2015 DementiaAustralia Engage Enable Empower Report

Engage, Enable,
Empower:
Living a healthy lifestyle with dementia
or mild cognitive impairment
ALZHEIMER’S AUSTRALIA DECEMBER 2015

Acknowledgements
Authors
Caitlin McDowell and Dr Maree Farrow
The authors would like to thank the Project Advisory Group and the Expert Advisory
Committee for their support throughout the development of this publication. Special thanks
to the people living with dementia who inspired and guided this work through participating
in the advisory group meetings, focus groups, interviews and surveys.
Suggested Citation:
McDowell, C. & Farrow, M. (2015). Engage, Enable, Empower: Living a healthy lifestyle
with dementia or mild cognitive impairment. Alzheimer’s Australia: Canberra.
Author Affiliations:
Caitlin McDowell1,2, Maree Farrow1,3,4
1. Alzheimer’s Australia Vic
2. L
a Trobe University
3. W
icking Dementia Research and Education Centre, University of Tasmania
4. Centre for Research on Ageing, Health and Wellbeing, The Australian National University
The Engage Enable Empower publication developed by Alzheimer’s Australia Vic was made possible by the
Alzheimer’s Australia National Quality Dementia Care Initiative funded by the Australian Government as part
of the Alzheimer’s Australia national project, Developing Innovative Methods to Respond to
Neurodegenerative Disease.
Disclaimer: This paper is for information purposes only and does not purport to provide medical
advice. Alzheimer’s Australia and its employees are not liable for any error or omission in the
information provided. The opinions expressed in this document are those of the authors and not
necessarily those of the Australian Government.
© Alzheimer’s Australia Inc 2015 ABN 79 625 582 771

ISBN 978-1-921570-61-2
Contents
Foreword 4
Executive Summary 5
1 Introduction 7
1.1 What is dementia and mild cognitive impairment? 7
1.2 How is dementia treated? 7
1.3 What is the purpose of this paper? 7
1.4 What is Engage, Enable, Empower? 7
2 Literature Search Strategy 8
3 MIND: Keeping the mind active 9
3.1 Cognitive stimulation 9
3.2 Cognitive training 9
3.3 Cognitive rehabilitation 10
3.4 Memory management training 10
3.5 Multi-component programs 11
3.6 Summary 11
4 BODY: Keeping the body active 12
4.1 Physical activity 12
4.2 National Physical Activity Guidelines 13
4.3 Summary 13
5 SUPPORT: Accessing appropriate support 14
5.1 Social support 14
5.2 Support needs 14
5.3 Health and community support services 15
5.4 Barriers and enablers to appropriate support 16
5.5 Summary 17
6 HEALTH: Managing health conditions and nutrition 18
6.1 Managing health conditions 18
6.2 Managing medications 18
6.3 Vascular risk factors 18
6.4 Depression 19
6.5 Nutrition 20
6.6 Malnutrition 21
6.7 Frontotemporal dementia and nutrition 21
6.8 Eat for Health Australian Dietary Guidelines 22
6.9 Summary 22
7 Conclusion 23
Glossary 24
References 26
Alzheimer’s Australia publications 33
3
Foreword
Although it might feel like it initially, a diagnosis of dementia is not the end.
Speaking from personal experience, life goes on. There are no magic pills
to cure dementia, but I’ve found ways to continue living a good life – an
active, meaningful life. I’ve accepted that I have dementia but I don’t let that
define me. I feel it’s important to maintain my roles as much as possible, as
a partner, a friend, and a volunteer. Being actively involved makes me feel
better about myself and what I can do. There are some things I can’t do
anymore on my own, but I can usually participate in some way with the right
support.
In my working life I was a physiotherapist. I loved helping people with their Maxine is a consumer
rehabilitation after an injury or illness. It was very difficult when I had to advocate living with
retire earlier than expected. A couple of years ago my partner Graeme and Posterior Cortical
I found a place where I can volunteer using my skills and knowledge as a Atrophy, which is a
physiotherapist. I help to run a gentle exercise group for older people with form of younger-onset
dementia in my local area. I get a lot of satisfaction from helping others in my Alzheimer’s disease.
community to maintain their health. Maxine is a member of
I am thrilled to have the opportunity to introduce this important publication. I the national Alzheimer’s
have been involved in the Engage, Enable, Empower project as a consumer Australia Dementia
advocate over the past two years. It is a health promotion project designed Advisory Committee,
specifically for people living with dementia. Through this project we have as well as the Engage,
developed a range of resources using dementia-friendly principles. This is a Enable, Empower
huge step in the right direction. As consumers, we want to be informed and Advisory Group
involved in our own health care as much as we can. and Younger Onset
Dementia Reference
This numbered publication reviews the evidence that supports the Engage,
Group at Alzheimer’s
Enable, Empower resources and key messages for people living with
Australia Vic.
dementia: (1) Keep your mind active; (2) Keep your body active; (3) Get
appropriate support; and (4) Look after your health. I have experienced and
seen first-hand what a difference it can make to keep active physically,
cognitively and socially. I have also found that it’s important to seek out
appropriate support and put it in place early, rather than wait until a crisis
point. Looking after general health and nutrition can also improve quality
of life. This publication is important because we all need to gain a better
understanding of what works and what doesn’t for people with dementia.
We need to look beyond the medical model and explore what we can do to
maintain or improve quality of life.
As a consumer of dementia-related community services, I’d like to advocate
for services that do things with us rather than for us. I want to be engaged,
enabled and empowered to maintain my valued roles and activities in daily
life. I encourage clinicians and service providers to continue reading this paper
to learn more about the research and consider how services may be adapted
and improved to better meet the needs of people living with dementia.
Further research is needed that focuses on ways to improve quality of life.
Furthermore, this research needs to be translated to an accessible format for
people living with dementia and the people who care about them.
I would also like to take this opportunity to acknowledge the Engage, Enable,
Empower project team. Graeme and I really appreciated their dedication and
empathy, and feel that this publication is a direct result of their commitment
to improving the lives of people living with dementia in the community.
Maxine Thompson
4 Alzheimer’s Australia Engage, Enable, Empower

Executive Summary
The prevalence of dementia and mild cognitive impairment (MCI) is increasing in
Australia and internationally. Dementia and MCI are conditions characterised by
a similar set of symptoms, commonly including cognitive decline and changes
in mood and behaviour, with dementia defined by severity of these symptoms
sufficient to interfere with daily activities. There are many different disease
processes that can lead to these conditions over many years or decades. The
progression of symptoms varies from person to person. Pharmacological treatment
options are limited, so it is important to consider what non-pharmacological
interventions or lifestyle changes may improve outcomes for this growing
population. This numbered publication reviews the evidence supporting four
main ways to improve health and quality of life when living with dementia or
MCI: cognitive interventions, physical activity, accessing appropriate support, and
managing health conditions and nutrition.
Research has shown that cognitive interventions can significantly improve
outcomes for people with dementia or MCI, including cognitive function and
quality of life. The strongest evidence supports the use of cognitive stimulation
interventions. In other words, any activity that engages and stimulates the brain is
likely to be beneficial. Structured programs such as cognitive training and memory
strategy training have also been developed to improve cognitive outcomes,
however there is currently insufficient evidence to suggest that these interventions
are superior to any other type of cognitive stimulation. Structured cognitive
rehabilitation programs have been more effective than standard cognitive training
programs, which may be because they are tailored to address the individual’s
unique cognitive deficits. Unfortunately, such programs are labour intensive, require
a skilled therapist and are not likely to benefit people with moderate to severe
dementia. Therefore cognitive stimulation is recommended as the most worthwhile,
cost-effective approach to implement for people living with dementia or MCI in all
types of settings.
Physical activity has also been shown to improve outcomes for people living with
dementia or MCI including improved cognition, physical function and fitness. There
is also growing evidence that physical activity may improve quality of life and reduce
behavioural and psychological symptoms of dementia. Unless contraindicated, the
National Physical Activity Guidelines recommend at least 30 minutes of moderate-
intensity physical activity on most days. Any activities that increase cardiovascular
fitness, strength, balance and flexibility are likely to be beneficial. Activities should
be encouraged that are appropriate to the individual’s physical and cognitive
abilities. Apart from these recommendations, there is a lack of evidence to suggest
any particular type of exercise program or activity is better than any other. Physical
activity has clear benefits for people in all stages of dementia or MCI who are living
in residential care or the broader community. Long periods of physical inactivity
should also be minimised as it may lead to poorer outcomes including increased
pain and changes in behaviour.
People living with dementia or MCI are likely to benefit from a combination of
informal social support and health and community services that are responsive to
their needs. Social engagement and support often improves quality of life, reduces
changes in behaviour, and may even delay cognitive decline. However, research
suggests that many people living with dementia or MCI experience a reduction
in their social network and underutilise the array of support services that are
available throughout Australia. People with dementia commonly need support with
activities of daily living such as health care, mobility, transportation and self-care
tasks. It is interesting to note that the most commonly reported need by people
living with dementia was the need to feel accepted and respected. In addition to
traditional medical services, there is growing evidence supporting the value of non-
5
pharmacological approaches, palliative care services, and technological advances for
people with dementia or MCI. A number of complex barriers often prevent people
living with dementia or MCI and their carers from accessing appropriate support.
It is recommended that services are flexible and responsive to individual needs,
ensuring appropriateness for a diverse range of consumers including people from
culturally and linguistically diverse (CALD) backgrounds and people with younger
onset dementia. Furthermore, information about services should be accessible and
designed appropriately for older people who may have limited vision, hearing or
ability to acquire knowledge.
Finally, managing health conditions and nutrition effectively can lead to improved
health, cognition and quality of life for people living with dementia or MCI. Some
health conditions and medications can affect the brain and worsen symptoms, so
it is important to consult with a doctor to best manage co-existing conditions such
as diabetes or depression. It is also recommended to manage vascular risk factors
such as high blood pressure and high cholesterol that can contribute to cognitive
decline and illnesses such as stroke and heart disease. Furthermore, it is important
that people with dementia or MCI maintain a healthy diet. A Mediterranean-style
diet (high in vegetables, fruits, whole grains and healthy fats) with limited processed
foods is recommended. Oral nutritional supplements may be useful for some
people. Malnutrition can occur amongst people with dementia, so it is important
that mealtime issues are identified and addressed as early as possible. Nutrient
deficiencies and dehydration can cause cognitive issues. Nutrient supplements may
be useful to address specific deficiencies, but there is currently a lack of evidence
to suggest that people without nutrient deficiencies will benefit from taking any
supplements. Advice should be sought from a doctor or dietician prior to making any
changes to diet including nutrition supplements such as vitamins, minerals or other
non-prescription remedies.
Few studies have investigated the effects of combining a number of lifestyle
interventions into multicomponent programs for people with dementia or MCI,
although preliminary research is promising. Further high quality research is
strongly recommended to determine what types of interventions or combinations
of interventions are most effective for and most important to people living with
different stages of dementia or MCI. Future research should focus on outcomes
that are of importance to consumers such as quality of life.
Based on the best available evidence, Alzheimer’s Australia has developed health
promotion resources entitled Engage, Enable, Empower, which provide accessible
information and recommendations for people living with dementia and their carers.
The four key messages are: keep your mind active, keep your body active, get
appropriate support, and look after your health (managing health conditions and
nutrition).
If there are any terms in this publication that you are not familiar with, please
see the glossary at the back of the publication.

