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Pharmacological and nonpharmacological approaches to reduce disinhibited behaviors in dementia: a systematic review

Published online by Cambridge University Press:  25 March 2022

Claire V. Burley Open the ORCID record for Claire V. Burley [Opens in a new window] ,
Kim Burns  and
Henry Brodaty Open the ORCID record for Henry Brodaty [Opens in a new window]
Claire V. Burley
Affiliation:
Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
Kim Burns
Affiliation:
Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
Henry Brodaty*
Affiliation:
Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
*
Correspondence should be addressed to: Henry Brodaty, Centre for Healthy Brain Ageing (CHeBA), Level 3, AGSM Building, School of Psychiatry, Faculty of Medicine and Health, University of New South Wales, Sydney NSW 2052, Australia. E-mail: [email protected]
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Abstract

Objectives:

Disinhibited behaviors in dementia are associated with multiple negative outcomes. However, effective interventions are under-researched. This systematic review aims to provide an overview of intervention studies that report outcome measures of disinhibited behaviors in dementia.

Design:

Systematic searches of the databases MEDLINE, EMBASE, and PsychINFO, Social Work Abstracts and Cochrane Central Register of Controlled Trial databases were conducted for publications published between 2002 and March 2020. We included hand-searched reviews, original articles, case reports, cohort studies, and randomized controlled trials (RCTs). All studies were rated for research quality. Statistical and clinical significance were considered for individual studies. Effect sizes were included where provided or calculated where possible. Mean effect sizes were calculated for RCTs only.

Participants:

The systematic review included studies involving people living with dementia.

Measurements:

The Neuropsychiatric Inventory disinhibition subscale was used most often.

Results:

Nine pharmacological and 21 nonpharmacological intervention studies utilized different theoretical/clinical approaches. These included pain management, antidepressants, models of care, education and/or training, music-based approaches, and physical activity. The quality of research in RCTs was strong with a greater effect size in nonpharmacological compared to pharmacological approaches (mean Cohen’s d = 0.49 and 0.27, respectively). Disinhibition was a secondary outcome in all studies.

Conclusion:

Pharmacological (including pain management and antidepressants) and, more so, nonpharmacological (models of care, education/training, physical activity, and music) approaches were effective in reducing disinhibition.

Keywords

BPSDdementiadisinhibited behaviorshypersexualitypharmacologicalbiopsychosocialnonpharmacological
Type
Review Article
Information
International Psychogeriatrics , Volume 34 , Issue 4: Issue Theme: Varied Facets of Dementia , April 2022 , pp. 335 - 351
Copyright
© International Psychogeriatric Association 2022

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