Effectiveness of Reminiscence Therapy

Abstract:

The main objective of this study was to conduct a meta-analysis to identify the effects of reminiscence therapy in people with dementia (PWD).

Methods:

A systematic search of randomized controlled trials (RCTs) was conducted using bibliographic databases. A total of 157 original published studies were identified in the search, and 24 complete articles were included in the final review to check for the level of evidence. Two of the study authors independently assessed the quality of the included studies using the “Risk of Bias” (ROB) tool developed by the Cochrane Collaboration. Depression, quality of life, and behavioral and psychological symptoms of dementia (BPSD) were selected to measure the effect of reminiscence therapy. To determine the effects of reminiscence therapy on these variables, each individual study was analyzed using Comprehensive Meta-Analysis Software® (Biostat, Englewood, NJ, USA).

Results:

The overall effect size was presented using standardized mean differences (SMDs) and 95% confidence intervals. Cohen’s d effect size for depression was -0.541 (95% CI: -0.847 to -0.234, Z = -3.730, p<0.001), indicating that depression was significantly reduced in the reminiscence group compared to the control group. Increased quality of life and decreased BPSD were also found in the reminiscence group compared to the control group.

Conclusion:

Reminiscence therapy has a moderate effect on depression and can be broadly used to decrease depression as an alternative to antipsychotics, which can have harmful side effects and high cost.

Citation:

Park, Kyongok & Lee, Seonhye & Yang, JeongEun & Song, Taekwon & Hong, Gwi-Ryung. (2019). A systematic review and meta-analysis on the effect of reminiscence therapy for people with dementia. International Psychogeriatrics. 1-17. 10.1017/S1041610218002168.

Effectiveness of Music Therapy

Abstract

Agitation is a common problem in patients suffering from dementia and encompasses a variety of behaviors such as repetitive acts, restlessness, wandering, and aggressive behaviors. Agitation reduces the probability of positive social interaction and increases the psychological and organizational burden. While medical interventions are common, there is need for complementary or alternative methods. Music intervention has been brought forward as a promising method to reduce agitation in dementia. While interventions, target groups and research designs differ, there has so far not been a systematic overview assessing the effect of music intervention for agitation in patients with dementia. A meta-analysis was conducted in order to investigate possible effects of music interventions. Twelve studies met inclusion criteria. Music intervention had a medium overall effect on agitation in dementia, suggesting robust clinical relevance. While the moderate number of studies does not allow for further differentiation between sub-types of music intervention, the sub-group comparisons indicated promising pathways for future systematic reviews. This meta-analysis is the first systematic and quantitative overview supporting clinically and statistically robust effects of music intervention on agitation in dementia. The analysis provides further arguments for this non-pharmacological approach and highlights needs for future systematic research reviews for the investigation of intervention types.

Citation

Pedersen SKA, Andersen PN, Lugo RG, Andreassen M, Sütterlin S. Effects of Music on Agitation in Dementia: A Meta-Analysis. Front Psychol. 2017;8:742. Published 2017 May 16. doi:10.3389/fpsyg.2017.00742

Feasibility of Using Virtual Reality for MCI and Dementia

Abstract

Virtual Reality (VR) has emerged as a promising tool in many domains of therapy and rehabilitation, and has recently attracted the attention of researchers and clinicians working with elderly people with MCI, Alzheimer’s disease and related disorders. Here we present a study testing the feasibility of using highly realistic image-based rendered VR with patients with MCI and dementia. We designed an attentional task to train selective and sustained attention, and we tested a VR and a paper version of this task in a single-session within-subjects design. Results showed that participants with MCI and dementia reported to be highly satisfied and interested in the task, and they reported high feelings of security, low discomfort, anxiety and fatigue. In addition, participants reported a preference for the VR condition compared to the paper condition, even if the task was more difficult. Interestingly, apathetic participants showed a preference for the VR condition stronger than that of non-apathetic participants. These findings suggest that VR-based training can be considered as an interesting tool to improve adherence to cognitive training in elderly people with cognitive impairment.