1 Introduction
1.1 What is dementia and mild cognitive impairment?
Dementia is an umbrella term for a number of health conditions with similar signs
and symptoms that affect everyday function. Dementia may also be called major
neurocognitive disorder. The most common forms of dementia are Alzheimer’s
disease, vascular dementia, frontotemporal dementia, and dementia with Lewy
bodies, however there are many others (AIHW, 2012). Cognitive abilities that may
be affected include memory, attention, language, and problem solving. Behavioural
and psychological symptoms of dementia are also common, and negatively impact
the quality of life of the person with dementia, their carer(s), and family (Beerens,
Zwakhalen, Verbeek, Ruwaard, & Hamers, 2013). Behavioural and psychological
symptoms of dementia may include depression, anxiety, apathy, agitation, delusions
and other psychiatric symptoms.
Dementia is a progressive condition, with biological changes occurring many years
before symptoms emerge. Therefore, there is a continuum between what is
considered healthy ageing and dementia. Mild cognitive impairment is a diagnosis
that may be given to people who experience a slight decline in their memory or
other cognitive functions, but no significant loss of function in their daily activities
(Levey, Lah, Goldstein, Steenland, & Bliwise, 2006). MCI may also be called mild
neurocognitive disorder or prodromal dementia. People with MCI are at higher risk
of developing dementia, however some people remain stable and some experience
improved cognition over time (Bruscoli & Lovestone, 2004).
1.2 How is dementia treated?
There are currently no known medications to prevent or cure dementia, however
there are several medications used to treat cognitive symptoms of dementia,
including cholinesterase inhibitors and memantine (AIHW, 2012). Behavioural and
psychological symptoms of dementia may also be treated using antidepressant
or antipsychotic medications, but some people with dementia may experience
significant side effects and/or a lack of improvement in their symptoms (Bains,
Birks, & Dening, 2002; Ballard, Waite, & Birks, 2006). Non-pharmacological therapies
appear to be a promising approach to improving a range of outcomes for people
with dementia and their carers (Gallagher-Thompson et al., 2012; Kverno, Black,
Nolan, & Rabins, 2009; Olazarán et al., 2010).
1.3 What is the purpose of this paper?
This paper will focus on the lifestyle factors associated with improved outcomes
for people living with dementia or MCI, including improved quality of life, mood,
cognition, behaviour, physical health, and ability to participate in activities of daily
living. Specifically, this paper will discuss four key strategies for promoting health
and wellbeing of people living with dementia or MCI.
The four strategies are
(1) keeping the mind active;
(2) keeping the body active;
(3) accessing appropriate support; and
(4) managing health conditions and nutrition.
These four key strategies are the basis of the Engage, Enable, Empower resources
developed by Alzheimer’s Australia.
7
1.4 What is Engage, Enable, Empower?
‘Engage, Enable, Empower’ are the messages underlying the development
of health promotion information and tools specifically for people living with
dementia. Several resources have been developed to support the messages.
The resources, including a booklet, website and video clips, are designed to
be as dementia-friendly as possible. The aim is to enable and empower people
living with dementia to remain as engaged as possible with their health care and
meaningful activities.
The development of these resources has been guided by this literature review,
along with consultation with a broad range of people with dementia, carers and
health professionals. Initial work was undertaken by Alzheimer’s Australia Vic,
and expanded to become a national project with support from the Australian
Government Department of Health.
2 Literature Search Strategy

A literature search was conducted to determine the relationship between lifestyle
factors and improved outcomes for people living with dementia. Three research
databases (CINAHL, Medline, and Cochrane Library) were searched for peer
reviewed journal articles published from 2000 - 2015. In addition, Google searches
were conducted for relevant grey literature and websites. The search terms included
Alzheimer’s disease, dementia, lifestyle, intervention, rehabilitation, exercise,
activity, support, nutrition, and training.
Due to the extensive research in this area and the varied quality of individual studies,
this paper will primarily focus on the findings from recent systematic reviews and
highlight examples from key studies, reports, or websites.

3 MIND: Keeping the mind active
Many studies and reviews have suggested that mental stimulation may slow
cognitive and functional decline of people with dementia or MCI. Research has
been conducted on a broad range of cognitive interventions including cognitive
stimulation, cognitive training, cognitive rehabilitation and memory strategies
training.
3.1 Cognitive stimulation
Cognitive stimulation refers to all activities that engage and challenge the brain
such as studying, cooking or dancing. Cognitive stimulation is generally less formal
and structured than other types of cognitive interventions. Often the activities are
enjoyable and take place in a social environment (Woods, Aguirre, Spector, & Orrell,
2012). Social activity is mentally stimulating, and therefore can be considered a
type of cognitive stimulation. People with dementia often become socially isolated
for various reasons such as reduced confidence, apathy or stigma. As a result,
people with dementia may experience loneliness, anxiety or depression, as well
as cognitive and functional decline. Social interaction may improve mood and
engagement in physical, cognitive and self-care tasks such as eating or showering.
A recent Cochrane review of cognitive stimulation for people with dementia
demonstrated significant improvements in cognition that were retained over time
(Woods et al., 2012). There were also improvements in self-reported quality of life
and well-being and in staff-reported communication and social interaction. However,
there does not appear to be evidence of any significant positive or negative impact
on family carers (Aguirre, Hoare, Spector, Woods, & Orrell, 2014; Woods et al.,
2012).
It is important to note that dementia can affect an individual’s ability to plan,
initiate, and participate in cognitive and social activities. If an activity becomes too
demanding or stressful for the person living with dementia or their carer, consider
whether it is a meaningful activity for the individual. If so, it is recommended that
the issue is discussed with a GP or community support service. Often the activity,
the environment or the level of support can be adapted to suit the individual’s
current abilities and strengths. People are more likely to engage with activities
that they perceive as meaningful and within their abilities. To avoid fatigue and
frustration, it is recommended that suitable activities are prioritised to promote
engagement of people living with different stages of dementia. For example, an
individual with mild dementia or MCI may be able to participate in goal-directed
activities such as baking a cake; whereas an individual with moderate or advanced
dementia may be able to engage with the activity by watching, helping to stir or
decorate, and enjoy the taste and smell of the cake.
3.2 Cognitive training
Cognitive training refers to structured training designed to improve specific
cognitive domains, such as memory, executive function, or attention. Cognitive
training usually involves repetitive performance of computerised cognitive tasks,
although can sometimes be offered in other formats such as pen-and-paper.
Three systematic reviews have investigated the effectiveness of cognitive
training for people living with MCI and have reported modest benefits. First,
a recent systematic review has suggested that cognitive training can improve
various aspects of cognitive functioning including memory, executive functioning,
processing speed, attention, fluid intelligence and subjective cognitive performance
in some people with MCI (Reijnders, van Heugten, & van Boxtel, 2013). A second
systematic review by Gates, Sachdev, Fiatarone Singh, and Valenzuela (2011) also
found that cognitive training improved memory and global cognitive outcomes,
and that it was more effective than memory strategies training. Finally, a Cochrane
review of cognitive training for people with MCI suggests that this intervention may
9
improve immediate and delayed recall compared to no treatment, but does not
appear to be significantly better than the alternative treatment control conditions
(Martin, Clare, Altgassen, Cameron, & Zehnder, 2011). However, the overall quality
of trials investigating cognitive training has been low to moderate (Bahar-Fuchs,
Clare, & Woods, 2013; Gates et al., 2011).
Similarly, there is limited evidence of any significant benefits of cognitive training for
people living with Alzheimer’s disease and vascular dementia, according to a recent
Cochrane review (Bahar-Fuchs, et al., 2013). A study comparing cognitive training
to cognitive stimulation (recreational activities) for people with mild to moderate
Alzheimer’s disease favoured the cognitive stimulation intervention (E. Farina et al.,
2006). Participants who received cognitive training experienced improved function
in daily living skills, whereas people who participated in cognitive stimulation
experienced improved function, memory, verbal fluency, and fewer behavioural
disturbances (E. Farina, et al., 2006). Significant differences between groups were
not found at the six month follow up, except that carer distress was lower in the
group that received cognitive stimulation.
Another review of three small studies also suggests that people living with mild to
moderate dementia can participate in computerised cognitive training to improve
their performance in specific functional tasks (Mahendra et al., 2005). Although the
improvements were not significant, the participants made fewer errors, took less
time and required fewer prompts to complete the target tasks such as learning a
new route or shopping for items on a list (Mahendra, et al., 2005).
In summary, there is currently limited evidence supporting the effectiveness
of cognitive training for people living with dementia or MCI. It is possible that
participants benefited from the intervention in ways that were not adequately
captured by the outcome measures used in the studies. Further high quality
randomised controlled trials are required to clarify the effectiveness of cognitive
training interventions. Overall, cognitive stimulation and cognitive rehabilitation
(described below) currently appear to be more promising approaches for people
living with mild to moderate dementia or MCI.
3.3 Cognitive rehabilitation
Cognitive rehabilitation is a structured intervention that is tailored to individual
needs. Preliminary evidence suggests cognitive rehabilitation may have more
significant benefits for people with dementia and carers than generic cognitive
training interventions (Bahar-Fuchs et al., 2013).
Three randomised controlled trials have shown benefits of cognitive rehabilitation
in combination with cholinesterase inhibitors for people with MCI (Rozzini et al.,
2007) and people living with early stage dementia (Clare et al., 2010; Loewenstein,
Acevedo, Czaja, & Duara, 2004). The benefits for people with MCI included
improved memory and abstract reasoning, and reduced behavioural disturbances
and depressive symptoms compared to no treatment or cholinesterase inhibitors
alone (Rozzini et al., 2007). Loewenstein et al. (2004) found that people with early-
stage dementia experienced better task performance on some types of cognitive
and functional tasks if they received the systematic cognitive rehabilitation program
rather than computer-based mental stimulation activities with a therapist. In the
study conducted by Clare et al. (2010), 69 people with Alzheimer’s disease or both
Alzheimer’s disease and vascular dementia were randomised to the cognitive
rehabilitation group or relaxation therapy or no treatment. The cognitive rehabilitation
intervention was individualised to personal goals and provided practical aids and
strategies. Techniques for learning, stress management, practice maintaining
attention and concentration were also provided. The group receiving cognitive

rehabilitation scored significantly higher on their personal goal performance and
satisfaction than the other two groups (Clare et al., 2010).
Although cognitive rehabilitation appears to have benefits for people with dementia
or MCI, there are several challenges to implementation for this group (Choi &
Twamley, 2013). It is labour intensive, deficit-focused, and may be difficult to adhere
to if participants are experiencing memory impairment or lack of motivation. It is
likely to be most useful for people with early dementia or MCI, rather than the later
stages of dementia.
3.4 Memory management training
The La Trobe University and Caulfield Hospital (LaTCH) memory management
training program involves education on memory strategies and use of memory aids.
Preliminary evidence suggests that participants are satisfied with the intervention
and their achievement of personal memory goals, however benefits have not been
observed on neuropsychiatric assessments (Kinsella et al., 2009). Current research
is evaluating the implementation of the LaTCH program by service providers and
investigating how to make the program accessible to people in rural communities.
Promoting Healthy Ageing with Cognitive Exercise (PACE) was a recent randomised
controlled trial of cognitive activity strategy training for people with MCI. Participants
were randomly allocated to a 5 week strategy training program or non-specific
educational program (Vidovich et al., 2015). The strategy training was focussed
on providing participants with strategies and techniques to manage deficiencies
in cognition such as memory, attention and word-finding. The education program
focussed on providing information about living with dementia rather than skill
development. The strategy training group experienced small improvements in
attention and quality of life compared to the education group, however overall there
were no significant differences in cognition between the groups over a period of
two years (Vidovich et al., 2015).
3.5 Multi-component programs
Multicomponent programs also appear to be beneficial for people living with
dementia and MCI. A randomised controlled trial found that cognitive rehabilitation
combined with social and motor activities and cholinesterase inhibitors may delay
cognitive decline and improve mood for people with mild to moderate dementia
and MCI (Olazarán et al., 2004). Another randomised controlled trial investigated a
4 week multi-component cognitive rehabilitation program for people with dementia
and MCI, that involved activity planning, self-assertiveness training, relaxation
techniques, stress management, memory aids, memory training and motor
exercise (Kurz, Pohl, Ramsenthaler, & Sorg, 2009). Participants with MCI showed
significant improvements in mood, activities of daily living, verbal and nonverbal
episodic memory. However, participants with mild dementia did not experience
these benefits and only had a small, non-significant improvement in verbal memory
(Kurz et al., 2009). These results for people with mild dementia were at odds with
the results of recent meta-analyses, so the authors suggested that certain aspects
of their program may have been pitched at a level too high for people with mild
dementia. It is likely that multicomponent programs may have some benefits for
people living with MCI and mild dementia, but may not be appropriate for people
with moderate to severe dementia.
3.6 Summary
There is growing evidence that cognitive stimulation and cognitive rehabilitation
improves outcomes for people with dementia and MCI. Cognitive stimulation is low
cost and simple for formal and informal carers to implement, therefore this approach
should be actively supported through policy and education. Cognitive remediation
11
requires skilled therapists and is a relatively costly intervention to administer. It is
likely not a suitable therapy for people with moderate to severe dementia. Further
research is recommended to determine who is most likely to benefit from this,
and how it can be delivered most effectively. Cognitive training and memory
management training also appear to be promising interventions for people with
dementia or MCI, although there is currently a lack of high quality evidence to
recommend their widespread use.
A review by Kurz, Leucht, and Lautenschlager (2011) suggests the effectiveness
of cognitive interventions is similar to current anti-dementia medications. However,
strong evidence for delayed cognitive decline, improved engagement in activities
of daily living, and achievement of personally relevant goals has only been obtained
by single trials. The wide variety of cognitive interventions and outcome measures
used in the research have made it difficult for researchers to synthesize the
evidence in the reviews discussed above and may obscure the potential benefits of
the interventions (Bahar-Fuchs et al., 2013; Reijnders et al., 2013). There is limited
evidence regarding which cognitive domains are amenable to change through
cognitive interventions (Spector, Orrell, & Hall, 2012) and there is also limited
evidence for the generalisability of any improvements in cognition to everyday
life activities (Reijnders et al., 2013). Ongoing research will play an important role
to clarify the therapeutic benefits and appropriate implementation of cognitive
interventions for this population.
4 BODY: Keeping the body active

4.1 Physical activity
There is strong evidence that physical activity has benefits for people across their
lifespan, including people at risk of developing dementia (Farrow & Ellis, 2013).
There is also growing evidence that people living with dementia can experience a
wide range of positive outcomes from participating in physical activity (Miskovski,
2014). A recent Cochrane review of 16 randomised controlled trials found that
exercise programs improved the ability to perform activities of daily living and
appeared to improve cognition for people with dementia (Forbes, Thiessen,
Blake, Forbes, & Forbes, 2013). The included trials varied significantly so there
was insufficient evidence to suggest that exercise had a positive impact on
other outcomes such as mood, quality of life, and behavioural and psychological
symptoms of dementia.
However, Heyn, Abreu, and Ottenbacher (2004) found that exercise training
improved fitness, physical function, and behaviour in people with dementia and
related cognitive impairment in their meta-analysis of 30 trials involving 2020
participants. Another review of 10 trials investigated motor interventions for elderly
people with dementia and found that the intervention improved psychosocial
function, physical health, mood, and carer distress (Christofoletti, Oliani, Gobbi,
& Stella, 2007). Also, a systematic review by N. Farina, Rusted, and Tabet (2014)
found that exercise can slow the rate of cognitive decline in Alzheimer’s disease.
Furthermore, a review of 10 studies found that dancing interventions in aged care
settings had benefits including reduced changes in behaviour and an increase in
social interaction and enjoyment in residents with dementia and staff (Guzmán-
García, Hughes, James, & Rochester, 2013).

