What to do with depression in patients with Alzheimer's disease?

Introduction: Non-pharmacological interventions, either alone or in combination with drug interventions, are the best interventions to reduce the depressive symptoms of dementia patients who have not been diagnosed with severe depression.

There are 50 million people diagnosed with dementia worldwide.

Approximately 16% of people with dementia are also diagnosed with major depressive disorder, but 32% of people with dementia will experience depressive symptoms (as part of the neuropsychiatric symptoms of dementia) without a formal diagnosis of major depressive disorder.

In patients with dementia, depressive symptoms are clinically manifested as physical (such as poor appetite, lack of energy) and behavior (such as irritability, social isolation, sadness) symptoms.

Although people with dementia and depressive symptoms may not meet all the diagnostic criteria for major depression, these symptoms still affect dementia patients and their caregivers.

Depressive symptoms of dementia patients are associated with adverse health outcomes, including reduced quality of life, functional decline, and increased risk of death, as well as increased pain, burden, and depression for their caregivers.

Drugs (such as antidepressants, antipsychotics) and non-drug (such as reminiscence therapy, exercise) intervention are used to treat depressive symptoms in patients with dementia.

There is more and more evidence that the use of antidepressants in Alzheimer's disease can cause harm (such as falls and fractures), and more and more people are paying attention to social prescriptions and linking patients to non-pharmacological interventions in the community , As an effective treatment against depression, loneliness and loneliness symptoms.

Pixabay.
com However, there are few randomized trials that directly compare the efficacy of pharmacological and non-pharmacological interventions, which brings uncertainty to clinical decision-making, namely choosing the best evidence-based interventions to treat depression symptoms in patients with dementia .

Based on this, some researchers have explored the comparison of the efficacy of drug and non-drug interventions in reducing neuropsychiatric symptoms or depressive symptoms in patients with dementia.

The research results were published in the journal BMJ recently.

This research is a systematic review and meta-analysis.
The data comes from data from Medline, Embase, the Cochrane Library, CINAHL, PsycINFO and grey literature from its inception to October 15, 2020.

The selection criteria for the study were randomized controlled trials comparing drug or non-pharmaceutical interventions with conventional care or any other intervention for depressive symptoms in patients with dementia.

Among the 22,138 citations selected, 256 studies (28,483 patients with dementia) were included.

Missing data is the biggest risk of review results.

The results of the study showed that compared with conventional care, there are 7 interventions that are related to significantly reducing the depressive symptoms of dementia patients, including: cognitive stimulation, cognitive stimulation combined with cholinesterase inhibitors, massage and touch therapy, multidisciplinary care, Occupational therapy, exercise combined with social and cognitive stimulation and recall therapy.

Except massage and touch therapy, cognitive stimulation combined with cholinesterase inhibitors, cognitive stimulation combined with exercise and social interaction are more effective than some drug interventions, there is no statistical difference in the efficacy of drug interventions and non-drug interventions.
Relieve depressive symptoms in dementia patients who are not diagnosed with major depressive disorder.

Description of highly effective non-pharmacological interventions for patients with dementia.
Network diagram of intervention networks aimed at reducing depressive symptoms in patients with dementia (non-severely depressed patients) The systematic review and network meta-analysis in this study show that non-pharmacological interventions are effective in reducing depression in patients with dementia Symptoms (patients not diagnosed with major depression) are as effective as or even more effective than drug intervention.

10 interventions are more effective than conventional care: animal companion therapy, cognitive stimulation, exercise, massage and touch therapy, recall therapy, multidisciplinary care, occupational therapy, cognitive stimulation and cholinesterase inhibitors, exercise combined with social interaction And cognitive stimulation, psychotherapy combined with recall therapy and environmental modification.

No single drug intervention was found to be more effective than conventional treatment.

The ranking of interventions indicates that non-pharmacological interventions, either alone or in combination with drug interventions, are the best interventions to reduce the depressive symptoms of dementia patients who are not diagnosed with major depression.

The results of this study further indicate that patients with dementia are likely to obtain clinically significant benefits from non-pharmacological interventions.

References: Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis.
BMJ 2021; 372 doi: https://doi.
org/10.
1136/bmj.
n532 (Published 24 March 2021) Cite this as: BMJ 2021;372:n532