BMJ: What about depression in Alzheimer's patients? Pet companions or other non-pharmacological interventions are worth considering

There are 50 million people diagnosed with dementia worldwide .
Approximately 16% of people with dementia are also diagnosed with major depressive disorder, but 32% of people with dementia will experience depressive symptoms (as part of the neuropsychiatric symptoms of dementia) without a formal diagnosis of major depressive disorder.
In patients with dementia, depressive symptoms are clinically manifested as physical (such as poor appetite, lack of energy) and behavior (such as irritability, social isolation, sadness) symptoms.

There are 50 million people diagnosed with dementia worldwide .
Approximately 16% of people with dementia are also diagnosed with major depressive disorder, but 32% of people with dementia will experience depressive symptoms (as part of the neuropsychiatric symptoms of dementia) without a formal diagnosis of major depressive disorder.
There are 50 million people diagnosed with dementia worldwide .
Approximately 16% of people with dementia are also diagnosed with major depressive disorder, but 32% of people with dementia will experience depressive symptoms (as part of the neuropsychiatric symptoms of dementia) without a formal diagnosis of major depressive disorder.
diagnosis

Although people with dementia and depressive symptoms may not meet all the diagnostic criteria for major depression, these symptoms still affect dementia patients and their caregivers.
Depressive symptoms of dementia patients are associated with adverse health outcomes, including reduced quality of life, functional decline, and increased risk of death, as well as increased pain, burden, and depression for their caregivers.

Depressive symptoms of dementia patients are associated with adverse health outcomes, including reduced quality of life, functional decline, and increased risk of death, as well as increased pain, burden, and depression for their caregivers.
Depressive symptoms of dementia patients are associated with adverse health outcomes, including reduced quality of life, functional decline, and increased risk of death, as well as increased pain, burden, and depression for their caregivers.

Drugs (such as antidepressants, antipsychotics) and non-drug (such as reminiscence therapy, exercise) intervention are used to treat depressive symptoms in patients with dementia.
There is more and more evidence that the use of antidepressants in Alzheimer's disease can cause harm (such as falls and fractures), and more and more people are paying attention to social prescriptions and linking patients to non-pharmacological interventions in the community , As an effective treatment against depression, loneliness and loneliness symptoms.

Drugs (such as antidepressants, antipsychotics) and non-drug (such as reminiscence therapy, exercise) intervention are used to treat depressive symptoms in patients with dementia.
There is more and more evidence that the use of antidepressants in Alzheimer's disease can cause harm (such as falls and fractures), and more and more people are paying attention to social prescriptions and linking patients to non-pharmacological interventions in the community , As an effective treatment against depression, loneliness and loneliness symptoms.
There is more and more evidence that the use of antidepressants in Alzheimer's disease can cause harm (such as falls and fractures), and more and more people are paying attention to social prescriptions and linking patients to non-pharmacological interventions in the community , As an effective treatment against depression, loneliness and loneliness symptoms.
There is more and more evidence that the use of antidepressants in Alzheimer's disease can cause harm (such as falls and fractures), and more and more people are paying attention to social prescriptions and linking patients to non-pharmacological interventions in the community , As an effective treatment against depression, loneliness and loneliness symptoms.

Pixabay.
com

Pixabay.
com

However, there are few randomized trials that directly compare the efficacy of pharmacological and non-pharmacological interventions, which brings uncertainty to clinical decision-making, that is, choosing the best evidence-based intervention to treat depression symptoms in patients with dementia.
Based on this, some researchers have explored the comparison of the efficacy of drug and non-drug interventions in reducing neuropsychiatric symptoms or depressive symptoms in patients with dementia.
The research results were published in the journal BMJ recently.

However, there are few randomized trials that directly compare the efficacy of pharmacological and non-pharmacological interventions, which brings uncertainty to clinical decision-making, that is, choosing the best evidence-based intervention to treat depression symptoms in patients with dementia.
Based on this, some researchers have explored the comparison of the efficacy of drug and non-drug interventions in reducing neuropsychiatric symptoms or depressive symptoms in patients with dementia.
The research results were published in the journal BMJ recently.

This research is a systematic review and meta-analysis.
The data comes from data from Medline, Embase, the Cochrane Library, CINAHL, PsycINFO and grey literature from its inception to October 15, 2020.
The selection criteria for the study were randomized controlled trials comparing drug or non-pharmaceutical interventions with conventional care or any other intervention for depressive symptoms in patients with dementia.

This research is a systematic review and meta-analysis.
The data comes from data from Medline, Embase, the Cochrane Library, CINAHL, PsycINFO and grey literature from its inception to October 15, 2020.
The selection criteria for the study were randomized controlled trials comparing drug or non-pharmaceutical interventions with conventional care or any other intervention for depressive symptoms in patients with dementia.

Among the 22,138 citations selected, 256 studies (28,483 patients with dementia) were included.
Missing data is the biggest risk of review results.
The results of the study showed that compared with conventional care, there are 7 interventions that are related to significantly reducing the depressive symptoms of dementia patients, including: cognitive stimulation, cognitive stimulation combined with cholinesterase inhibitors, massage and touch therapy, multidisciplinary care, Occupational therapy, exercise combined with social and cognitive stimulation and recall therapy.
Except massage and touch therapy, cognitive stimulation combined with cholinesterase inhibitors, cognitive stimulation combined with exercise and social interaction are more effective than some drug interventions, there is no statistical difference in the efficacy of drug interventions and non-drug interventions.
Relieve depressive symptoms in dementia patients who are not diagnosed with major depressive disorder.

