The impact of pharmacologic and nonpharmacologic interventions to improve physical health outcomes in people with dementia : a meta-review of meta-analyses of randomized controlled trials

Objectives: We summarized and compared meta-analyses of pharmacologic and nonpharmacologic interventions targeting physical health outcomes among people with dementia. Design: This is a systematic review and meta-analysis. Setting and Participants: People with dementia, confirmed through validated assessment measures. Methods: Major databases were searched until October 21, 2019. Effect sizes [standardized mean difference (SMD)/Hedges g or risk ratio (RR)] were compared separately. Results: Of 3773 search engine hits, 4 meta-analyses were included, representing 31 meta-analyzed trials and 10,054 study participants. Although meta-analyses were generally of adequate high quality, meta-analyzed studies were less so. Nutritional supplements were the only one to show a weight-increasing effect [SMD 0.53, 95% confidence interval (CI) 0.38-0.68, ie, medium effect; N = 12, n = 748]. Acetyl cholinesterase inhibitors are associated with an increased risk for weight loss (RR 2.1, 95% CI 1.5"’3.0; N = 9, n = 7010). For the treatment of pain, sensory stimulation has a medium effect (SMD - 0.58, 95% CI -0.99 to-0.17; N = 6, n = 199), whereas physical activity has a small effect (SMD -0.24, 95% CI -1.06 to 0.59; N = 2, n = 75). When exploring the characteristics of the psychosocial interventions, group-based interventions demonstrated a medium (SMD -0.55, 95% CI -1.02 to -0.09; N = 6, n = 157) and individual psychosocial interventions a small effect (SMD -0.27, 95% CI -1.06 to 0.53; N = 2, n = 55). Conclusions and Implications: Despite frequent physical comorbidities, the current evidence for pharmacologic and nonpharmacologic interventions in people with dementia to prevent and treat these conditions is still in its infancy, and larger trials targeting a wide range of physical health outcomes are urgently needed. Based on the SMDs and RRs, nutritional supplements can be recommended as an intervention to treat malnutrition. Clinicians should be careful in treating patients with acetylcholinesterase inhibitors, as it shows medium weight reducing effects. For the treatment of comorbid pain, sensory stimulation and psychosocial interventions are recommended.