Featured Research

from universities, journals, and other organizations

Non-drug Treatment Of Alzheimer's Disease? Long-term Benefit Not Proven

Date:
April 20, 2009
Source:
Institute for Quality and Efficiency in Health Care
Summary:
Whether people with Alzheimer's disease benefit in the long term from non-drug treatment interventions remains an unanswered question. This unsatisfactory finding is mainly due to the fact that convincing studies are lacking so far. For individual approaches, the studies provide indications of a benefit, but also of harm.

Whether people with Alzheimer's disease benefit in the long term from non-drug treatment interventions remains an unanswered question. This unsatisfactory finding is mainly due to the fact that convincing studies are lacking so far. For individual approaches, the studies provide indications of a benefit, but also of harm.

This is the result of the final report by the Institute for Quality and Efficiency in Health Care (IQWiG) published on 17 March 2009.

According to IQWiG, a general problem of the benefit assessment of non-drug treatment interventions is particularly shown in the therapy of Alzheimer's disease: small research budgets and an underdeveloped study methodology lead to the situation that even for procedures with potential, no reliable conclusions can be drawn and thus no proof of a benefit can be provided.

Alleviate accompanying symptoms, strengthen competence in daily activities

The needs of patients with Alzheimer's disease are complex and change with disease progression. The treatments developed so far are just as varied; in addition to drugs, non-drug interventions are also used. The latter are often designed to alleviate accompanying symptoms, such as depression, restlessness, sleep disorders, and aggressive behaviour, or to improve cognitive function and retentiveness. Other non-drug approaches attempt to strengthen patients' competence in their daily activities and support caregiving relatives (hereinafter referred to as "caregivers”); for example, together with their caregivers or professional carers, people with Alzheimer's disease can learn to develop a daily routine.

No studies available for various treatment concepts

In order to determine the long-term benefit of non-drug interventions, IQWiG and its external experts searched for studies lasting at least 4 months: 33 studies including a total of 3800 patients with Alzheimer's disease were identified. The studies can be classified into 4 main treatment approaches: caregiver training, emotion-orientated interventions (validation and reminiscence therapy), cognitive training procedures, and activity-based interventions (physical and psychosocial activation). A number of further treatment concepts exist, but no studies on them are available.

None of the 33 studies compared a non-drug intervention with a drug intervention assessed by IQWiG (cholinesterase inhibitors, ginkgo compounds, memantine).

IQWiG categorized the reporting quality of 29 of the 33 studies as "poor”. They are prone to bias and the data cannot be interpreted reliably. Overall, the long-term benefit of the treatment approaches investigated is thus not proven.

Caregiver training has been relatively well investigated

The evidence base on caregiver training is relatively good. As many as 17 of the 33 studies identified investigated this procedure. These studies also provided indications of a benefit, both with regard to accompanying symptoms, such as depression or agitated behaviour, and to the quality of life of caregivers. However, it remains unclear whether the statistically significant differences are large enough to be clinically relevant, i.e., relevant to affected persons in their daily life.

Caregiver training also seems to clearly delay nursing home placement of patients with dementia. However, this type of treatment may also cause harm: patients whose caregivers participated in a training programme were admitted to hospital or an emergency room more often than those whose caregivers did not.

Patients with Alzheimer's disease may also benefit from cognitive training procedures. IQWiG found indications that these procedures improve retentiveness in patients at an early stage of the disease.

IQWiG thinks that studies in the German health care setting are necessary

In view of these disappointingly unclear results, the Institute thinks that additional randomized controlled trials (RCTs) are absolutely necessary. These studies should contain multiple arms, i.e., should compare not only two, but several treatment alternatives. In IQWiG's opinion, only such a design would enable a direct and fair comparison of drug and non-drug treatment strategies. In addition, the studies should be conducted in Germany, as for some non-drug interventions, such as caregiver training, the national health care setting, i.e., the specific organization of health care, presumably plays an essential role.

The Institute Director Professor Peter T. Sawicki comments, "We have a growing medical and social problem; it is not to be expected that this problem will be solved with the help of drugs in the near future. Non-drug interventions are available that at least seem to have potential, but there are no studies that could prove this. It is not justifiable to make an exception for these interventions and use them widely without available proof of their effects, thus also accepting risks.”

