effectiveness. Exercise interventions were not effective in improving neuropsychiatric symptoms, cognition or functioning. We discuss evidence for other treatments for specific neuropsychiatric symptoms.
Conclusion
There is developing evidence for benefit of psychological and social interventions on key outcomes including cognition, neuropsychiatric symptoms and quality of life, with sufficient strength of evidence and cost‐effectiveness to justify these being implemented and offered routinely to people with dementia. Interventions generally should be tailored to specific symptoms and individualised to patient preferences and goals. Most interventions have been tested in majority ethnic populations in high income countries: future interventions should be co‐designed with local communities to ensure that they are appropriate for the context, culture, beliefs and practices.
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Details
- Title
- Interventions for people living with dementia: updates from 2024 Lancet Commission
- Creators
- Andrew Sommerlad - University College LondonJonathan D Huntley - University College LondonKathy Y Liu - University College LondonSergi Costafreda Gonzalez - University College LondonGeir Selbaek - Oslo University HospitalSuvarna Alladi - National Institute of Mental Health and NeurosciencesDavid Ames - National Ageing Research InstituteSube Banerjee - University of NottinghamAlistair Burns - University of ManchesterCarol Brayne - University of CambridgeNick C Fox - University College LondonCleusa P Ferri - Hospital Alemão Oswaldo CruzLaura N. Gitlin - Drexel UniversityRobert J Howard - University College LondonHelen C Kales - University of California, DavisMika Kivimaki - University College LondonEric B Larson - Kaiser Permanente Washington Health Research InstituteNoeline Nakasujja - Makerere UniversityKenneth Rockwood - Dalhousie UniversityQuincy M Samus - Johns Hopkins UniversityKokoro Shirai - The University of OsakaArchana Singh-Manoux - University College LondonLon S. S. Schneider - University of Southern CaliforniaSebastian Walsh - Cambridge University Health PartnersYao Yao - Peking UniversityNaaheed Mukadam - University College LondonGill Livingston - Camden and Islington NHS Foundation Trust
- Publication Details
- Alzheimer's & dementia, v 20(S4)
- Publisher
- Wiley
- Number of pages
- 2
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- College of Nursing and Health Professions
- Other Identifier
- 991022018708204721