Citation

Manera V, Chapoulie E, Bourgeois J, Guerchouche R, David R, Ondrej J, et al. (2016) A Feasibility Study with Image-Based Rendered Virtual Reality in Patients with Mild Cognitive Impairment and Dementia. PLoS ONE 11(3): e0151487. https://doi.org/10.1371/journal.pone.0151487

VR as a Dementia Screening Tool

Abstract

Background: Dementia is a multifaceted disorder that impairs cognitive functions, such as memory, language, and executive functions necessary to plan, organize, and prioritize tasks required for goal-directed behaviors. In most cases, individuals with dementia experience difficulties interacting with physical and social environments. The purpose of this study was to establish ecological validity and initial construct validity of a fire evacuation Virtual Reality Day-Out Task (VR-DOT) environment based on performance profiles as a screening tool for early dementia.

Objective: The objectives were (1) to examine the relationships among the performances of 3 groups of participants in the VR-DOT and traditional neuropsychological tests employed to assess executive functions, and (2) to compare the performance of participants with mild Alzheimer’s-type dementia (AD) to those with amnestic single-domain mild cognitive impairment (MCI) and healthy controls in the VR-DOT and traditional neuropsychological tests used to assess executive functions. We hypothesized that the 2 cognitively impaired groups would have distinct performance profiles and show significantly impaired independent functioning in ADL compared to the healthy controls.

Methods: The study population included 3 groups: 72 healthy control elderly participants, 65 amnestic MCI participants, and 68 mild AD participants. A natural user interface framework based on a fire evacuation VR-DOT environment was used for assessing physical and cognitive abilities of seniors over 3 years. VR-DOT focuses on the subtle errors and patterns in performing everyday activities and has the advantage of not depending on a subjective rating of an individual person. We further assessed functional capacity by both neuropsychological tests (including measures of attention, memory, working memory, executive functions, language, and depression). We also evaluated performance in finger tapping, grip strength, stride length, gait speed, and chair stands separately and while performing VR-DOTs in order to correlate performance in these measures with VR-DOTs because performance while navigating a virtual environment is a valid and reliable indicator of cognitive decline in elderly persons.

Results: The mild AD group was more impaired than the amnestic MCI group, and both were more impaired than healthy controls. The novel VR-DOT functional index correlated strongly with standard cognitive and functional measurements, such as mini-mental state examination (MMSE; rho=0.26, P=.01) and Bristol Activities of Daily Living (ADL) scale scores (rho=0.32, P=.001).

Conclusions: Functional impairment is a defining characteristic of predementia and is partly dependent on the degree of cognitive impairment. The novel virtual reality measures of functional ability seem more sensitive to functional impairment than qualitative measures in predementia, thus accurately differentiating from healthy controls. We conclude that VR-DOT is an effective tool for discriminating predementia and mild AD from controls by detecting differences in terms of errors, omissions, and perseverations while measuring ADL functional ability.

Citation

Tarnanas I, Schlee W, Tsolaki M, Müri R, Mosimann U, Nef T
Ecological Validity of Virtual Reality Daily Living Activities Screening for Early Dementia: Longitudinal Study, JMIR Serious Games 2013;1(1):e1. URL: https://games.jmir.org/2013/1/e1

Effectiveness of Virtual Reality for Dementia

Abstract

Purpose of the Study

To measure and describe the effectiveness of a Virtual Reality Forest (VRF) on engagement, apathy, and mood states of people with dementia, and explore the experiences of staff, people with dementia and their families.

Design and Methods

A mixed-methods study conducted between February and May 2016. Ten residents with dementia, 10 family members, and 9 care staff were recruited from 2 residential aged care facilities, operated by one care provider, located in Victoria, Australia. Residents participated in one facilitated VRF session. Residents’ mood, apathy, and engagement were measured by the Observed Emotion Rating Scale, Person–Environment Apathy Rating Scale, and Types of Engagement. All participants were interviewed.

