Efficacy of Non-pharmacological Interventions for Dementia: Defining the 'Dose' and Mechanisms of Action

Abstract

The effects of physical, social, and cognitive stimulation on dementia are well established. When applying such evidence into clinical practice and intervention design, however, challenges exist as to deciding on the appropriate “dose” and judging how much flexibility can be allowed in tailoring the intervention for specific needs and capabilities. For example, it is being debated whether cognitive stimulation therapy works either in the form of individual or group-based activities, or if the social interaction of the latter is essential for it to be effective. We discuss here the quantification method used in the Six Arts intervention, a holistic, multi-level programme covering physical activities, social interactions, and cognitive domains or intelligences including visuospatial, attention and fine motor skills; language and verbal ability; music and rhythm; executive function, logic and mathematics. Trainers are provided with a pool of activities from which he/she can create different programme combinations tailored for the group’s level and interest. Because of the varieties within this intervention, a scoring system is developed as a proxy dosage to operationalize and systematically measure the intervention delivered. A dosage score is also automatically computed each time a session is designed to provide reference for the trainer, patients and their family. The scoring system can be used in clinical trials with a design that allows “dose finding” and test various research questions such as additive or synergistic effects of components within the holistic intervention programme. With the help of statistical methods for complex systems we may possibly be able to pin down the mechanisms of action.