Review

. 2021 Feb;17(2):255-270.

doi: 10.1002/alz.12188. Epub 2020 Nov 20.

Toward a theory-based specification of non-pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

Sietske A M Sikkes^{1

2}, Yi Tang³, Roos J Jutten^{1

2}, Linda M P Wesselman^{1

2}, Lyn S Turkstra⁴, Henry Brodaty⁵, Linda Clare⁶, Erin Cassidy-Eagle⁷, Kay L Cox⁸, Gaël Chételat⁹, Sophie Dautricourt⁹, Klodian Dhana¹⁰, Hiroko Dodge^{11

12}, Rose-Marie Dröes¹³, Benjamin M Hampstead¹⁴, Thomas Holland¹⁰, Amit Lampit¹⁵, Kate Laver¹⁶, Antoine Lutz¹⁷, Nicola T Lautenschlager^{15

18}, Susan M McCurry¹⁹, Franka J M Meiland¹³, Martha Clare Morris¹⁰, Kimberly D Mueller²⁰, Ruth Peters^{21

22}, Gemma Ridel²³, Aimee Spector²⁴, Jenny T van der Steen^{25

26}, Jeanette Tamplin²⁷, Zara Thompson²⁷; ISTAART Non-pharmacological Interventions Professional Interest Area; Alex Bahar-Fuchs^{15

28}

Affiliations

¹ Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands.
² Department of Clinical, Neuro- and Developmental Psychology, VU University, Amsterdam, the Netherlands.
³ Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China.
⁴ School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
⁵ Centre for Healthy Brain Ageing and Dementia Centre for Research Collaboration, School of Psychiatry, UNSW, Sydney, Australia.
⁶ Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.
⁷ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.
⁸ Medical School, University of Western Australia, Perth, Western Australia, Australia.
⁹ Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France.
¹⁰ Section on Nutrition and Nutritional Epidemiology, Department of Internal Medicine, Rush University, Chicago, Illinois, USA.
¹¹ Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.
¹² Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
¹³ Department of Psychiatry, Amsterdam University Medical Center, VUmc, Amsterdam, the Netherlands.
¹⁴ Department of Psychiatry, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
¹⁵ Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁶ Department of Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
¹⁷ Lyon Neuroscience Research Center INSERM U1028, CNRS UMR5292, Lyon University, Lyon, France.
¹⁸ NorthWestern Mental Health, Melbourne Health, Melbourne, Australia.
¹⁹ Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA.
²⁰ Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
²¹ Department of Psychology, University of New South Wales, Randwick, Sydney, Australia.
²² Neuroscience Research Australia, Sydney, Australia.
²³ The University of East Anglia, Norwich, UK.
²⁴ Department of Clinical, Educational & Health Psychology, University College London, London, UK.
²⁵ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
²⁶ Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
²⁷ Faculty of Fine Arts and Music, University of Melbourne, Melbourne, Victoria, Australia.
²⁸ Centre for Research on Ageing, Health, and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia.

PMID: 33215876
PMCID: PMC7970750
DOI: 10.1002/alz.12188

Review

Toward a theory-based specification of non-pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

Sietske A M Sikkes et al. Alzheimers Dement. 2021 Feb.

. 2021 Feb;17(2):255-270.

doi: 10.1002/alz.12188. Epub 2020 Nov 20.

Authors

Affiliations

¹ Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands.
² Department of Clinical, Neuro- and Developmental Psychology, VU University, Amsterdam, the Netherlands.
³ Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Disorders, Beijing, China.
⁴ School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
⁵ Centre for Healthy Brain Ageing and Dementia Centre for Research Collaboration, School of Psychiatry, UNSW, Sydney, Australia.
⁶ Centre for Research in Ageing and Cognitive Health, College of Medicine and Health, University of Exeter, Exeter, UK.
⁷ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.
⁸ Medical School, University of Western Australia, Perth, Western Australia, Australia.
⁹ Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders,", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France.
¹⁰ Section on Nutrition and Nutritional Epidemiology, Department of Internal Medicine, Rush University, Chicago, Illinois, USA.
¹¹ Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA.
¹² Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
¹³ Department of Psychiatry, Amsterdam University Medical Center, VUmc, Amsterdam, the Netherlands.
¹⁴ Department of Psychiatry, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
¹⁵ Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.
¹⁶ Department of Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
¹⁷ Lyon Neuroscience Research Center INSERM U1028, CNRS UMR5292, Lyon University, Lyon, France.
¹⁸ NorthWestern Mental Health, Melbourne Health, Melbourne, Australia.
¹⁹ Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA.
²⁰ Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
²¹ Department of Psychology, University of New South Wales, Randwick, Sydney, Australia.
²² Neuroscience Research Australia, Sydney, Australia.
²³ The University of East Anglia, Norwich, UK.
²⁴ Department of Clinical, Educational & Health Psychology, University College London, London, UK.
²⁵ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
²⁶ Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
²⁷ Faculty of Fine Arts and Music, University of Melbourne, Melbourne, Victoria, Australia.
²⁸ Centre for Research on Ageing, Health, and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia.

PMID: 33215876
PMCID: PMC7970750
DOI: 10.1002/alz.12188

Abstract

Introduction: Non-pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological rigor and continues to produce mixed results.

Methods: In the current position paper, experts in NPT research have specified treatment targets, aims, and ingredients using an umbrella framework, the Rehabilitation Treatment Specification System.

Results: Experts provided a snapshot and an authoritative summary of the evidence for different NPTs based on the best synthesis efforts, identified main gaps in knowledge and relevant barriers, and provided directions for future research. Experts in trial methodology provide best practice principles and recommendations for those working in this area, underscoring the importance of prespecified protocols.

Discussion: We conclude that the evidence strongly supports various NPTs in relation to their primary targets, and discuss opportunities and challenges associated with a unifying theoretical framework to guide future efforts in this area.

Keywords: cognitive rehabilitation; cognitive stimulation therapy; cognitive training; cognitive-behavioral therapy for insomnia; communication treatments; framework; meditation; mild cognitive impairment; multisensory treatments; music-based treatments; neuromodulation; neuropsychiatric; non-pharmacological; nutritional interventions; occupational therapy; physical exercise training; reminiscence therapy; subjective cognitive decline.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

GC reports coordination of a European Union Horizon 2020 program (Silver-Sante Study-Medit-Ageing), with no stock options, patent or royalties. AL reports being co-investigator in clinical trials of computerized cognitive training using programs provided free-of-charge by HAPPYneuron Inc. and Synaptikon GmbH. GR and AS report offering training courses in CST and receiving occasional private income for training courses for dementia outside usual work. The remaining authors report no relevant conflict of interest.

Figures

**FIGURE 1**
Timeline of the Non-Pharmacological Interventions Professional Interest Area Position Paper Project

**FIGURE 2**
Overview of Cochrane reviews on non-pharmacological treatments (NPTs)

**FIGURE 3**
The tripartite structure of treatment theory. Source: Hart et al.

**FIGURE 4**
Overview of methodological considerations in the design of non-pharmacological treatments

See this image and copyright information in PMC

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Toward a theory-based specification of non-pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

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Toward a theory-based specification of non-pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

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