Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews

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#activities-of-daily-living #alzheimer-disease #caregivers #cholinesterase-inhibitors #complementary-therapies

Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews

Laver et al., 2016 | BMJ Open | Systematic Review

Citation

Laver Kate, Dyer Suzanne, ... Crotty Maria. Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews. BMJ Open. 2016-Apr-27;6(4):e010767. doi:10.1136/bmjopen-2015-010767

Abstract

OBJECTIVE: To summarise existing systematic reviews that assess the effects of non-pharmacological, pharmacological and alternative therapies on activities of daily living (ADL) function in people with dementia. DESIGN: Overview of systematic reviews. METHODS: A systematic search in the Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE and PsycInfo in April 2015. Systematic reviews of randomised controlled trials conducted in people with Alzheimer's disease or dementia measuring the impact on ADL function were included. Methodological quality of the systematic reviews was independently assessed by two authors using the AMSTAR tool. The quality of evidence of the primary studies for each intervention was assessed using GRADE. RESULTS: A total of 23 systematic reviews were included in the overview. The quality of the reviews varied; however most (65%) scored 8/11 or more on the AMSTAR tool, indicating high quality. Interventions that were reported to be effective in minimising decline in ADL function were: exercise (6 studies, 289 participants, standardised mean difference (SMD) 0.68, 95% CI 0.08 to 1.27; GRADE: low), dyadic interventions (8 studies, 988 participants, SMD 0.37, 95% CI 0.05 to 0.69; GRADE: low) acetylcholinesterase inhibitors and memantine (12 studies, 4661 participants, donepezil 10 mg SMD 0.18, 95% CI 0.03 to 0.32; GRADE: moderate), selegiline (7 studies, 810 participants, SMD 0.27, 95% CI 0.13 to 0.41; GRADE: low), huperzine A (2 studies, 70 participants, SMD 1.48, 95% CI 0.95 to 2.02; GRADE: very low) and Ginkgo biloba (7 studies, 2530 participants, SMD 0.36, 95% CI 0.28 to 0.44; GRADE: very low). CONCLUSIONS: Healthcare professionals should ensure that people with dementia are encouraged to exercise and that primary carers are trained and supported to provide safe and effective care for the person with dementia. Acetylcholinesterase inhibitors or memantine should be trialled unless contraindicated. TRIAL REGISTRATION NUMBER: CRD42015020179.

Key Findings

A total of 23 systematic reviews were included in the overview. The quality of the reviews varied; however most (65%) scored 8/11 or more on the AMSTAR tool, indicating high quality. Interventions that were reported to be effective in minimising decline in ADL function were: exercise (6 studies, 289 participants, standardised mean difference (SMD) 0.68, 95% CI 0.08 to 1.27; GRADE: low), dyadic interventions (8 studies, 988 participants, SMD 0.37, 95% CI 0.05 to 0.69; GRADE: low) acetylcholineste

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 289
Age Range See abstract
Condition See abstract

MeSH Terms

  • Activities of Daily Living
  • Alzheimer Disease
  • Caregivers
  • Cholinesterase Inhibitors
  • Complementary Therapies
  • Dementia
  • Dopamine Agents
  • Exercise
  • Humans
  • Memantine
  • Quality of Life

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Research Support, Non-U.S. Gov't, Systematic Review
  • Vertical: ginkgo

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09