The majority of trials included in these systematic reviews involved participants
in residential aged care facilities. Few adverse effects were noted. The evidence
supporting exercise is promising, however the studies were too varied to conclude
which type of intervention, frequency, and duration is most effective for people
living with dementia. N. Farina et al. (2014) also suggest that it is difficult to draw
conclusions when only global measures of cognition are used as the primary
outcome or when the measures included in more sensitive cognitive test batteries
vary between studies.
Individual studies have shown that aerobic exercise improved cognition in
people with dementia (McDonnell, Smith, & Mackintosh, 2011). Multicomponent
interventions (a combination of endurance, strength and balance) have resulted in
larger improvements in gait speed, functional mobility and balance, compared to
progressive resistance training alone (Blankevoort et al., 2010).
A review by Eggermont and Scherder (2006) suggested that exercise programmes
should be offered frequently during the week over the long-term, should include a
walking activity and take at least 30 minutes in order to improve mood, sleep, and
ability to perform activities of daily living.
According to Ahlskog, Geda, Graff-Radford, and Petersen (2011), there are two
plausible biological reasons why aerobic exercise may improve cognition. Moderate-
intensity exercise may mitigate neurodegenerative processes and age-related loss
of synapses, and/or may reduce vascular risk factors that are known to contribute to
dementia.
Given the benefits of physical activity, it is not surprising that physical inactivity
has been linked to changes in behavioural and psychological symptoms and pain in
people living with dementia (Plooij, Scherder, & Eggermont, 2012; Scherder, Bogen,
Eggermont, Hamers, & Swaab, 2010). Behavioural and psychological symptoms
of dementia and pain may contribute to low levels of physical activity, and physical
inactivity may, in turn, contribute to these adverse symptoms. Living in a nursing
home is associated with higher rates of physical inactivity, and the use of physical
restraints reduces activity to a minimum (Scherder et al., 2010).
While most research has focussed on people with dementia in aged care facilities,
recent randomised control trials have investigated the effectiveness of home-
based exercise programmes (Cox et al., 2013; Steinberg, Leoutsakos, Podewils,
& Lyketsos, 2009; Suttanon et al., 2013). For example, the Fitness for the Ageing
Brain Study (FABS) trial assessed the effectiveness of a 6-month physical activity
intervention for people with MCI living at home (Lautenschlager et al., 2008). People
in the intervention group experienced modest improvements in cognition over an 18
month follow up period. Cox et al. (2010) suggested that interventions that support
self-efficacy of participants may improve adherence over the short-term and the
long-term. The Fitness for the Ageing Brain Study (FABS) II trial will investigate the
effectiveness of the same intervention for people living with dementia and we await
the results of this randomised controlled trial (Cyarto et al., 2010). Several other
large randomised controlled trials are currently being conducted to assess the value
of aerobic exercise (Hoffmann et al., 2013; Hooghiemstra et al., 2012; Pitkala et al.,
2010), and balance training exercise for this population (Hill et al., 2009).
4.2 National Physical Activity Guidelines
The evidence described above suggests that physical exercise has many benefits
for people with dementia. The National Physical Activity Guidelines for Older
Australians offers practical advice for people with dementia or MCI.
13
National Physical Activity Guidelines for Older Australians
1. Older people should do some form of physical activity, no matter what their age,
weight, health problems or abilities.
2. Older people should be active every day in as many ways as possible, doing a
range of physical activities that incorporate fitness, strength, balance and flexibility.
3. Older people should accumulate at least 30 minutes of moderate intensity
physical activity on most, preferably all, days.
4. Older people who have stopped physical activity, or who are starting a new physical
activity, should start at a level that is easily manageable and gradually build up the
recommended amount, type and frequency of activity.
5. Older people who continue to enjoy a lifetime of vigorous physical activity should
carry on doing so in a manner suited to their capability into later life, provided
recommended safety procedures and guidelines are adhered to.
(Department of Health, 2014)
4.3 Summary
The research suggests that people living with dementia or MCI benefit from physical
activity in a number of ways including improved cognition and physical function. This
does not require complex, high cost training programs or highly skilled therapists or
carers. It can consist of simple activities such as walking, tai chi, dancing or even
housework. There is a lack of evidence to suggest that one type of physical activity
is better than another, although people are likely to benefit from participating in a
variety of activities that promote cardiovascular health, strength, fitness and balance.
Unless, contraindicated, people with dementia and MCI should be encouraged and
supported to accumulate at least 30 minutes of physical activity on a daily basis.
Long periods of passive, sedentary activities should be avoided, or broken up with
opportunities to move about. These recommendations are applicable to people living
in residential care services as well as people living in the broader community. Even
in the more advanced stages of dementia, encouraging physical activity appropriate
for the individual is important.
5 SUPPORT:
Accessing appropriate support
Access to appropriate health and community services, as well as informal social
support, is clearly important. However, people living with dementia or MCI often
experience many barriers to receiving adequate support. Dementia can hinder one’s
ability to communicate effectively and seek assistance when required. Therefore
people living with dementia in the community and in residential care are likely to
have unmet needs. This section of the paper will briefly outline the types of support
that may be available to people with dementia or MCI, their support needs, and the
barriers and enablers to accessing appropriate support.

5.1 Social support
Social engagement and support are related to improved quality of life and reduced
behavioural and psychological symptoms of dementia for people living with
dementia (Ataollahi Eshkoor, Hamid, Nudin, & Mun, 2014; Nelson & Tabet, 2015).
There is not yet sufficient evidence to confirm whether social engagement slows
cognitive decline in people with dementia or MCI, however there are several
proposed mechanisms for its benefits (Gow, Corley, Starr, & Deary, 2013). First,
social engagement is a type of cognitive stimulation. As discussed earlier in this
paper, cognitive stimulation can be an effective intervention for people with
dementia or MCI. Research has shown that social stimuli are more engaging than
non-social stimuli for people with dementia (Cohen-Mansfield, Thein, Dakheel-
Ali, Regier, & Marx, 2010). One-to-one human interaction was most effective in
terms of attention, duration and attitude towards the stimulus. Animals, dolls, and
animal-like robots also promoted engagement to a greater extent than non-social
stimuli such as a ball, puzzle, or folding towels. The second potential reason why
social engagement is effective is that it reduces social isolation, in turn reducing
depression and the physiological impact of stress (Gow et al., 2013).
There are clear benefits of social interaction, however many people with dementia
experience a diminishing network of social relationships and support. Often people
living with dementia withdraw from social activities and relationships that they
previously enjoyed. Social withdrawal is a common symptom of dementia that
can precede cognitive symptoms (Nelson & Tabet, 2015). Withdrawal may also be
a conscious choice due to stigma, embarrassment, or a range of other reasons.
Friends and family members may also withdraw in some cases (Harris, 2012).
People with dementia or MCI, their carers and friends should be educated and
supported by service providers to continue their social relationships and interactions
as best as they are able.
5.2 Support needs
Dementia is a complex, progressive condition. People living with dementia often
require medical, psychological, community and social services. A systematic
review noted that the prominent needs include early diagnosis, education, therapy,
medication, caregiver support and management of co-existing conditions and
changes in behaviour (Weber, Pirraglia, & Kunik, 2011).
The Survey of Disability, Ageing and Carers is a comprehensive national survey that
measures the prevalence of disability and long term health conditions amongst older
people in Australia, as well as their support needs. The survey found that people
with dementia in the community were most likely to need help with the following
activities of daily living: health care (84%), mobility (80%), transportation (80%),
cognitive and emotional tasks (64%), and self-care (62%) (AIHW, 2012). The survey
also found some gender differences, with women more likely than men to need
assistance with household chores and cognitive and emotional tasks. Men were
more likely to need assistance with home maintenance than women (AIHW, 2012).
A review of 34 studies related to the subjective needs of people living with dementia
found that most people reported needs related to well-being and coping, whereas
few identified instrumental needs (van der Roest et al., 2007). In this review,
the most commonly reported needs were to be accepted and respected, to find
adequate coping strategies, and to come to terms with their situation.
People living with dementia and their carers benefit from using community-
based services. A review of the evidence found that service users with dementia
experienced greater life satisfaction and engagement in activities, and reduced
changes in behaviour and communication difficulties. This review also found that
carers benefited, as they experienced less stress, depression, anger, and perceived
burden (Ploeg et al., 2009).
15
Non-pharmacological interventions
There is growing evidence that people living with dementia benefit from non-
medical and non-pharmacological approaches to treatment. It has frequently been
argued that psychotropic medication has been over-prescribed and over-used in the
management of behavioural and psychological symptoms of dementia (Dawson,
Bowes, Kelly, Velzke, & Ward, 2015). These medications do not treat the underlying
cause of symptoms, may have limited effectiveness in treating symptoms, may
have severe side effects and have been linked to an increase in premature deaths.
Therefore it is recommended to explore alternative approaches prior to trying
psychotropic medications, such as anti-psychotics.
Several systematic reviews have been conducted and have shown the benefits
of non-pharmacological interventions such as cognitive interventions and physical
activity interventions as discussed in the previous sections of this paper ( Ayalon,
Gum, Feliciano, & Areán, 2006; Olazarán et al., 2010). The reviews also included
a range of other interventions that may be beneficial such as music therapy,
reminiscence therapy, aromatherapy, massage, and assistive technology. The
research suggests that non-pharmacological approaches may improve quality of
life of people with dementia (Cooper et al., 2012) and delay functional decline
(McLaren, LaMantia, & Callahan, 2013) and institutionalisation (Spijker et al., 2008).
Furthermore, these approaches may reduce symptoms of dementia such as sleep
disturbances (Brown et al., 2013), wandering (Forbes, 2007), agitation (Kong, Evans,
& Guevara, 2009) and psychological symptoms (Seitz et al., 2012).
Many of these non-pharmacological approaches can be implemented by carers
for little to no cost, and few require any specific training (Hulme, Wright, Crocker,
Oluboyede, & House, 2010).
Palliative care
Increasingly, dementia is being recognised as a terminal condition and the
accessibility of palliative care is improving for this population. However, further
improvement is required. Dawson et al. (2015) suggest that provision of palliative
care services can be enhanced by developing appropriate assessment, tailored
support, and improving coordination of services.
Use of technology
A growing area of research and development is technology designed for people
living with dementia and their carers. Simplified videophones, assistance robots,
GPS technology and monitoring systems are examples of technological advances
that may increase feelings of safety and social connectedness. A systematic review
of the research suggests that these types of technology solutions have the potential
to alleviate frequently reported unmet needs including the need for information,
support to manage symptoms, social contact and health monitoring (Lauriks et
al., 2007). They also have potential to reduce carer stress and costs of health care
(Buettner, Yu, & Burgener, 2010), although further research is required to determine
which technological advances are effective and in what circumstances.
5.3 Health and community support services
Friends and family carers can offer invaluable emotional and practical support for
people living with dementia or MCI. However, the demands of caring can increase
over time and it is important that informal care is supplemented by formal support
services.
Countries such as Australia offer an array of health and community support
services to meet the varied needs of people living with dementia or MCI. General
practitioners play an important role in health care, including providing information,