Methodological requirements for studies investigating non-drug interventions are high

According to IQWiG, the general problem of the benefit assessment of non-drug interventions is shown particularly clearly in Alzheimer's disease. These interventions are complex, and, for example, interaction between treating staff and patients may play a larger role than in drug interventions. The requirements for the planning and conduct of such studies are all the higher.

However, regarding study methodology, non-drug interventions lag far behind drug interventions. One important reason for this deficit is that, in contrast to the pharmaceutical sector, there are no authorities to press for the development of methods by means of the required approval studies. Unfortunately the IQWiG report on Alzheimer's disease once more confirms this well-known deficit. It was therefore hardly surprising to IQWiG that the methodological quality of studies in which the pharmaceutical industry was involved was relatively good.

Current promotion of research could help close gaps in knowledge

This addresses the next main problem: the funding possibilities for clinical research are in general clearly worse in the non-drug sector than in the pharmaceutical sector. Although there are, for example, manufacturers of medical technologies who could conduct studies, there is a lack of incentives and constraints in the form of patents and approval requirements.

Peter Sawicki states, "What is lacking in Germany is public research funding, independent of industry, for research questions relevant to the treatment of patients. This applies very specifically to non-drug treatment approaches. We must finally be allowed access to public financial sources for this type of research.”

A step is being taken to solve this problem, at least in the case of Alzheimer's disease. At the end of 2007, the Federal Ministry of Health initiated a corresponding research promotion programme. In the area "Ensuring evidence-based health care”, the Lighthouse Project Dementia also grants funding for the systematic evaluation of the latest scientific evidence. In particular, RCTs on non-drug interventions are being funded, which is the type of study design IQWiG considered in its benefit assessment.


Story Source:

The above story is based on materials provided by Institute for Quality and Efficiency in Health Care. Note: Materials may be edited for content and length.


Cite This Page:

Institute for Quality and Efficiency in Health Care. "Non-drug Treatment Of Alzheimer's Disease? Long-term Benefit Not Proven." ScienceDaily. ScienceDaily, 20 April 2009. <www.sciencedaily.com/releases/2009/04/090415102136.htm>.
Institute for Quality and Efficiency in Health Care. (2009, April 20). Non-drug Treatment Of Alzheimer's Disease? Long-term Benefit Not Proven. ScienceDaily. Retrieved August 21, 2014 from www.sciencedaily.com/releases/2009/04/090415102136.htm
Institute for Quality and Efficiency in Health Care. "Non-drug Treatment Of Alzheimer's Disease? Long-term Benefit Not Proven." ScienceDaily. www.sciencedaily.com/releases/2009/04/090415102136.htm (accessed August 21, 2014).

Share This




More Health & Medicine News

Thursday, August 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Possible Ebola Patient in Isolation at California Hospital

Possible Ebola Patient in Isolation at California Hospital

Reuters - US Online Video (Aug. 20, 2014) — A patient who may have been exposed to the Ebola virus is in isolation at the Kaiser Permanente South Sacramento Medical Center. Linda So reports. Video provided by Reuters
Powered by NewsLook.com
Raw: World's Oldest Man Lives in Japan

Raw: World's Oldest Man Lives in Japan

AP (Aug. 20, 2014) — A 111-year-old Japanese was certified as the world's oldest man by Guinness World Records on Wednesday. Sakari Momoi, a native of Fukushima in northern Japan, was given a certificate at a hospital in Tokyo. (Aug. 20) Video provided by AP
Powered by NewsLook.com
Do More Wedding Guests Make A Happier Marriage?

Do More Wedding Guests Make A Happier Marriage?

Newsy (Aug. 20, 2014) — A new study found couples who had at least 150 guests at their weddings were more likely to report being happy in their marriages. Video provided by Newsy
Powered by NewsLook.com
Ebola-Hit Sierra Leone's Freetown a City on Edge

Ebola-Hit Sierra Leone's Freetown a City on Edge

AFP (Aug. 19, 2014) — Residents of Sierra Leone's capital voice their fears as the Ebola virus sweeps through west Africa. Duration: 00:56 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins