Toward a theory-based specification of non-pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations

Alzheimers Dement. 2021 Feb;17(2):255-270. doi: 10.1002/alz.12188. Epub 2020 Nov 20.


Introduction: Non-pharmacological treatments (NPTs) have the potential to improve meaningful outcomes for older people at risk of, or living with dementia, but research often lacks methodological rigor and continues to produce mixed results.

Methods: In the current position paper, experts in NPT research have specified treatment targets, aims, and ingredients using an umbrella framework, the Rehabilitation Treatment Specification System.

Results: Experts provided a snapshot and an authoritative summary of the evidence for different NPTs based on the best synthesis efforts, identified main gaps in knowledge and relevant barriers, and provided directions for future research. Experts in trial methodology provide best practice principles and recommendations for those working in this area, underscoring the importance of prespecified protocols.

Discussion: We conclude that the evidence strongly supports various NPTs in relation to their primary targets, and discuss opportunities and challenges associated with a unifying theoretical framework to guide future efforts in this area.

Keywords: cognitive rehabilitation; cognitive stimulation therapy; cognitive training; cognitive-behavioral therapy for insomnia; communication treatments; framework; meditation; mild cognitive impairment; multisensory treatments; music-based treatments; neuromodulation; neuropsychiatric; non-pharmacological; nutritional interventions; occupational therapy; physical exercise training; reminiscence therapy; subjective cognitive decline.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aging / physiology*
  • Cognitive Behavioral Therapy
  • Dementia* / rehabilitation
  • Dementia* / therapy
  • Exercise
  • Humans
  • Meditation
  • Music Therapy