treatment options and referrals to specialists and community support services
(Brodaty & Cumming, 2010). As a peak body, Alzheimer’s Australia offers
information, education, and support for people living with all types of dementia and
MCI and their carers.
The Commonwealth Home Support Programme (CHSP) provides a co-ordinated
package of services to enable older people to remain living in their homes. Home
care packages can assist with personal care, meals, transportation, domestic tasks,
and home maintenance and modification as required. Community nurses also offer
assistance to people in their own homes. Many people living with dementia or
MCI wish to remain in their home for as long as possible, and also function best in
a familiar environment. Services should support clients and their carers to prevent
unnecessary transition, and support them through times of transition if required. For
short-term support and therapy following a hospital admission, there are transitional
care services that are designed to prevent premature entry into residential aged
care. If or when residential care is required, an aged care assessment will be carried
out to determine whether a low or high level of care is appropriate, or a dementia-
specific unit.
The Dementia and Cognition Supplement provides additional funding to home
care recipients and aged care services that are caring for people with cognitive
impairment associated with dementia and other conditions. This supplement is
available in all levels of the Commonwealth funded Home Care Packages Program
for people with moderate to severe levels of cognitive impairment associated with
dementia or other conditions.
For people with dementia or MCI living in the community, there are often respite
options available in-home or at a centre, including day or overnight care (Brodaty
& Cumming, 2010). In Australia, day programs are also known as planned activity
groups and are usually centre-based, although some involve community outings.
There has been limited research regarding the effectiveness of respite services,
however they appear to be beneficial to the health and wellbeing of carers. There is
no reliable evidence that respite programs have a positive or negative effect on care
recipients (Dawson et al., 2015).
My Aged Care was introduced by the Australian Government on 1 July 2013 and
consists of the My Aged Care website (www.myagedcare.gov.au) and the My Aged
Care contact centre (1800 200 422).
My Aged Care has created a clear entry point to the aged care system and currently
provides:
• information about aged care to consumers, family members and carers;
• information for service providers;
• online service finders that provide information about aged care service providers
and assessors; and
• online fee estimators for pricing on home care packages and residential care.
5.4 Barriers and enablers to appropriate support
A comprehensive range of medical and support services exist for people with
dementia or MCI, however research suggests that these services are underutilised
(Ploeg et al., 2009). Access Economics reported that more than a third (37%)
of Australians living with dementia received no formal support services in 2008
(Brodaty & Cumming, 2010). An American literature review also found that more
than half of people with dementia did not receive home and community support
services such as personal care, meal preparation, and respite services (Weber et
al., 2011). The authors suggest that underutilisation may be due, in part, to a lack of
awareness of services. Furthermore, the complexity of the health and social service
system may make it difficult for consumers, carers, and health professionals to
navigate (Ploeg et al., 2009). 17
Accessible information is essential for people to better understand what support
options are available and what types of interventions are based on reliable evidence.
This will assist people with dementia and their carers and health professionals to
make timely decisions about accessing services (Dawson et al., 2015). Accessibility
of information can be improved by offering it in multiple formats and languages.
It is also important to consider that people living with dementia are more likely to
experience cognitive, visual and hearing impairments than the general population
due to age or symptoms of their condition. For printed and online resources, using a
large, sans-serif font, simple language, and contrasting colours is recommended.
In addition to accessible information, help-seeking behaviour promotes access to
appropriate services. One study investigating help-seeking behaviour found that
older people were likely to have unmet needs for which they have not sought help
(Walters, Iliffe, & Orrell, 2001). Barriers to help-seeking may include withdrawal,
resignation, and low expectations of the available services (Walters et al., 2001).
Furthermore, people with dementia or MCI often experience symptoms which may
hinder their ability to seek and navigate the service system.
Considering the timing of help-seeking may also be important for improving
outcomes for people with dementia and their carers. A British study found that
people from culturally and linguistically diverse backgrounds sought assistance for
memory concerns significantly later than Caucasian British people (Dawson et al.,
2015). A Canadian community health survey of people with dementia also found
that there were gender differences in relation to service use (Forbes et al., 2008).
On average, women received more community health services and experienced
better health than their male counterparts. Although men received more home care
services than women, they experienced poorer health, and therefore their carers
were more vulnerable to negative outcomes (Forbes et al., 2008). It is important
that services are designed to meet the unique needs of their clients and local
communities. Services that are person-centred and culturally appropriate are more
likely to promote early help-seeking (Dawson et al., 2015).
Age appropriateness is also an important consideration. People with younger onset
dementia such as frontotemporal dementia may experience unique challenges and
barriers to accessing appropriate services (Morhardt, 2011). For example, they may
not be eligible for services designed for older people or those services may not
adequately meet their needs. Furthermore, people with frontotemporal dementia
and their families have expressed that they have had difficulty obtaining a diagnosis
and have financial concerns due to loss of employment (Morhardt, 2011).
One study investigated why some people with dementia were reluctant to attend
day services (Durand, James, Ravishankar, Bamrah, & Purandare, 2009). The most
common reasons reported were that they like to be on their own and that they
believed they would not enjoy it. They also tended to be concerned about meeting
new people, losing their independence and being institutionalised. A screening tool
used to detect depression in people with dementia was used, and suggested that
more than half of the people who refused day services may meet the criteria for
major depression (Durand et al., 2009). This may have contributed to their reluctance
to engage with services.
5.5 Summary
People with dementia or MCI are likely to have a broad range of needs for informal
and formal support and services. Many require social and emotional support,
as well as health and community services. There is growing evidence that non-
pharmacological approaches can be therapeutic, cost-effective and simple to
implement across all different types of settings. There is also rapid progress in the

development and evaluation of modern technological advances that may improve
safety, independence and social connectedness.
It appears that service need and service availability do not adequately predict
service use by people living with dementia or MCI and their families. A survey of
over 600 carers found that other factors were in fact more predictive of service
use, including living arrangement, gender, age, ethnicity, location, availability of
transport, health insurance, and the relationship between the carer and person
with dementia (Toseland, McCallion, Gerber, & Banks, 2002). Many researchers
have noted that services for people living with dementia or MCI are often under-
utilised, particularly amongst minority groups. Further research is required to
better understand the barriers to accessing appropriate services and addressing
these accessibility issues.
6 HEALTH: Managing health conditions

and nutrition
6.1 Managing health conditions
Dementia is caused by diseases affecting the brain. If other health conditions that
can affect brain function are also present, the symptoms of dementia may be
exacerbated. The burden of coexisting medical conditions in Alzheimer’s disease is
greater than for individuals without dementia and is associated with poorer cognition
(Duthie, Chew, & Soiza, 2011). Therefore management of dementia should include
preventative approaches to maintain health and wellbeing as much as possible. The
management of other health conditions may have to be modified in the presence of
dementia as the person becomes less able to self-manage their healthcare (Hogan
et al., 2008).
Delirium is an acute condition with symptoms similar to those of dementia, but
usually temporary and reversible. Delirium is common in older people, and even
more common in those with dementia where it is associated with accelerated
cognitive decline and adverse events. (Nelson & Tabet, 2015). Given the overlapping
symptoms, delirium can be difficult to recognise in people with dementia, however,
recognition is important as delirium often has an identifiable and treatable cause
(Nelson & Tabet, 2015).
6.2 Managing medications
Certain medications, especially those with anticholinergic or sedative effects, can
worsen cognition in people with dementia, and adversely affect their physical
function and activities of daily living (Bell et al., 2012). They may also blunt the
effects of the cholinesterase inhibitors used to treat Alzheimer’s disease (Hogan
et al., 2008). Anticholinergics are a class of drugs that block the action of the
neurotransmitter acetylcholine in the brain, which is important for memory and
cognitive function and is found in reduced levels in Alzheimer’s disease. Drugs
with anticholinergic effects include some medications used to treat conditions
such as asthma and other respiratory disorders, incontinence, gastrointestinal
disorders, muscle spasms, depression and other psychiatric disorders, and sleep
disorders. Their use should be minimised in patients with Alzheimer’s disease and
other dementias (Bell et al., 2012). In many cases, alternative medications without
anticholinergic effects are available. For people with dementia, a medicines review
is essential with the aim of reducing or stopping any unnecessary medicines, or
19
those that are contraindicated or should be used with caution (Pond, 2012). With
cessation or reduction of some medications with anticholinergic or sedative effects,
the person with dementia may become more alert and engage more effectively
(Pond, 2012).
6.3 Vascular risk factors
Modifiable vascular risk factors are common in older people and can contribute
to brain vascular disease and cognitive impairment. They include high blood
pressure, high cholesterol and obesity, and lifestyle factors such as excessive
alcohol consumption and smoking. Price and Keady (2010) suggest that people with
dementia can benefit from health promotion initiatives to address these modifiable
risk factors. People with vascular dementia are particularly likely to benefit, however
vascular risk factors are also strongly associated with Alzheimer’s disease (Duthie
et al., 2011) and can be detrimental to people with all types of dementia and MCI.
Reduction in blood pressure, cholesterol levels, blood sugar, weight, alcohol intake,
and smoking may improve cognitive function or delay the progression of dementia
(Pond, 2012).
High blood pressure, or hypertension, is a risk factor for stroke, vascular dementia
and Alzheimer’s disease, as well as heart disease and kidney disease, and becomes
increasingly common with older age. Treatment of high blood pressure with blood
pressure lowering medications has been associated with reduced risk of dementia
and better cognitive performance in some studies (Gorelick et al., 2011; Nelson &
Tabet, 2015). High blood pressure can lead to damage to brain blood vessels and
brain cells and increase the pathology of Alzheimer’s disease (beta amyloid plaques)
(Duthie et al., 2011). Low blood pressure (hypotension) in later life can also lead to
brain blood vessel and brain cell damage and decreased brain blood flow that can
contribute to cognitive impairment (Duthie et al., 2011; Nelson & Tabet, 2015). While
the optimal blood pressure for people with dementia has not been determined,
careful treatment of hypertension (while avoiding hypotension) is recommended,
and is likely to be beneficial in people with dementia or MCI (Nelson & Tabet, 2015).
Diabetes is also associated with an increased risk of dementia (Lu, Lin, & Kho,
2009). Diabetes can lead to blood vessel disease, inflammation and oxidation in the
brain, and may also contribute to the pathology of Alzheimer’s disease, all of which
increase the risk of dementia. Additionally, several studies have shown that diabetes
and poor glucose control are themselves associated with cognitive impairment
and greater cognitive decline (Lu et al., 2009; Yaffe et al., 2012). Hyperglycaemia
(elevated glucose) adversely affects cognition and is associated with changes
in brain blood flow, but this is reversible when good glucose control is restored
(Gorelick et al., 2011). Other complications of diabetes such as hypoglycaemia (low
glucose), dehydration and infections can also contribute to cognitive impairment
(Dunning, Duggan, & Savage, 2014). So careful treatment of diabetes, avoiding
hyperglycaemia and hypoglycaemia, is recommended.
High cholesterol in midlife is associated with increased risk of later developing
dementia (Anstey, Lipnicki, & Low, 2008). High cholesterol levels increase the
build-up of Alzheimer’s disease pathology and contribute to blood vessel damage,
increasing the risk of dementia. The use of statins (cholesterol lowering drugs)
has been associated with reduced risk of dementia (Swiger, Manalac, Blumenthal,
Blaha, & Martin, 2013), although randomised controlled trials of statins for treating
dementia per se have failed to show any benefit for cognitive function (McGuinness,
2014). However, for people with high cholesterol and dementia, effective treatment
of the high cholesterol has been shown to reduce cognitive decline (Deschaintre,
Richard, Leys, & Pasquier, 2009). There has been some controversy that statins
cause memory loss, but recent reviews found no evidence for any adverse cognitive
effects of these drugs (Richardson et al., 2013; Swiger et al., 2013).

