Study finds pharmacological treatments may help people with severe dementia

Dementia is a progressive neurodegenerative syndrome that has no cure. The researchers reviewed the effectiveness of both pharmacological and non-pharmacological treatments for people with severe dementia and assessed the quality of the evidence.

The study looked at 30 trials in total, of which 14 evaluated the effectiveness of pharmacological treatments and 16 evaluated a non-pharmacological intervention.

They found that for people with severe dementia, pharmacological treatments may decrease the severity of the condition and improve their functioning. They found low quality evidence that pharmacological treatments may also improve other outcomes, such as reducing mortality.

Clinical guidelines suggest that pharmacological treatments should be used to treat the neuropsychiatric symptoms that people with severe dementia commonly experience – such as agitation and psychosis. However, the researchers found no evidence that pharmacological treatments improve these symptoms, raising questions about their widespread use in both community and long-term care settings.

The researchers did find that non-pharmacological treatments – such as multi-sensory stimulation and activities-based interventions – are probably effective in reducing neuropsychiatric symptoms, but the quality of evidence for this was low.

Overall, the findings show that people with severe dementia remain substantially under-represented in treatment trials, indicating that this group remains excluded from potentially effective treatments and the development of effective care interventions.  

The researchers argue that there is an urgent need for high-quality evidence to test the effectiveness of treatments for people with severe dementia, and that this should be a priority for future research.

MSc student Elena Profyri who led the research as part of her MSc dissertation (UCL Division of Psychiatry) said:

“We were particularly interested in people with severe dementia as they are largely either under-treated (not being offered medications/access to effective care) or over-treated (being prescribed potentially harmful anti-psychotic medications for treating neuropsychiatric symptoms). Recent epidemiological data also project this group to increase substantially in prevalence over the next years in comparison to people living with mild and moderate dementia.”

Senior author Dr Vasiliki Orgeta (UCL Division of Psychiatry) said:

“Despite the substantial impact of advanced dementia to individuals, their families and our society, our review suggests that this group continues to remain under-represented in research, raising questions of continuing health inequalities in dementia care. The evidence-base of effectiveness of treatments for people with severe dementia remains small and should be a priority in terms of future investment and funding in the area.”

Related

• Effectiveness of treatments for people living with severe dementia: A systematic review and meta-analysis of randomised controlled clinical trials
• Dr Vasiliki Orgeta’s academic profile
• Elena Profyri’s academic profile
• UCL Division of Psychiatry

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