Non-pharmacological interventions to reduce neuropsychiatric symptoms in hospitalised patients for behavioural crises with cognitive impairment: A systematic review

Non-pharmacological interventions are pivotal to reducing neuropsychiatric symptoms (NPS) in patients with cognitive impairment. This systematic review assessed the effectiveness of non-pharmacological interventions applicable by nursing staff to reduce NPS in older patients with cognitive impairment hospitalised for behavioural crises. Six databases were searched for randomised or non-randomised controlled trials. Two authors screened full-texts and assessed the quality of the studies using the Modified Downs and Black Checklist. Results were presented narratively using the PRISMA guideline. Only five studies could be included, all were conducted in geriatric psychiatry. Three studies showed significant effects on NPS. They tested physical exercise, behavioural activation for meaningful activity and listening to individualised music and were of good, moderate and low quality, respectively. The best evidence was found for physical exercise. Due to the small number of studies with heterogeneous quality, the results must be interpreted with caution, limiting the scope of conclusions. While more research is needed, we recommend that non-pharmacological interventions in clinical practice be adjusted to patient characteristics, contextual factors and existing care practices.