There has been little research investigating the effects of vascular risk factor treatment
in people with dementia. Treating high blood pressure, high cholesterol and diabetes
was associated with significantly less cognitive decline in people with Alzheimer’s
disease over an average follow up time of 2.3 years (Deschaintre et al., 2009).
Neuroimaging studies have demonstrated benefits of vascular risk factor treatment in
people with dementia, such as slowed progression of white matter lesions (Richard,
Gouw, Scheltens, & van Gool, 2010). In the Deschaintre et al. (2009) study, only 7%
of people with Alzheimer’s disease had no vascular risk factors, suggesting these
coexisting conditions are common in the dementia population. Given the potential for
vascular risk factors to negatively impact the brain and cognitive function, effective
treatment is a preventative measure that may help reduce the cognitive burden for
people living with dementia or MCI.
6.4 Depression
Depression commonly coexists with dementia and has been found to increase its
rate of progression (Nelson & Tabet, 2015). Whether depressive symptoms develop
independently from the dementia or are a part of the dementia syndrome is unclear.
A history of depression is associated with increased risk of developing dementia,
however late-life depression could also be an early sign of dementia (Nelson & Tabet,
2015). Depression is itself associated with cognitive impairment and has serious
effects on physical and mental functioning. Depression can interfere with memory
and concentration, but these effects can be reversible with treatment. For people with
dementia or MCI, depression should be managed with appropriate behavioural and/or
pharmacological treatments, with careful monitoring to determine effectiveness and
any adverse effects (Bridges-Webb & Wolk, 2003). Effective treatment of depression
in people with dementia may have a positive influence on both the depression and the
dementia (Nelson & Tabet, 2015).
Biological, psychological and social factors may all play a role in causing depression.
Genetic factors, ongoing stress, chronic pain, social isolation, medications, and other
illnesses can contribute to depression. Older people (including those with MCI or
dementia) may experience depression as a result of major life changes, such as the
loss of a partner, retirement, moving into residential care or coping with increasing
frailty. However, they are less likely to receive assessment, diagnosis and treatment
for depression.
Studies examining the use of antidepressant medications to treat depression in people
with dementia have resulted in mixed findings (Bains et al., 2002; NICE, 2006). Some
positive effects have been found for slowing cognitive decline, reducing agitation
and improving quality of life; however, several large trials conducted in people with
dementia have not shown benefit (in group data) for antidepressants for treatment
of depression per se (Sepehry, Lee, Hsiung, Beattie, & Jacova, 2012). Continuous
antidepressant use has been associated with a reduced rate of cognitive decline in
people with depression and Alzheimer’s disease (Mossello et al., 2008). Depression
has also been identified as a risk factor for early transition to residential care in
people with dementia, with antidepressant treatment seeming to protect against this
outcome (Dorenlot, Harboun, Bige, Henrard, & Ankri, 2005). However, a meta-analysis
of five randomised controlled trials indicated that antidepressants do not have a
statistically significant impact on depression in people with dementia overall (Sepehry
et al., 2012). Of course, this does not mean antidepressants will not have benefits
for some people with dementia and depression, however non-pharmacological
approaches are generally recommended (Nelson & Tabet, 2015). Antidepressant
medications with anticholinergic effects (e.g., tricyclic antidepressants) should be
avoided because they may adversely affect cognition (NICE, 2006).
Research into non-pharmacological interventions to treat depression in people with
dementia has used a number of different approaches or strategies. Interventions that
21
involved multiple components frequently found significant reductions in depressive
symptoms and improved quality of life in the person with dementia (Olazarán et
al., 2010). These findings suggest that an approach that is tailored to the abilities
and preferences of the person with dementia and involves multiple intervention
approaches may be most beneficial. Multicomponent interventions that were
effective typically involved engagement in activities that are enjoyable for the person
with dementia plus individualised support (Burgener, Yang, Gilbert, & Marsh-Yant,
2008; Olazarán et al., 2010).
Research has found that music therapy was associated with reduced symptoms
of depression in people with dementia (Cooke, Moyle, Shum, Harrison, & Murfield,
2010; Ueda, Suzukamo, Sato, & Izumi, 2013). A review of music therapy for people
with dementia found this to be particularly useful for people with anxiety, and also
found that programs of longer duration appeared to be more beneficial (Ueda et al.,
2013).
Results of trials examining the effects of support and psychotherapy for people with
dementia and depression have been mixed (Olazarán et al., 2010). A trial involving
intensive counselling (30 minutes, three times a week for 16 weeks) reported a
significant reduction in depressive symptoms in the intervention group (Tappen &
Williams, 2009).
6.5 Nutrition
Nutrition is critically important for health in the general population, including people
with dementia or MCI. Dehydration or deficiencies in certain nutrients can cause
cognitive problems such as confusion, disorientation or poor memory which can
mimic the symptoms of dementia, or make cognitive symptoms worse for someone
with dementia or MCI (Yen, 2003).
Several systematic reviews have investigated the potential benefits of specific
nutrients for people with dementia. Low levels of omega-3 fatty acid in the brain
are associated with cognitive decline, however clinical trials have not demonstrated
efficacy of omega-3 fatty acid supplementation in the treatment of dementia
(Jicha & Markesbery, 2010). The main dietary source of omega-3 is oily fish,
such as salmon, sardines, and fresh tuna (Prince, Albanese, Guerchet, & Prina,
2014). Further research is required to determine whether omega-3 fatty acid
supplementation may be useful for people with early stage dementia or MCI (Jicha
& Markesbery, 2010).
Similarly, low concentrations of vitamin D have been associated with poor cognitive
function, however it remains unclear whether taking vitamin D supplements may
have any benefits for people with dementia (Balion et al., 2012; Etgen, Sander,
Bickel, Sander, & Förstl, 2012). Low levels of folate and vitamin B12 are also
associated with cognitive impairment, yet randomised controlled trials conducted to
date have not demonstrated the effectiveness of folate (Malouf & Grimley Evans,
2008) or vitamin B12 supplementation (Ellinson, Thomas, & Patterson, 2004; Malouf
& Areosa Sastre, 2003; Vogel, Dali-Youcef, Kaltenbach, & Andrès, 2009) as a form
of treatment. One preliminary study suggested folate may improve the efficacy
of cholinesterase inhibitors for people with Alzheimer’s disease, however further
research is required (Malouf & Grimley Evans, 2008).
There is also a lack of high quality evidence to suggest that people with dementia or
MCI would benefit from taking vitamin B6 (Malouf & Grimley Evans, 2003), thiamine
(Rodríguez, Qizilbash, & López-Arrieta, 2001), vitamin E
(N. Farina, Isaac, Clark, Rusted, & Tabet, 2012), ginseng (Geng et al., 2010), ginkgo
biloba (Birks & Grimley Evans, 2009) or multi-vitamins (Nelson & Tabet, 2015).

Few studies have investigated how complete diets impact on the course of
dementia. One study found a correlation between cognitive impairment and a
diet high in processed foods amongst people with MCI (Torres et al., 2012). A
recent systematic review has shown that adhering to a Mediterranean diet may
play a protective role against cognitive decline and development of Alzheimer’s
disease (Opie, Ralston, & Walker, 2013). One study found that adherence to
the Mediterranean diet was associated with reduced risk of MCI progression
to Alzheimer’s disease dementia (Scarmeas et al., 2009). Furthermore, a higher
adherence to a Mediterranean diet was associated with a lower risk of mortality for
people living with Alzheimer’s disease (Scarmeas, Luchsinger, Mayeux, & Stern,
2007). Consuming this diet rich in fruits, vegetables, low-fat dairy products and
minimal saturated fat and sodium may improve outcomes by reducing the vascular
risk factors known to contribute to dementia (Yen, 2003).
Medical foods/drinks have been developed specifically to improve brain function of
people living with dementia and are sold in Australian pharmacies. Clinical trials have
had mixed results, however the findings of one trial suggest that people with mild
Alzheimer’s disease may experience modest benefits from the product Souvenaid,
including slight improvements in memory and brain electrical activity (Scheltens
et al., 2012; Scheltens et al., 2010; Shah et al., 2013). There is a lack of evidence
to suggest that medical foods are of benefit to people with moderate to severe
dementia.
6.6 Malnutrition
Malnutrition can occur amongst people with dementia (Allen, Methven, & Gosney,
2013). Oral nutritional supplements are products designed to improve nutritional
intake and are high in energy, protein, and micronutrients. A systematic review by
Allen et al., (2013) found that oral nutritional supplements have positive outcomes
for older people with dementia, including weight gain and improved cognition.
However, two other reviews suggested there is insufficient evidence to definitively
conclude the benefits of thickened fluids and oral liquid nutritional supplements for
people with dementia in residential aged care (Hines, McCrow et al., 2010; Hines,
Wilson et al., 2010). Hines, Wilson et al. (2010) emphasised the need for nursing
and care staff to ensure nutritional supplements are prescribed and administered
appropriately.
Some people with dementia experience mealtime difficulties, which may contribute
to malnutrition (Aselage & Amella, 2010; Watson & Green, 2006). A systematic
review of seven studies suggests that the use of relaxing music during mealtimes
may help to reduce agitation or aggression in some older people with dementia,
however preferences for music vary from person to person (Johnson, Taylor,
Watson, & Huei-chuan, 2011). Extra staff time and staff training has been shown
to have a positive effect on nutritional intake of aged care residents with dementia
(Cole, 2012). Cole (2012) suggests it is important to identify eating difficulties
as early as possible, engage the advice of a dietician, and allow extra time for
individuals with dementia to eat.
A larger review of 22 studies (9 randomised controlled trials) found that there
were five different types of interventions commonly used to address mealtime
difficulties, including nutritional supplements, training/education programs,
environment/routine modification, feeding assistance, and mixed interventions
(Wen, Jooyoung, & Thomas, 2014). This review concluded that there was moderate
evidence supporting the use of nutritional supplements, as well as training/
education programs to increase eating time. However, training/education programs
and feeding assistance did not significantly improve food intake. Limited evidence
supported the use of environmental/routine modification to increase food intake and
to reduce agitation (Wen, et al., 2014).
23
6.7 Frontotemporal dementia and nutrition
People with frontotemporal dementia often experience an increased appetite,
increased cravings for sweet foods, and as a result, are likely to gain weight. Some
also develop a tendency to eat non-edible things (Ikeda, Brown, Holland, Fukuhara,
& Hodges, 2002). It is recommended that people experiencing changes to their
appetite or eating, or their carers, should advise their doctor to discuss treatment
options. Preliminary research has shown that selective serotonin reuptake inhibitors
may be effective in treating behavioural symptoms of frontotemporal dementia
including problematic cravings and eating behaviours (Ikeda et al., 2002).
6.8 Eat for Health Australian Dietary Guidelines
The Eat for Health Australian Dietary Guidelines 2013 offer useful suggestions for
eating a range of nutritious foods (NHMRC, 2013). An excerpt from these guidelines
has been included below. Individuals should consult with their doctor prior to
changing their diet or taking nutritional supplements or herbal medicines.
Eat for Health Australian Dietary Guidelines 2013

1. To achieve and maintain a healthy weight, be physically active and choose amounts
of nutritious food and drinks to meet your energy needs
• Older people should eat nutritious foods and keep physically active to help maintain
muscle strength and a healthy weight.
2. Enjoy a wide variety of nutritious foods from these five food groups every day:
• Plenty of vegetables of different types and colours, and legumes/beans
• Fruit
• Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as
breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
• Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans
• Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat
• And drink plenty of water.
3. Limit intake of foods containing saturated fat, added salt, added sugars and alcohol
• Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries,
pies, processed meats, commercial burgers, pizza, fried foods, potato chips,
crisps and other savoury snacks.
• Replace high fat foods which contain predominately saturated fats such as
butter, cream, cooking margarine, coconut and palm oil with foods which contain
predominately polyunsaturated and monounsaturated fats such as oils, spreads,
nut butters/pastes and avocado.
• Limit intake of foods and drinks containing added salt.
• Read labels to choose lower sodium options among similar foods.
• Do not add salt to foods in cooking or at the table.
• Limit intake of foods and drinks containing added sugars such as confectionary,
sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and
sports drinks.
• If you choose to drink alcohol, limit intake.
4. Care for your food; prepare and store it safely (NHMRC, 2013).

6.9 Summary
Managing health conditions and nutrition when living with dementia or MCI can be
challenging, but the research suggests that this can promote cognitive function,
quality of life and related outcomes. Some health conditions can exacerbate the
symptoms of dementia, and therefore should be well-managed or prevented where
possible. Addressing vascular risk factors such as high blood pressure and high
cholesterol is likely to improve cognition and reduce the risk of stroke, heart disease,
diabetes and a range of other conditions. Other co-existing conditions such as
diabetes, depression and delirium should be well managed, and medications should
be reviewed regularly to avoid continued use of medication that is unnecessary or
contraindicated for people with dementia.
Nutrition can play an important role in managing the health and wellbeing of people
living with dementia or MCI. People who are dehydrated or malnourished are likely
to experience cognitive problems. While some nutrient deficiencies are related to
poor cognition, there is a lack of high quality evidence to suggest that particular
vitamin or nutrient supplements are effective as a treatment option for people with
dementia or MCI. There has also been limited research regarding which types of
complete diets may be beneficial, but there is some evidence that adherence to
a Mediterranean diet may reduce cognitive decline and risk of mortality. Also, a
diet high in processed food may be related to cognitive impairment. For general
guidance regarding a healthy diet, the Eat for Health Australian Guidelines may
be useful. Malnutrition and weight loss are common and can be a serious issue
for people with dementia. The research suggests that it’s important to identify
mealtime issues early and consult with a dietician. In a residential care setting,
additional staff time and training and environmental/routine modification may
improve outcomes. People with frontotemporal dementia may experience appetite
changes and weight gain. It is recommended that individuals discuss their nutritional
needs with their doctor, and seek medical advice prior to changing their diet,
nutritional supplements or non-prescription medicines/herbal remedies.
7 Conclusion
Lifestyle factors can have a significant impact on the cognitive and physical function,
quality of life and health of people living with dementia and MCI. While medical
treatment options are currently limited, non-pharmacological interventions have
emerged as a useful, versatile and cost-effective option to improve a broad range of
outcomes for people across the course of Alzheimer’s disease and other types of
dementia and MCI. In particular, cognitive interventions, physical activity, appropriate
support and management of health and nutrition have the strongest evidence to
support and recommend their use. At present, the quantity and quality of research
in this area is limited, but is certainly promising. Even small delays in the onset or
progression of symptoms could greatly improve quality of life and reduce the burden
of disease (Deweerdt, 2011).
25
Glossary
Adherence
Adherence is the extent to which an individual follows a treatment plan (e.g. medication,
exercise regime, diet, etc.) without close supervision.
Aerobic exercise
Aerobic or endurance exercise is physical activity that increases your breathing rate and
heart rate. Performed regularly it improves physical endurance and the health and fitness
of your lungs, heart, and blood vessels. It includes moderate-to-high intensity activities like
walking, jogging, swimming, cycling and even energetic housework.
Alzheimer’s disease
Alzheimer’s disease is a physical brain disease that causes dementia. It is named after
Alois Alzheimer, who first described it in 1907. The brain degeneration that occurs in
Alzheimer’s disease affects memory, thinking skills, emotions, behavior and mood. As
a result, a person’s ability to carry out daily activities becomes impaired. As the disease
progresses, symptoms worsen. Alzheimer’s disease is characterized by an abnormal
build-up of a protein called beta amyloid, which forms ‘plaques’ outside brain cells. Inside
brain cells, another protein called tau builds up into ‘tangles’.
Apathy
Apathy may be defined as a lack of interest, motivation or concern for things that others
generally find interesting. Apathy is a common symptom of dementia and MCI.
Behavioural and psychological symptoms of dementia
The term “behavioural and psychological symptoms of dementia” encompasses an array
of non-cognitive symptoms that are often associated with dementia. Symptoms may
include changes in behaviour, mood or perception, such as wandering, agitation, sexual
dis-inhibition, depression, anxiety, or delusions.
Cholinesterase inhibitors
Cholinesterase inhibitors are medications that inhibit a brain enzyme and increase levels of
a chemical (acetylcholine) that is deficient in some dementias.
Cognitive decline
Cognitive decline is a gradual decrease in cognitive function over time. Cognitive decline is
a defining feature of MCI and dementia.
Cognitive function
Cognitive function is the process by which we perceive, think, and understand information
and ideas.
Cognitive rehabilitation
Cognitive rehabilitation is an individualised intervention designed to relearn and improve
areas of cognition affected by dementia or other brain conditions or injuries. It is delivered
by a trained therapist and involves structured skills training and practice to compensate for
cognitive deficits. This intervention may be suitable for people with mild dementia or MCI.
Cognitive stimulation
Cognitive stimulation is the provision of individualised or group activities that engage and
stimulate. This intervention aims to improve cognition, mood and functioning for people
living with dementia or MCI.
Cognitive training
Cognitive training is structured practice to improve specific aspects of cognitive
functioning such as memory, attention and processing speed. This practice is often
completed individually using a computer program, but may also be delivered in groups
and/or using paper-based worksheets. This intervention is designed for people with mild
dementia or MCI.

