Non pharmacological interventions

Non-pharmacological interventions (aka psychosocial or behavioural interventions)

  • Authors should be aware of the aim of the intervention which is usually not to treat or control dementia but treatment/control of symptoms of dementia especially behavioural and psychological symptoms of dementia (BPSD).
  • Often, caregivers are the target of the intervention (sometimes both caregivers and people with dementia).
  • The HTA by Livingston et al. (2014) provides a helpful overview and a sub-categorisation, dividing interventions into o psychological interventions (e.g. person-centred care) o behavioural interventions (e.g. exercise interventions) o sensory interventions (e.g. snoezelen) o environmental interventions (e.g. environmental modifications in nursing homes)
  • Usually multimodal (“complex”) interventions consisting of more than one intervention component
  • Special attention should be given to the description of the intervention, ideally by using complex intervention frameworks (e.g. the MRC framework) including description of underlying theories, development and feasibility testing, intervention components and description of the control condition (mostly usually care). The use of reporting guidelines (especially the CONSORT Extension for Non-Pharmacologic Treatment, CReDECI criteria, TIDIer checklist) is highly recommended. A Cochrane handbook chapter on complex interventions will be published soon.

Reviews of qualitative studies / Mixed-methods reviews

  • Especially in reviews on non-pharmacological interventions it may not be sufficient to focus solely on randomised-controlled trials.
  • Inclusion of non-randomised trials (including qualitative studies) may help to explain and/or supplement findings from RCTs.
  • Mixed-methods reviews including both quantitative and qualitative data pose special challenges with only a few examples in the Cochrane library. The review by Lins et al. (2014) on “Efficacy and experiences of telephone counselling for informal carers of people with dementia” prototypically shows how this could be done within the CDCIG.
  • For qualitative studies, chapter 21 of the Cochrane handbook gives important recommendations, and the Cochrane Qualitative and Implementation Methods Group provides further guidance.