Among the 22,138 citations selected, 256 studies (28,483 patients with dementia) were included.
Missing data is the biggest risk of review results.
The results of the study showed that compared with conventional care, there are 7 interventions that are related to significantly reducing the depressive symptoms of dementia patients, including: cognitive stimulation, cognitive stimulation combined with cholinesterase inhibitors, massage and touch therapy, multidisciplinary care, Occupational therapy, exercise combined with social and cognitive stimulation and recall therapy.
Except massage and touch therapy, cognitive stimulation combined with cholinesterase inhibitors, cognitive stimulation combined with exercise and social interaction are more effective than some drug interventions, there is no statistical difference in the efficacy of drug interventions and non-drug interventions.
Relieve depressive symptoms in dementia patients who are not diagnosed with major depressive disorder.
Compared with conventional nursing care, there are 7 interventions related to significantly reducing the depressive symptoms of dementia patients, including: cognitive stimulation, cognitive stimulation combined with cholinesterase inhibitors, massage and touch therapy, multidisciplinary care, occupational therapy, exercise Combine social and cognitive stimulation and recall therapy.
Except massage and touch therapy, cognitive stimulation combined with cholinesterase inhibitors, cognitive stimulation combined with exercise and social interaction are more effective than some drug interventions, there is no statistical difference in the efficacy of drug interventions and non-drug interventions.
Relieve depressive symptoms in dementia patients who are not diagnosed with major depressive disorder.
Compared with conventional care, there are 7 interventions that are related to significantly reducing the depressive symptoms of dementia patients, including: cognitive stimulation, cognitive stimulation combined with cholinesterase inhibitors, massage and touch therapy, multidisciplinary care, occupational therapy, exercise Combine social and cognitive stimulation and recall therapy.
Except massage and touch therapy, cognitive stimulation combined with cholinesterase inhibitors, cognitive stimulation combined with exercise and social interaction are more effective than some drug interventions, there is no statistical difference in the efficacy of drug interventions and non-drug interventions.
Relieve depressive symptoms in dementia patients who are not diagnosed with major depressive disorder.

Description of highly effective non-pharmacological interventions for patients with dementia

Description of highly effective non-pharmacological interventions for patients with dementia

Network diagram of intervention network aimed at reducing depressive symptoms in patients with dementia (non-severely depressed patients)

Network diagram of intervention network aimed at reducing depressive symptoms in patients with dementia (non-severely depressed patients)

The systematic review and network meta-analysis in this study showed that non-pharmacological interventions are as effective as or even more effective in reducing the depressive symptoms of patients with dementia (patients not diagnosed with major depression) as pharmacological interventions.
10 interventions are more effective than conventional care: animal companion therapy, cognitive stimulation, exercise, massage and touch therapy, recall therapy, multidisciplinary care, occupational therapy, cognitive stimulation and cholinesterase inhibitors, exercise combined with social interaction And cognitive stimulation, psychotherapy combined with recall therapy and environmental modification.
No single drug intervention was found to be more effective than conventional treatment.

The systematic review and network meta-analysis in this study showed that non-pharmacological interventions are as effective as or even more effective in reducing the depressive symptoms of patients with dementia (patients not diagnosed with major depression) as pharmacological interventions.
10 interventions are more effective than conventional care: animal companion therapy, cognitive stimulation, exercise, massage and touch therapy, recall therapy, multidisciplinary care, occupational therapy, cognitive stimulation and cholinesterase inhibitors, exercise combined with social interaction And cognitive stimulation, psychotherapy combined with recall therapy and environmental modification.
No single drug intervention was found to be more effective than conventional treatment.
Non-pharmacological interventions are as effective as or even more effective in reducing the depressive symptoms of patients with dementia (patients not diagnosed with major depression) as drug interventions.
10 interventions are more effective than conventional care: animal companion therapy, cognitive stimulation, exercise, massage and touch therapy, recall therapy, multidisciplinary care, occupational therapy, cognitive stimulation and cholinesterase inhibitors, exercise combined with social interaction And cognitive stimulation, psychotherapy combined with recall therapy and environmental modification.
Non-pharmacological interventions are as effective as or even more effective in reducing the depressive symptoms of patients with dementia (patients not diagnosed with major depression) as drug interventions.
10 interventions are more effective than conventional care: animal companion therapy, cognitive stimulation, exercise, massage and touch therapy, recall therapy, multidisciplinary care, occupational therapy, cognitive stimulation and cholinesterase inhibitors, exercise combined with social interaction And cognitive stimulation, psychotherapy combined with recall therapy and environmental modification.

The ranking of interventions shows that non-pharmacological interventions, either alone or in combination with drug interventions, are the best interventions to alleviate the depressive symptoms of dementia patients who have not been diagnosed with major depression.
The results of this study further indicate that patients with dementia are likely to obtain clinically significant benefits from non-pharmacological interventions.

The ranking of interventions shows that non-pharmacological interventions, either alone or in combination with drug interventions, are the best interventions to alleviate the depressive symptoms of dementia patients who have not been diagnosed with major depression.
The results of this study further indicate that patients with dementia are likely to obtain clinically significant benefits from non-pharmacological interventions.
The ranking of interventions shows that non-pharmacological interventions, either alone or in combination with drug interventions, are the best interventions to alleviate the depressive symptoms of dementia patients who have not been diagnosed with major depression.
The results of this study further indicate that patients with dementia are likely to obtain clinically significant benefits from non-pharmacological interventions.

References: Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis.
BMJ 2021; 372 doi: https://doi.
org/10.
1136/bmj.
n532 (Published 24 March 2021) Cite this as: BMJ 2021;372:n532

References: Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis.

BMJ 2021; 372 doi: https://doi.
org/10.
1136/bmj.
n532 (Published 24 March 2021) the this AS auf cite: BMJ 2021; 372: n532
doi: https://doi.
org/10.
1136/bmj.
n532 in this message