Cognition
Cognition is the collection of mental abilities related to perceiving, thinking and
understanding. This includes memory, learning, attention, language, decision making,
reasoning, judgment, comprehension, spatial skills and planning.
Dementia with Lewy bodies
Dementia with Lewy bodies is a type of dementia characterised by cognitive decline.
Often people with this condition also experience hallucinations. It is closely related to
Parkinson’s disease and has been attributed to the presence of abnormal clumps of
proteins in the brain known as Lewy bodies.
Depression
Depression is a mental illness that is defined by a persistent low mood that interferes
with daily life. People with depression often experience changes to their thinking,
behavior and feelings, and withdraw from activities that they previously enjoyed. Often
people also experience changes to their memory, concentration, sleep and appetite.
Diabetes
Diabetes is a chronic condition in which the pancreas does not produce enough of
the hormone insulin or the body does not respond appropriately to it. This results in
abnormally high levels of glucose (sugar) in the blood, which must be monitored and
managed to avoid complications.
Episodic memory
Episodic memory is a category of long-term memory that involves the recollection of
specific events, situations and experiences, such as your first day of school or attending
a friend’s birthday party. In addition to the event itself, episodic memory also involves
your memory of the place and time that the event occurred, as well as the emotions,
sights, sounds and smells associated with the event.
Executive function
Executive function is an umbrella term for high-level cognitive abilities that influence
more basic abilities like attention, memory and motor skills. Executive functions include
organisation, planning, sequencing, problem solving, cognitive flexibility, abstract
thinking, self-control, emotional regulation, monitoring internal and external stimuli,
initiating and inhibiting behaviour, reasoning and decision-making.
Exercise
Exercise is a type of physical activity that is planned, often with the objective of
improving or maintaining aspects of physical fitness.
Frontotemporal dementia
Frontotemporal dementia is a form of dementia that involves damage to the frontal
and/or temporal lobes of the brain. Behaviour, language and other cognitive skills are
affected.
Mediterranean diet
A diet which places particular emphasis on fruits, vegetables, fish and healthy fats.
Meta-analysis
A meta-analysis takes the data from all similar studies and combines them, providing
an overall result from all the relevant research. This is a higher level of evidence that is
more convincing than a finding from any single study.
Mild cognitive impairment
Mild cognitive impairment (MCI) is defined by a decline in cognitive functions such as
memory and thinking skills. It is an intermediate stage where decline is greater than
what is experienced through normal ageing, but less severe than dementia. People
with MCI have an increased risk of dementia, however a diagnosis of MCI does not
necessarily progress to dementia.
27
Non-pharmacological interventions
Non-pharmacological interventions are treatments or approaches that may be pursued
as an alternative to medicine. People with dementia or MCI may benefit from non-
pharmacological treatment such as cognitive interventions, physical activity, music
therapy, or a range of other activities or interventions.
Palliative care
Palliative care is an approach to service delivery that focuses on improving quality of
life and reducing suffering of people with life-threatening illness such as advanced
dementia.
Randomised controlled trials
Randomised controlled trials are a type of scientific experiment. They involve randomly
allocating individuals to a treatment (e.g. drug or behavioural intervention) or a no-
treatment (placebo) condition. A well-managed randomised controlled trial provides a
higher quality of evidence than other types of experiments.
Saturated fats
Saturated fats are those that tend to be solid at room temperature and can be found in
whole milk, cream, butter, cheese, meats, coconut oil, palm oil, chicken skin, biscuits
and pastries. Many ‘fast food’ products, processed meats and deep fried food also
contain saturated fats. Saturated fats contribute to the risk of heart and brain disease by
raising blood cholesterol levels.
Selective serotonin reuptake inhibitors
Selective serotonin reuptake inhibitors are medications that increase the amount of a
neurotransmitter called serotonin between cells in the brain. They are commonly used
to treat psychological symptoms related to depression and anxiety.
Self-efficacy
Self-efficacy is an individual’s estimate or personal judgment of their own ability to
succeed in reaching a specific goal, for example, quitting smoking or losing weight.
Systematic review
A systematic review is a structured review of the literature that identifies, appraises, and
synthesises relevant high quality research to address a specific research question.
Vascular
Vascular means ‘related to blood vessels’. Vascular risk factors are those that can affect
the health and function of our blood vessels, including high blood pressure and high
cholesterol.
Vascular dementia
Vascular dementia is a form of dementia associated with problems of circulation of
blood to the brain. It can sometimes result from a stroke or many mini-strokes.

References
Aguirre, E., Hoare, Z., Spector, A., Woods, R., & Orrell, M. (2014). The effects of a Cognitive Stimulation Therapy [CST]
programme for people with dementia on family caregivers’ health. BMC Geriatrics, 14(1), 1-31.
Ahlskog, J. E., Geda, Y. E., Graff-Radford, N. R., & Petersen, R. C. (2011). Physical exercise as a preventive or disease-
modifying treatment of dementia and brain aging. Mayo Clinic proceedings, 86(9), 876-884.
Australian Institute of Health and Welfare. (2012). Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW. Available at
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737422943
Allen, V. J., Methven, L., & Gosney, M. A. (2013). Use of nutritional complete supplements in older adults with dementia:
Systematic review and meta-analysis of clinical outcomes. Clinical Nutrition, 32(6), 950-957.
Anstey, K. J., Lipnicki, D. M., & Low, L.-F. (2008). Clinical review: Cholesterol as a risk factor for dementia and cognitive
decline: A systematic review of prospective studies with meta-analysis. The American Journal of Geriatric Psychiatry, 16,
343-354.
Aselage, M. B., & Amella, E. J. (2010). An evolutionary analysis of mealtime difficulties in older adults with dementia.
Journal of Clinical Nursing, 19(1-2), 33-41.
Ataollahi Eshkoor, S., Hamid, T., Nudin, S., & Mun, C. (2014). The effects of social support, substance abuse and health
care supports on life satisfaction in dementia. Social Indicators Research, 116(2), 535-544.
Ayalon, L., Gum, A. M., Feliciano, L., & Areán, P. A. (2006). Effectiveness of nonpharmacological interventions for
the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Archives of Internal
Medicine, 166(20), 2182-2188.
Bahar-Fuchs, A., Clare, L., & Woods, B. (2013). Cognitive training and cognitive rehabilitation for mild to moderate
Alzheimer’s disease and vascular dementia. Cochrane Database of Systematic Reviews, (6). Retrieved from http://
onlinelibrary.wiley.com/doi/10.1002/14651858.CD003260.pub2/abstract. doi:10.1002/14651858.CD003260.pub2
Bains, J., Birks, J., & Dening, T. (2002). Antidepressants for treating depression in dementia. Cochrane Database of
Systematic Reviews, (4). Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003944/abstract.
doi:10.1002/14651858.CD003944
Balion, C., Griffith, L. E., Strifler, L., Henderson, M., Patterson, C., Heckman, G., et al. (2012). Vitamin D, cognition, and
dementia: A systematic review and meta-analysis. Neurology, 79(13), 1397-1405.
Ballard, C. G., Waite, J., & Birks, J. (2006). Atypical antipsychotics for aggression and psychosis in Alzheimer’s disease.
Cochrane Database of Systematic Reviews, (1). Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.
CD003476.pub2/abstract. doi:10.1002/14651858.CD003476.pub2
Beerens, H. C., Zwakhalen, S. M. G., Verbeek, H., Ruwaard, D., & Hamers, J. P. H. (2013). Factors associated with quality
of life of people with dementia in long-term care facilities: A systematic review. International Journal of Nursing Studies,
50(9), 1259-1270.
Bell, J. S., Mezrani, C., Blacker, N., Leblanc, T., Frank, O., Alderman, C. P., et al. (2012). Anticholinergic and sedative
medicines - Prescribing considerations for people with dementia. Australian Family Physician, 41(1-2), 45-49.
Birks, J., & Grimley Evans, J. (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of
Systematic Reviews, (1). Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003120.pub3/abstract.
doi:10.1002/14651858.CD003120.pub3
Blankevoort, C. G., van Heuvelen, M. J. G., Boersma, F., Luning, H., de Jong, J., & Scherder, E. J. A. (2010). Review
of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia.
Dementia & Geriatric Cognitive Disorders, 30(5), 392-402.
Bridges-Webb, C., & Wolk, J. (2003). Care of patients with dementia in general practice: NSW Department of Health.
Brodaty, H., & Cumming, A. (2010). Dementia services in Australia. International Journal of Geriatric Psychiatry, 25(9),
887-995.
Brown, C. A., Berry, R., Tan, M. C., Khoshia, A., Turlapati, L., & Swedlove, F. (2013). A critique of the evidence base for
non-pharmacological sleep interventions for persons with dementia. Dementia (14713012), 12(2), 210-237.
Bruscoli, M., & Lovestone, S. (2004). Is MCI really just early dementia? A systematic review of conversion studies.
International Psychogeriatrics, 16(2), 129-140.
Buettner, L. L., Yu, F., & Burgener, S. C. (2010). Evidence supporting technology-based interventions for people with
early-stage Alzheimer’s disease. Journal of Gerontological Nursing, 36(10), 15-19.
29
Burgener, S. C., Yang, Y., Gilbert, R., & Marsh-Yant, S. (2008). The effects of a multimodal intervention on outcomes of
persons with early-stage dementia. American Journal of Alzheimer’s Disease & Other Dementias, 23(4), 382-394.
Choi, J., & Twamley, E. W. (2013). Cognitive rehabilitation therapies for Alzheimer’s disease: A review of methods to
improve treatment engagement and self-efficacy. Neuropsychology Review, 23(1), 48-62.
Christofoletti, G., Oliani, M. M., Gobbi, S., & Stella, F. (2007). Effects of motor intervention in elderly patients with
dementia: an analysis of randomized controlled trials. Topics in Geriatric Rehabilitation, 23(2), 149-154.
Clare, L., Linden, D. E. J., Woods, R. T., Whitaker, R., Evans, S. J., Parkinson, C. H., et al. (2010). Goal-oriented cognitive
rehabilitation for people with early-stage Alzheimer disease: A single-blind randomized controlled trial of clinical efficacy.
The American Journal of Geriatric Psychiatry, 18(10), 928-939.
Cohen-Mansfield, G. J., Thein, S. K., Dakheel-Ali, S. M., Regier, S. N., & Marx, S. M. (2010). The value of social attributes
of stimuli for promoting engagement in persons with dementia. The Journal of Nervous and Mental Disease, 198(8), 586-
592.
Cole, D. (2012). Optimising nutrition for older people with dementia. Nursing Standard, 26(20), 41-48.
Cooke, M., Moyle, W., Shum, D., Harrison, S., & Murfield, J. (2010). A randomized controlled trial exploring the effect of
music on quality of life and depression in older people with dementia. Journal of Health Psychology, 15(5), 765-776.
Cooper, C., Mukadam, N., Katona, C., Lyketsos, C. G., Ames, D., Rabins, P., et al. (2012). Systematic review of the
effectiveness of non-pharmacological interventions to improve quality of life of people with dementia. International
Psychogeriatrics, 24(6), 856-870.
Cox, K., Lautenschlager, N., Flicker, L., Greenop, K., Hendriks, J., & Almeida, O. (2010). The role of self-efficacy in the
adoption and maintenance of a home-based physical activity program in older adults with memory complaints. Journal of
Science and Medicine in Sport, 12, e188-e189.
Cox, K. L., Flicker, L., Almeida, O. P., Xiao, J., Greenop, K. R., Hendriks, J., et al. (2013). The FABS trial: a randomised
control trial of the effects of a 6-month physical activity intervention on adherence and long-term physical activity and
self-efficacy in older adults with memory complaints. Preventive medicine, 57(6), 824.
Cyarto, E. V., Cox, K. L., Almeida, O. P., Flicker, L., Ames, D., Byrne, G., et al. (2010). The fitness for the Ageing Brain
Study II (FABS II): protocol for a randomized controlled clinical trial evaluating the effect of physical activity on cognitive
function in patients with Alzheimer’s disease. Trials, 11(120), 1-8.
Dawson, A., Bowes, A., Kelly, F., Velzke, K., & Ward, R. (2015). Evidence of what works to support and sustain care at
home for people with dementia: a literature review with a systematic approach. BMC Geriatrics, 15(1), 1.
Department of Health. (2014). Physical activity recommendations for older Australians (65 years and older). Retrieved
March 27, 2014, from http://www.health.gov.au/paguidelines - chba
Deschaintre, Y., Richard, F., Leys, D., & Pasquier, F. (2009). Treatment of vascular risk factors is associated with slower
decline in Alzheimer disease. Neurology, 73(9), 674-680.
Deweerdt, S. (2011). Activity is the best medicine: can exercise, social interaction and the Mediterranean diet really help
to keep the cognitive decline of Alzheimer’s disease at bay? Nature, 475(7355), S16(12).
Dorenlot, P., Harboun, M., Bige, V., Henrard, J.-C., & Ankri, J. (2005). Major depression as a risk factor for early
institutionalization of dementia patients living in the community. International Journal of Geriatric Psychiatry, 20(5), 471-
478.
Dunning, T., Duggan, N., & Savage, S. (2014). The McKellar guidelines for managing older people with diabetes in
residential and other care settings: Centre for Nursing and Allied Health, Deakin University and Barwon Health, Geelong.
Durand, M., James, A., Ravishankar, A., Bamrah, J. S., & Purandare, N. B. (2009). Domiciliary and day care services: Why
do people with dementia refuse? Aging & Mental Health, 13(3), 414-419.
Duthie, A., Chew, D., & Soiza, R. L. (2011). Non-psychiatric comorbidity associated with Alzheimer’s disease. QJM:
Monthly Journal of the Association of Physicians, 104(11), 913-920.
Eggermont, L. H. P., & Scherder, E. J. A. (2006). Physical activity and behaviour in dementia: a review of the literature
and implications for psychosocial intervention in primary care. Dementia, 5(3), 411-428.
Ellinson, M., Thomas, J., & Patterson, A. (2004). A critical evaluation of the relationship between serum vitamin B12,
folate and total homocysteine with cognitive impairment in the elderly. Journal of Human Nutrition & Dietetics, 17(4),
371.

