Non-drug interventions highly efficacious at reducing depressive symptoms in people with dementia

1. Systematic review found that social prescribing was associated with a reduction in depressive symptoms in patients with dementia without a diagnosis of major depressive disorder.

2. Non-drug interventions either alone or in combination with drug interventions may be the most efficacious intervention for these patients.

Evidence Rating Level: 1 (Excellent)

Study Rundown: 32% of people diagnosed with dementia experience depressive symptoms without meeting the full criteria for major depressive disorder. In the elderly population, antidepressants may do more harm than good, due to increased risk of falls and other side effects. It is therefore important that social prescribing, or non-drug interventions, are evaluated as potential therapies. In this systematic review and meta-analysis of 256 articles, ten non-drug therapies were found to be more effective at treating depressive symptoms than usual care. These social therapies included cognitive stimulation, exercise, social interaction, massage therapy and animal therapy. Massage and touch therapy, as well as cognitive stimulation combined with either exercise and social interaction or cholinesterase inhibitors were found to be more effective than some drug therapies. Many social therapies were found to have a high likelihood of lowering depressive symptoms, reported on the Cornell Score. Furthermore, drug interventions alone were not found to be significantly more effective than non-drug interventions or treatment as usual in this population. More research still needs to be done for non-Alzheimer’s dementia, intervention risks, as well as feasibility. While shown to have a high likelihood of successfully lowering depressive symptoms, these therapies may pose challenges to many members of an aging population. Many elderly people have difficulties with ambulation, hearing, and/or vision, which may impact their ability to utilize social interventions. Nonetheless, this is a large-scale systematic review with conclusions that are important for clinical consideration by physicians, caregivers, and patients.

Click to read the study in the BMJ (British Medical Journal)

Click to read an accompanying editorial in the BMJ

Relevant Reading: Depression—an underrecognized target for prevention of dementia in Alzheimer’s disease

In-Depth [systematic review and meta-analysis]: 3542 full text articles were screened for a final total of 256 articles included in the systematic review. Inclusion criteria included randomized control trials of drug and non-drug therapies with the primary outcome of depressive symptoms in patients with dementia. The most common outcome measure was the Cornell scale for depression in dementia. 213/256 studies, which totaled 25 177 people with dementia, were included in the meta-analysis. Ten therapies were found to be more effective than treatment as usual for reducing depressive symptoms in people with dementia without a diagnosis of major depressive disorder: cognitive stimulation, cognitive stimulation combined with a cholinesterase inhibitor, exercise combined with social interaction and cognitive stimulation, massage and touch therapy, multidisciplinary care, occupational therapy, reminiscence therapy, animal therapy, exercise, and psychotherapy combined with reminiscence therapy and environmental medication. Treatment as usual was defined as adequate access to clinical care, such as nurse or doctor visits. No statistical difference was seen between the efficacy of non-drug therapies and drug therapies, except for cognitive stimulation combined with exercise and social interaction, cognitive stimulation combined with cholinesterase inhibitor, and massage and touch therapy, which were found to be more effective than some drugs.

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