Results

Overall, the VRF was perceived by residents, family members, and staff to have a positive effect. During the VRF experience, residents experienced more pleasure (p = .008) and a greater level of alertness (p < .001). They also experienced a greater level of fear/anxiety during the forest experience than the comparative normative sample (p = .016).
Implications
This initial, small-scale study represents the first to introduce the VRF activity and describe the impact on people with dementia. The VRF was perceived to have a positive effect on people with dementia, although, compared to the normative sample, a greater level of fear/anxiety during the VRF was experienced. This study suggests virtual reality may have the potential to improve quality of life, and the outcomes can be used to inform the development of future Virtual Reality activities for people with dementia.

Citation

Wendy Moyle, Cindy Jones, Toni Dwan, Tanya Petrovich, Effectiveness of a Virtual Reality Forest on People With Dementia: A Mixed Methods Pilot Study, The Gerontologist, Volume 58, Issue 3, June 2018, Pages 478–487, https://doi.org/10.1093/geront/gnw270

Effectiveness of Pet Therapy

Abstract

Background

Dementia represents a mental and economic burden for both patients and their caregivers. Therefore, the aim of this study is to explore the effectiveness of animal assisted therapy (AAT) with special focus on canis therapy among people with dementia, specifically Alzheimer’s disease.

Methods

The key method of this review study is a systematic review of the research studies detected in the Web of Science, Scopus and PubMed. The search was conducted for the studies dating from 2016 till 31 August 2018 because several review studies were published before. Eventually, only six studies were involved into the final analysis.

Results

The findings of this review, based on significant effect sizes, reveal that AAT may work as a beneficial and effective complementary treatment, especially in the area of behavioral and psychological symptoms, for patients with different degree of dementia severity if AAT is targeted at their specific needs and interests.

Conclusions

More research in the area of methodology for the implementation of AAT is necessary, and more research should be conducted with respect to the use of AAT for the improvement of cognitive functions in people with dementia.

Citation

Klimova, B., Toman, J. & Kuca, K. Effectiveness of the dog therapy for patients with dementia – a systematic review. BMC Psychiatry 19, 276 (2019) doi:10.1186/s12888-019-2245-x https://doi.org/10.1186/s12888-019-2245-x

Effectiveness of VR for Psychiatric Disorders

Abstract

In this paper, we conduct a literature survey on various virtual reality (VR) treatments in psychiatry. We collected 36 studies that used VR to provide clinical trials or therapies for patients with psychiatric disorders. In order to gain a better understanding of the management of pain and stress, we first investigate VR applications for patients to alleviate pain and stress during immersive activities in a virtual environment. VR exposure therapies are particularly effective for anxiety, provoking realistic reactions to feared stimuli. On top of that, exposure therapies with simulated images are beneficial for patients with psychiatric disorders such as phobia and posttraumatic stress disorder (PTSD). Moreover, VR environments have shown the possibility of changing depression, cognition, even social functions. We review empirical evidence from VR-based treatments on psychiatric illnesses such as dementia, mild cognitive impairment (MCI), schizophrenia and autism. Through cognitive training and social skill training, rehabilitation through VR therapies helps patients to improve their quality of life. Recent advances in VR technology also demonstrate potential abilities to address cognitive and functional impairments in dementia. In terms of the different types of VR systems, we discuss the feasibility of the technology within different stages of dementia as well as the methodological limitations. Although there is room for improvement, its widespread adoption in psychiatry is yet to occur due to technical drawbacks such as motion sickness and dry eyes, as well as user issues such as preoccupation and addiction. However, it is worth mentioning that VR systems relatively easily deliver virtual environments with well-controlled sensory stimuli. In the future, VR systems may become an innovative clinical tool for patients with specific psychiatric symptoms.

Citation

Park, M. J., Kim, D. J., Lee, U., Na, E. J., & Jeon, H. J. (2019). A Literature Overview of Virtual Reality (VR) in Treatment of Psychiatric Disorders: Recent Advances and Limitations. Frontiers in psychiatry, 10, 505. https://dx.doi.org/10.3389%2Ffpsyt.2019.00505