Etgen, T., Sander, D., Bickel, H., Sander, K., & Förstl, H. (2012). Vitamin D deficiency, cognitive impairment and dementia:
A systematic review and meta-analysis. Dementia & Geriatric Cognitive Disorders, 33(5), 297-305.
Farina, E., Mantovani, F., Fioravanti, R., Pignatti, R., Chiavari, L., Imbornone, E., et al. (2006). Evaluating two group
programmes of cognitive training in mild-to-moderate AD: Is there any difference between a ‘global’ stimulation and a
‘cognitive-specific’ one? Aging & Mental Health, 10(3), 211-218.
Farina, N., Isaac, M. G. E. K. N., Clark, A. R., Rusted, J., & Tabet, N. (2012). Vitamin E for Alzheimer’s dementia and mild
cognitive impairment. Cochrane Database of Systematic Reviews, (11). Retrieved from http://onlinelibrary.wiley.com/
doi/10.1002/14651858.CD002854.pub3/abstract. doi:10.1002/14651858.CD002854.pub3
Farina, N., Rusted, J., & Tabet, N. (2014). The effect of exercise interventions on cognitive outcome in Alzheimer’s
disease: a systematic review. International Psychogeriatrics, 26(01), 9-18.
Farrow, M., & Ellis, K. (2013). Physical activity for brain health and fighting dementia, Alzheimer’s Australia Paper 36 (pp.
1-21). Canberra: Alzheimer’s Australia.
Forbes, D. A. (2007). Review: sparse evidence supports non-pharmacological interventions for preventing wandering in
people with dementia. Evidence Based Nursing, 10(1), 15-15.
Forbes, D. A., Jansen, S. L., Markle-Reid, M., Hawranik, P., Morgan, D., Henderson, S., et al. (2008). Gender differences
in use and availability of home and community-based services for people with dementia. The Canadian Journal Of
Nursing Research, 40(1), 39-59.
Forbes, D. A., Thiessen, E. J., Blake, C. M., Forbes, S. C., & Forbes, S. (2013). Exercise programs for people
with dementia. Cochrane Database of Systematic Reviews, (12). Retrieved from http://onlinelibrary.wiley.com/
Gallagher-Thompson, D., Tzuang, Y. M., Au, A., Brodaty, H., Charlesworth, G., Gupta, R., et al. (2012). International
Perspectives on Nonpharmacological Best Practices for Dementia Family Caregivers: A Review. Clinical Gerontologist,
35(4), 316-355.
Gates, N. J., Sachdev, P. S., Fiatarone Singh, M. A., & Valenzuela, M. (2011). Cognitive and memory training in adults at
risk of dementia: A Systematic Review. BMC Geriatrics, 11, 55.
Geng, J., Dong, J., Ni, H., Lee Myeong, S., Wu, T., Jiang, K., et al. (2010). Ginseng for cognition. Cochrane Database of
Systematic Reviews, (12). Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007769.pub2/abstract.
doi:10.1002/14651858.CD007769.pub2
Gorelick, P. B., Scuteri, A., Black, S. E., Decarli, C., Greenberg, S. M., Iadecola, C., et al. (2011). Vascular contributions
to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/
American Stroke Association. Stroke, 42(9), 2672-2713.
Gow, A. J., Corley, J., Starr, J. M., & Deary, I. J. (2013). Which social network or support factors are associated with
cognitive abilities in old age? Gerontology, 59(5), 454-463.
Guzmán-García, A., Hughes, J. C., James, I. A., & Rochester, L. (2013). Dancing as a psychosocial intervention in care
homes: a systematic review of the literature. International Journal of Geriatric Psychiatry, 28(9), 914-924.
Harris, P. B. (2012). Maintaining friendships in early stage dementia: Factors to consider. Dementia, 11(3), 305-314.
Heyn, P., Abreu, B. C., & Ottenbacher, K. J. (2004). The effects of exercise training on elderly persons with cognitive
impairment and dementia: a meta-analysis. Archives of Physical Medicine and Rehabilitation, 85(10), 1694.
Hill, K. D., LoGiudice, D., Lautenschlager, N. T., Said, C. M., Dodd, K. J., & Suttanon, P. (2009). Effectiveness of balance
training exercise in people with mild to moderate severity Alzheimer’s disease: Protocol for a randomised trial. BMC
Geriatrics, 9(1), 29-29.
Hines, S., McCrow, J., Abbey, J., & Gledhill, S. (2010). Thickened fluids for people with dementia in residential aged care
facilities. International Journal of Evidence-Based Healthcare, 8(4), 252-255.
Hines, S., Wilson, J., McCrow, J., Abbey, J., & Sacre, S. (2010). Oral liquid nutritional supplements for people with
dementia in residential aged care facilities. International Journal of Evidence-Based Healthcare, 8(4), 248-251.
Hoffmann, K., Cotman, C. W., Hasselbalch, S. G., Waldemar, G., Frederiksen, K. S., Sobol, N. A., et al. (2013). Preserving
cognition, quality of life, physical health and functional ability in Alzheimer’s disease: the effect of physical exercise (ADEX
trial): rationale and design. Neuroepidemiology, 41(3-4), 198-207.
Hogan, D. B., Bailey, P., Black, S., Carswell, A., Chertkow, H., Clarke, B., et al. (2008). Diagnosis and treatment of
dementia: 4. approach to management of mild to moderate dementia, CMAJ, 179(8), 787-793.
31
Hooghiemstra, A. M., Eggermont, L. H. P., Scheltens, P., van der Flier, W. M., Bakker, J., de Greef, M. H. G., et al.
(2012). Study protocol: EXERcise and cognition in sedentary adults with early-ONset dementia (EXERCISE-ON). BMC
Neurology, 12(1), 75-82.
Hulme, C., Wright, J., Crocker, T., Oluboyede, Y., & House, A. (2010). Non-pharmacological approaches for dementia that
informal carers might try or access: a systematic review. International Journal of Geriatric Psychiatry, 25(7), 756-763.
Ikeda, M., Brown, J., Holland, A., Fukuhara, R., & Hodges, J. (2002). Changes in appetite, food preference, and eating
habits in frontotemporal dementia and Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 73(4),
371-376.
Jicha, G. A., & Markesbery, W. R. (2010). Omega-3 fatty acids: potential role in the management of early Alzheimer’s
disease. Clinical Interventions in Aging, 5, 45-61.
Johnson, R., Taylor, C., Watson, R., & Huei-chuan, S. (2011). Can playing pre-recorded music at mealtimes reduce the
symptoms of agitation for people with dementia? ...including commentary by Watson R and Sung HC. International
Journal of Therapy & Rehabilitation, 18(12), 700-708.
Kinsella, G. J., Mullaly, E., Rand, E., Ong, B., Burton, C., Price, S., et al. (2009). Early intervention for mild cognitive
impairment: a randomised controlled trial. Journal of Neurology, Neurosurgery, and Psychiatry, 80(7), 730.
Kong, E., Evans, L. K., & Guevara, J. P. (2009). Nonpharmacological intervention for agitation in dementia: a systematic
review and meta-analysis. Aging & Mental Health, 13(4), 512-520.
Kurz, A., Leucht, S., & Lautenschlager, N. T. (2011). The clinical significance of cognition-focused interventions for
cognitively impaired older adults: a systematic review of randomized controlled trials. International Psychogeriatrics, 23(9),
1364-1375.
Kurz, A., Pohl, C., Ramsenthaler, M., & Sorg, C. (2009). Cognitive rehabilitation in patients with mild cognitive impairment.
International Journal of Geriatric Psychiatry, 24(2), 163-168.
Kverno, K. S., Black, B. S., Nolan, M. T., & Rabins, P. V. (2009). Research on treating neuropsychiatric symptoms of
advanced dementia with non-pharmacological strategies, 1998-2008: a systematic literature review. International
Psychogeriatrics, 21(5), 825-843.
Lauriks, S., Reinersmann, A., Van der Roest, H. G., Meiland, F. J. M., Davies, R. J., Moelaert, F., et al. (2007). Review of
ICT-based services for identified unmet needs in people with dementia. Ageing Research Reviews, 6(3), 223-246.
Lautenschlager, N. T., Cox, K. L., Flicker, L., Foster, J. K., van Bockxmeer, F. M., Xiao, J., et al. (2008). Effect of physical
activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA: the journal of the
American Medical Association, 300(9), 1027-1037.
Levey, A., Lah, J., Goldstein, F., Steenland, K., & Bliwise, D. (2006). Mild cognitive impairment: an opportunity to
identify patients at high risk for progression to Alzheimer’s disease. Clinical Therapeutics, 28(7), 991-1001.
Loewenstein, D. A., Acevedo, A., Czaja, S. J., & Duara, R. (2004). Cognitive rehabilitation of mildly impaired Alzheimer
disease patients on cholinesterase inhibitors. The American Journal of Geriatric Psychiatry, 12(4), 395-402.
Lu, F.-P., Lin, K.-P., & Kuo, H.-K. (2009). Diabetes and the risk of multi-system aging phenotypes: a systematic review and
meta-analysis. PLoS ONE, 4(1), 1-12.
Mahendra, N., Kim, E. S., Bayles, K. A., Hopper, T., Cleary, S. J., & Azuma, T. (2005). Evidence-based practice
recommendations for working with individuals with dementia: computer-assisted cognitive interventions (CACIs). Journal
of Medical Speech-Language Pathology, 13(4), xxxv-xliv.
Malouf, R., & Areosa Sastre, A. (2003). Vitamin B12 for cognition. Cochrane Database of Systematic Reviews, (3).
Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004394/abstract. doi:10.1002/14651858.
CD004394
Malouf, R., & Grimley Evans, J. (2003). Vitamin B6 for cognition. Cochrane Database of Systematic Reviews, (4).
Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004393/abstract. doi:10.1002/14651858.
CD004393
Malouf, R., & Grimley Evans, J. (2008). Folic acid with or without vitamin B12 for the prevention and treatment of healthy
elderly and demented people. Cochrane Database of Systematic Reviews, (4). Retrieved from http://onlinelibrary.wiley.
com/doi/10.1002/14651858.CD004514.pub2/abstract. doi: 10.1002/14651858.CD004514.pub2.
Martin, M., Clare, L., Altgassen, A. M., Cameron, M. H., & Zehnder, F. (2011). Cognition-based interventions for healthy
older people and people with mild cognitive impairment. Cochrane Database of Systematic Reviews, (1). Retrieved from
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006220.pub2/abstract. doi:10.1002/14651858.CD006220.pub2

