gms | German Medical Science

According to a recent report of the World Health Organization [1] dementia is a public health priority (WHO, 2015). In Germany, around 1.6 million people (nearly 2% of the general population) suffer from dementia [2].

While several risk factors are associated with dementia there is a need for multimodal interventions addressing these risk factors comprehensively [3]. My PhD thesis focusses on multimodal interventions and I will conduct a systematic literature review of multi-modal interventions for elderly people with dementia on (i) cognitive impairment, (ii) functioning in everyday activities, (iii) quality of live, (iv) motivation to change behavior, and (v) social inclusion.

Many reviews of unimodal dementia interventions exist but unimodal interventions fall short to address complex conditions like dementia or other chronic diseases. Multimodal interventions differ in both the specific components they entail and the outcome variables they address. The current review aims to specify a) what types of multimodal interventions exist, b) which interventions are effective for specific outcomes, and c) how they were tested and validated (as a critical assessment of the methodological quality of each study).

Research Questions: My research question focusses on the large variety of different multi-modal interventions differing in their a) setting, b) individual components, and c) primary and secondary outcome measurements. In a systematic review of empirical studies, I will investigate the relation between multi-modal interventions and their effects on (i) cognitive impairment, (ii) functioning in everyday activities, (iii) quality of live, (iv) motivation to change behavior, (v) social inclusion, and (vi) dropout rate in longitudinal studies.

Methods: In my PhD thesis I will conduct a systematic literature search of empirical research with a focus on multimodal interventions for people with dementia. The search syntax was specified in accordance with the research hypotheses and will contain a combination of the following keywords: “intervention”, “multimodal intervention”, “multisite intervention”, “multidomain intervention”, “multicomponent intervention”, “cognitive impairment”, “dementia”, “Alzheimer's disease”, “cognitive decline”, “Alzheimer prevention”, and “dementia prevention”.

Inclusion and exclusion criteria are: a) studies that are primary research studies published in a scientific journal, b) studies published within the last 10 years, c) studies on multimodal interventions (involving at least two distinct components), d) study samples with a significant proportion of people older than 60 years, and e) studies published in either English or German.

The systematic search performed in PubMed and EBSCOHost (PsycInfo) resulted in a total of 16309 articles of which duplicates, book chapters and all studies which do not meet eligibility criteria will be excluded during title and abstract screening. Remaining articles will be examined in full-text.

I will provide narrative descriptions of multi-modal interventions and conduct where feasible meta-analyses for specific effects of interventions on certain outcome variables using Review Manager from Cochrane Library and applying a fixed-effects model.

Expected Results: A large variety of multi-modal interventions will be presented in a narrative overview. The focus will be on both components of multimodal interventions and outcome variables. It will be assessed which, and how often intervention components are used. Additionally, the nature and frequency of outcome variables and an analysis on how (strong) they are affected by the intervention will be provided. Four possibilities may emerge: i) an outcome variable is analyzed in many interventions and is affected strongly, ii) an outcome variable is analyzed in many interventions and is affected moderately or not at all iii) an outcome variable is analyzed in few interventions and is affected strongly, or iv) an outcome variable is analyzed in few interventions and is affected moderately or not at all.

Discussion: Gaps in multi-modal interventions will be identified and it could be specified: i) which other outcome variables could be relevant to include in future multi-modal intervention trials, ii) which components are occurring most often, iii) which intervention components deserve more attention, iv) which variables are occurring most often, and v) which variables are affected most strongly by interventions.

From a practical point of view, the review can help health-care staff to decide on what components of interventions to include in the treatment and care of people with dementia depending on the lifestyle factors or outcome variables to be improved.

Key Words: dementia, multi-modal intervention, multi-component intervention, cognitive impairment, social inclusion, everyday functioning, quality of life, motivation to change behavior, drop-out rate

Research field: Interventional health-care research