Alice

Systematic review

Background

More than 57 million people live with Dementia worldwide, and that is expected to increase to 152.8 million in 2050 given the ageing population. It is estimated that 20-70% of those living with a dementia diagnosis experience Dementia-related Psychosis (D-RP). D-RP results in decreased quality of life, increased carer burden, increased rapid cognitive decline, hospitalisation, and earlier care/nursing home admission all which come at a considerable cost to primary and secondary care.

Atypical antipsychotic medications are typically used to treat hallucinations and delusions in those with dementia but have short-term efficacy and are often associated with sedation, falls, extrapyramidal effects, and worsening cognition. Warnings have been issued by MHRA and NICE about the risks of prescribing anti-psychotics for dementia-related psychosis and the side effects it can cause in older people, including increased risks of strokes and mortality. Despite this, there is a high-prescribing rate for those experiencing dementia-related psychosis. 

Non-pharmacological interventions such as cognitive therapy, aromatherapy, psychoeducation, and bright light therapy, have been developed to support people living with dementia to help manage their symptoms and have been tested in randomised controlled trials. Effective dementia-related psychosis management without the use of pharmacology could improve the quality of life of those living with dementia as well as reduce carer burden, delay care/nursing home admission, reduce hospitalisation and the burden on primary care and the NHS. 

Study overview

There are a range of systematic reviews of overall behavioural an dpsychological symptoms of dementia and individual symptoms like agitation. However, no review currently centralises around the symptoms of dementia-related psychosis. Thus, we wim to systematically review the randomised controlled tiral evidence available for dementia-related psychosis in the community, residential and nursing homes.

Six databases have been searched for randomised controlled trials investigating non-pharmacological interventions for the management of dementia-related psychosis, in people with a diagnosis of dementia. Out of the 4,288 studies identified, 19 have been included in the final analysis. Meta-analysis will be undertaken where interventions and outcomes are sufficiently similar to combine; otherwise, we will use narrative synthesis. Intervention categories include exercise, sensory interventions, cognitive stimulation therapy, doll therapy, music therapy, and interdisciplinary interventions. 

The findings will identify which non-pharmacological interventions are effective management of dementia-related psychosis. This could enable health care professionals to improve dementia-related psychosis without medication, reducing the burden on people with dementia, their carers, family members, healthcare systems and in turn be more cost effective for the NHS.