I’ve just finished another, more recent review paper looking at non-pharmacological treatments for people with dementia (Olazarán, 2010). This one is somewhat more encouraging…
The author initially found 1313 studies and then filtered that down to 179 studies that were of sufficiently high quality to warrant inclusion in the meta-analysis; this includes studies on reminiscence therapy (see Table 1, Olazarán, 2010). By far the majority of studies included in the group were rated as ‘low quality’ rather than ‘high quality’. Nonetheless the authors could analyse the data and, overall, the results show a positive impact.
They make recommendations about the impact of “Multicomponent interventions for PWD, enriched group cognitive stimulation: cognitive stimulation and some of the following: reminiscence, physical exercise, ADL training, support”. They found this type of activity to have positive impacts on cognition, activities for daily living (ADL), behaviour and mood. This is certainly encouraging and they make the following comment about the cost effectiveness of these types of approaches:
“Multicomponent interventions based on CG education and support delayed the institutionalization of ADRD persons (Fig. 3, Olazarán, 2010) with only modest amounts of resources used. This important outcome in relation to both QoL and cost was not found with any other treatment approach on the basis of high-quality evidence. For other outcomes (cognition, ADLs, behavior, mood), the magnitude of the effect seemed to be similar to the effect obtained by drugs (Table 2, Olazarán, 2010). Due to the general absence of side effects and since they can be more readily individualized, NPTs are preferable when particular ADLs or behaviors are targeted. Moreover, higher responsiveness to NPTs than to drugs should be expected for some other outcomes (QoL, CG psychological well-being, CG QoL). However, rather than being viewed as an alternative to medications, NPTs and drugs should be understood as complementary approaches.”
However, they also note that: “Some intervention categories (e.g. cognitive training, ADL training) related to specific benefits in the targeted domains whereas others (e.g. reminiscence, recreation therapy) may have more diffuse effects. NPTs lacking any recommendation were: transcutaneous electrical stimulation, physical exercise, use of music, reminiscence, massage and touch, recreation therapy, use of light, multisensory stimulation, support and psychotherapy, validation, case management and respite care. Problems included lack of studies, lack of adequate measures, poor design and insufficient duration of intervention.” It should be emphasised that this doesn’t mean that these approaches don’t work – just that there isn’t enough quality evidence around to show that they do on a clinical level.
The lack of quality information and a lack of clarity regarding what the therapeutic intentions behind reminiscence therapy (and other person-centred approaches) is an stumbling block when trying to state what the benefits of these approaches are. There is some work out there on building a consensus approach to research in this field and on the health-economics of these approaches, which has the (potential) virtue of allowing us to define what it is we need to know.
Olazarán, J. et al. (2010) ‘Nonpharmacological Therapies in Alzheimer’s Disease: A Systematic Review of Efficacy’, Dementia & Geriatric Cognitive Disorders, 30, 161–178