McDonnell, M. N., Smith, A. E., & Mackintosh, S. F. (2011). Aerobic exercise to improve cognitive function in adults with
neurological disorders: A systematic review. Archives of Physical Medicine & Rehabilitation, 92(7), 1044-1052.
McGuinness, B. (2014). Statins for the treatment of dementia. Cochrane Database of Systematic Reviews, 7. Retrieved
from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007514.pub3/abstract. doi: 10.1002/14651858.CD007514.
pub3
McLaren, A. N., LaMantia, M. A., & Callahan, C. M. (2013). Systematic review of non-pharmacologic interventions to
delay functional decline in community-dwelling patients with dementia. Aging & Mental Health, 17(6), 655-666.
Miskovski, K. (2014). The benefits of physical activity and exercise for people living with dementia. Discussion Paper 11:
Alzheimer’s Australia NSW.
Morhardt, D. (2011). Accessing community-based and long-term care services: challenges facing persons with
frontotemporal dementia and their families. Journal of Molecular Neuroscience, 45(3), 737-741.
Mossello, E., Boncinelli, M., Caleri, V., Cavallini, M. C., Palermo, E., Di Bari, M., et al. (2008). Is antidepressant treatment
associated with reduced cognitive decline in Alzheimer’s disease? Dementia & Geriatric Cognitive Disorders, 25(4), 372-
379.
Nelson, L., & Tabet, N. (2015). Slowing the progression of Alzheimer’s disease; what works? Ageing Research Reviews,
23(Pt B), 193-209.
NHMRC. (2013). Eat for health: Australian dietary guidelines. Retrieved February 20, 2014, from http://www.nhmrc.gov.
au/_files_nhmrc/publications/attachments/n55a_australian_dietary_guidelines_summary_131014.pdf
National Institute for Health and Care Excellence. (2006). Dementia: Supporting people with dementia and their carers in
health and social care. NICE guidelines [CG42]. Available at http://www.nice.org.uk/guidance/cg42
Olazarán, J., Frank, A., Galiano, M., Fernández-Bullido, Y., Serra, J. A., González-Salvador, M. T., et al. (2004). Benefits of
cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology, 63(12), 2348-2353.
Olazarán, J., Reisberg, B., Clare, L., Cruz, I., Peña-Casanova, J., del Ser, T., et al. (2010). Nonpharmacological therapies in
Alzheimer’s disease: A systematic review of efficacy. Dementia & Geriatric Cognitive Disorders, 30(2), 161-178.
Opie, R. S., Ralston, R. A., & Walker, K. Z. (2013). Adherence to a Mediterranean-style diet can slow the rate of cognitive
decline and decrease the risk of dementia: A systematic review. Nutrition & Dietetics, 70(3), 206-217.
Pitkala, K. H., Raivio, M. M., Laakkonen, M.-L., Tilvis, R. S., Kautiainen, H., & Strandberg, T. E. (2010). Exercise
rehabilitation on home-dwelling patients with Alzheimer’s disease--a randomized, controlled trial. Study protocol. Trials,
11(1), 92-92.
Ploeg, J., Denton, M., Tindale, J., Hutchison, B., Brazil, K., Akhtar-Danesh, N., et al. (2009). Older adults’ awareness of
community health and support services for dementia care. Canadian Journal on Aging, 28(4), 359-370.
Plooij, B., Scherder, E. J. A., & Eggermont, L. H. P. (2012). Physical inactivity in aging and dementia: a review of its
relationship to pain. Journal of Clinical Nursing, 21(21/22), 3002-3008.
Pond, D. (2012). Dementia - An update on management. Australian Family Physician, 41(12), 936-939.
Price, R. S., & Keady, J. (2010). Systematic review: role of health promotion in vascular dementia. Journal of Nursing &
Healthcare of Chronic Illnesses, 2(2), 88-101.
Prince, M., Albanese, E., Guerchet, M., & Prina, M. (2014). Nutrition and dementia: A review of available evidence.
London, Alzheimer’s Disease International.
Reijnders, J., van Heugten, C., & van Boxtel, M. (2013). Cognitive interventions in healthy older adults and people with
mild cognitive impairment: A systematic review. Ageing Research Reviews, 12(1), 263-275.
Richard, E., Gouw, A. A., Scheltens, P., & van Gool, W. A. (2010). Vascular care in patients with Alzheimer disease with
cerebrovascular lesions slows progression of white matter lesions on MRI: the evaluation of vascular care in Alzheimer’s
disease (EVA) study. Stroke, 41(3), 554-556.
Richardson, K., Schoen, M., French, B., Umscheid, C. A., Mitchell, M. D., Arnold, S. E., et al. (2013). Statins and cognitive
function: A systematic review. Annals of Internal Medicine, 159(10), 688-698.
Rodríguez, J.-L., Qizilbash, N., & López-Arrieta, J. (2001). Thiamine for Alzheimer’s disease. Cochrane Database of
Systematic Reviews, (2). Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001498/abstract.
doi:10.1002/14651858.CD001498
Rozzini, L., Costardi, D., Chilovi, B. V., Franzoni, S., Trabucchi, M., & Padovani, A. (2007). Efficacy of cognitive
rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. International Journal of
Geriatric Psychiatry, 22(4), 356-360.
33
Scarmeas, N., Luchsinger, J. A., Mayeux, R., & Stern, Y. (2007). Mediterranean diet and Alzheimer disease mortality.
Neurology, 69(11), 1084-1093.
Scarmeas, N., Stern, Y., Mayeux, R., Manly, J. J., Schupf, N., & Luchsinger, J. A. (2009). Mediterranean diet and mild
cognitive impairment. Archives of Neurology, 66(2), 216-225.
Scheltens, P., de Waal, H., Wurtman, R. J., Wieggers, R. L., Vellas, B., Kamphuis, P. J. G. H., et al. (2012). Efficacy of
Souvenaid in mild Alzheimer’s disease: results from a randomized, controlled trial. Journal of Alzheimer’s Disease, 31(1),
225.
Scheltens, P., Kamphuis, P. J. G. H., Verhey, F. R. J., Olde Rikkert, M. G. M., Wurtman, R. J., Wilkinson, D., et al. (2010).
Efficacy of a medical food in mild Alzheimer’s disease: A randomized, controlled trial. Alzheimer’s & Dementia: The
Journal of the Alzheimer’s Association, 6(1), 1-10.e11.
Scherder, E. J. A., Bogen, T., Eggermont, L. H. P., Hamers, J. P. H., & Swaab, D. F. (2010). The more physical inactivity,
the more agitation in dementia. International Psychogeriatrics, 22(8), 1203-1208.
Seitz, D. P., Brisbin, S., Herrmann, N., Rapoport, M. J., Wilson, K., Gill, S. S., et al. (2012). Efficacy and feasibility of
nonpharmacological interventions for neuropsychiatric symptoms of dementia in long term care: A systematic review.
Journal of the American Medical Directors Association, 13(6), 503-506.e502.
Sepehry, A. A., Lee, P. E., Hsiung, G. Y. R., Beattie, B. L., & Jacova, C. (2012). Effect of selective serotonin reuptake
inhibitors in Alzheimer’s disease with comorbid depression a meta-analysis of depression and cognitive outcomes. Drugs
& Aging, 29(10), 793-806.
Shah, R. C., Scheltens, P., Bennett, D. A., Kamphuis, P. J., Leurgans, S., Swinkels, S. H., et al. (2013). The S-Connect
study: results from a randomized, controlled trial of Souvenaid in mild-to-moderate Alzheimer’s disease. Alzheimer’s
Research & Therapy, 59(6), 1-9.
Spector, A., Orrell, M., & Hall, L. (2012). Systematic Review of Neuropsychological Outcomes in Dementia from
Cognition-Based Psychological Interventions. Dementia & Geriatric Cognitive Disorders, 34(3/4), 244-255.
Spijker, A., Vernooij-Dassen, M., Vasse, E., Adang, E., Wollersheim, H., Grol, R., et al. (2008). Effectiveness of
nonpharmacological interventions in delaying the institutionalization of patients with dementia: a meta-analysis. Journal of
the American Geriatrics Society, 56(6), 1116-1128.
Steinberg, M., Leoutsakos, J., Podewils, L. J., & Lyketsos, C. G. (2009). Evaluation of a home-based exercise program in
the treatment of Alzheimer’s disease: the Maximizing Independence in Dementia (MIND) study. International Journal of
Geriatric Psychiatry, 24(7), 680-685.
Suttanon, P., Hill, K. D., Said, C. M., Williams, S. B., Byrne, K. N., LoGiudice, D., et al. (2013). Feasibility, safety and
preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer’s
disease: A pilot randomized controlled trial. Clinical Rehabilitation, 27(5), 427-438.
Swiger, K. J., Manalac, R. J., Blumenthal, R. S., Blaha, M. J., & Martin, S. S. (2013). Statins and cognition: a systematic
review and meta-analysis of short-and long-term cognitive effects. Mayo Clinic Proceedings, 88(11), 1213-1222.
Tappen, R. M., & Williams, C. L. (2009). Therapeutic conversation to improve mood in nursing home residents with
Alzheimer’s disease. Research in Gerontological Nursing, 2(4), 267-275.
Torres, S. J., Lautenschlager, N. T., Wattanapenpaiboon, N., Greenop, K. R., Beer, C. D., Flicker, L., et al. (2012). Dietary
patterns are associated with cognition among older people with mild cognitive impairment. Nutrients, 4(11), 1542-1551.
Toseland, R. W., McCallion, P., Gerber, T., & Banks, S. (2002). Predictors of health and human services use by persons
with dementia and their family caregivers. Social Science & Medicine, 55, 1255-1266.
Ueda, T., Suzukamo, Y., Sato, M., & Izumi, S.-I. (2013). Review: Effects of music therapy on behavioral and psychological
symptoms of dementia: A systematic review and meta-analysis. Ageing Research Reviews, 12, 628-641.
van der Roest, H., G., Meiland, F. J. M., Maroccini, R., Comijs, H. C., Jonker, C., & Droes, R.-M. (2007). Subjective needs
of people with dementia: A review of the literature. International Psychogeriatrics, 19(3), 559-592.
Vidovich, M. R., Lautenschlager, N. T., Flicker, L., Clare, L., McCaul, K., & Almeida, O. P. (2015). The PACE study: a
randomized clinical trial of cognitive activity strategy training for older people with mild cognitive impairment. American
Journal of Geriatric Psychiatry, 23(4), 360-372.
Vogel, T., Dali-Youcef, N., Kaltenbach, G., & Andrès, E. (2009). Homocysteine, vitamin B12, folate and cognitive
functions: A systematic and critical review of the literature. International Journal of Clinical Practice, 63(7), 1061-1067.

Walters, K., Iliffe, S., & Orrell, M. (2001). An exploration of help-seeking behaviour in older people with unmet needs.
Family Practice, 18(3), 277-282.
Watson, R., & Green, S. M. (2006). Feeding and dementia: A systematic literature review. Journal of Advanced Nursing,
54(1), 86-93.
Weber, S. R., Pirraglia, P. A., & Kunik, M. E. (2011). Use of services by community-dwelling patients with dementia: A
systematic review. American Journal of Alzheimer’s Disease & Other Dementias, 26(3), 195-204.
Wen, L., Jooyoung, C., & Thomas, S. A. (2014). Interventions on mealtime difficulties in older adults with dementia: A
systematic review. International Journal of Nursing Studies, 51(1), 14-27.
Woods, B., Aguirre, E., Spector, A. E., & Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in
people with dementia. Cochrane Database of Systematic Reviews. Retrieved from http://onlinelibrary.wiley.com/
Yaffe, K., Falvey, C., Hamilton, N., Schwartz, A. V., Simonsick, E. M., Satterfield, S., et al. (2012). Diabetes, glucose
control, and 9-year cognitive decline among older adults without dementia. Archives Of Neurology, 69(9), 1170-1175.
Yen, P. K. (2003). Nutrition & wellness. Maintaining cognitive function with diet. Geriatric Nursing, 24(1), 62-63.
35
Engage, Enable, Empower
livingwellwithdementia.org.au
FIGHTDEMENTIA.ORG.AU
Visit the Alzheimer’s Australia website for comprehensive

information about dementia, care information, education,
training and other services offered by member organisations.
or for information and advice contact the
NATIONAL DEMENTIA HELPLINE

1800 100 500
Helpline is funded by the Australian Government
or the Dementia Behaviour Management Advisory Service (DBMAS)
1800 699 799

2015 DementiaAustralia Engage Enable Empower Report

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2015 DementiaAustralia Engage Enable Empower Report

Uploaded by

Copyright:

Available Formats

Engage, Enable,

ALZHEIMER’S AUSTRALIA DECEMBER 2015

© Alzheimer’s Australia Inc 2015 ABN 79 625 582 771

4 Alzheimer’s Australia Engage, Enable, Empower

6 Alzheimer’s Australia Engage, Enable, Empower

2 Literature Search Strategy

8 Alzheimer’s Australia Engage, Enable, Empower

10 Alzheimer’s Australia Engage, Enable, Empower

4 BODY: Keeping the body active

12 Alzheimer’s Australia Engage, Enable, Empower

14 Alzheimer’s Australia Engage, Enable, Empower

16 Alzheimer’s Australia Engage, Enable, Empower

18 Alzheimer’s Australia Engage, Enable, Empower

6 HEALTH: Managing health conditions

20 Alzheimer’s Australia Engage, Enable, Empower

22 Alzheimer’s Australia Engage, Enable, Empower

Eat for Health Australian Dietary Guidelines 2013

24 Alzheimer’s Australia Engage, Enable, Empower

26 Alzheimer’s Australia Engage, Enable, Empower

28 Alzheimer’s Australia Engage, Enable, Empower

30 Alzheimer’s Australia Engage, Enable, Empower

32 Alzheimer’s Australia Engage, Enable, Empower

34 Alzheimer’s Australia Engage, Enable, Empower

Visit the Alzheimer’s Australia website for comprehensive

NATIONAL DEMENTIA HELPLINE

or the Dementia Behaviour Management Advisory Service (DBMAS)

1800 699 799

You might also like