OBJECTIVES We summarized and compared meta-analyses of pharmacologic and nonpharmacologic interventions targeting physical health outcomes among people with dementia. DESIGN This is a systematic review and meta-analysis. SETTING AND PARTICIPANTS People with dementia, confirmed through validated assessment measures. METHODS Major databases were searched until October 21, 2019. Effect sizes [standardized mean difference (SMD)/Hedges g or risk ratio (RR)] were compared separately. RESULTS Of 3773 search engine hits, 4 meta-analyses were included, representing 31 meta-analyzed trials and 10,054 study participants. Although meta-analyses were generally of adequate high quality, meta-analyzed studies were less so. Nutritional supplements were the only one to show a weight-increasing effect [SMD 0.53, 95% confidence interval (CI) 0.38-0.68, ie, medium effect; N = 12, n = 748]. Acetylcholinesterase inhibitors are associated with an increased risk for weight loss (RR 2.1, 95% CI 1.5‒3.0; N = 9, n = 7010). For the treatment of pain, sensory stimulation has a medium effect (SMD -0.58, 95% CI -0.99 to -0.17; N = 6, n = 199), whereas physical activity has a small effect (SMD -0.24, 95% CI -1.06 to 0.59; N = 2, n = 75). When exploring the characteristics of the psychosocial interventions, group-based interventions demonstrated a medium (SMD -0.55, 95% CI -1.02 to -0.09; N = 6, n = 157) and individual psychosocial interventions a small effect (SMD -0.27, 95% CI -1.06 to 0.53; N = 2, n = 55). CONCLUSIONS AND IMPLICATIONS Despite frequent physical comorbidities, the current evidence for pharmacologic and nonpharmacologic interventions in people with dementia to prevent and treat these conditions is still in its infancy, and larger trials targeting a wide range of physical health outcomes are urgently needed. Based on the SMDs and RRs, nutritional supplements can be recommended as an intervention to treat malnutrition. Clinicians should be careful in treating patients with acetylcholinesterase inhibitors, as it shows medium weight reducing effects. For the treatment of comorbid pain, sensory stimulation and psychosocial interventions are recommended.

中文翻译：

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药物和非药物干预对改善痴呆症患者身体健康结果的影响：随机对照试验荟萃分析的荟萃评论

目标 我们总结并比较了针对痴呆症患者身体健康结果的药物和非药物干预的荟萃分析。设计 这是一项系统评价和荟萃分析。地点和参与者 通过经过验证的评估措施确认的痴呆症患者。方法 主要数据库检索至 2019 年 10 月 21 日。分别比较效应量 [标准化平均差 (SMD)/Hedges g 或风险比 (RR)]。结果 在 3773 次搜索引擎点击中，包括 4 项荟萃分析，代表 31 项荟萃分析试验和 10,054 名研究参与者。尽管荟萃分析通常具有足够高的质量，但荟萃分析的研究却不尽如人意。营养补充剂是唯一一种显示体重增加效果的补充剂 [SMD 0.53，95% 置信区间 (CI) 0.38-0.68，即，中等效果；N = 12，n = 748]。乙酰胆碱酯酶抑制剂与体重减轻风险增加相关（RR 2.1，95% CI 1.5-3.0；N = 9，n = 7010）。对于疼痛的治疗，感觉刺激具有中等效果（SMD -0.58, 95% CI -0.99 to -0.17; N = 6, n = 199），而体力活动的效果很小（SMD -0.24, 95% CI -1.06 到 0.59；N = 2，n = 75）。在探索社会心理干预的特征时，基于群体的干预表现出中等（SMD -0.55，95% CI -1.02 至 -0.09；N = 6，n = 157）和个体心理社会干预的小影响（SMD -0.27， 95% CI -1.06 至 0.53；N = 2，n = 55)。结论和意义 尽管经常出现躯体合并症，目前关于对痴呆症患者进行药物和非药物干预以预防和治疗这些疾病的证据仍处于起步阶段，迫切需要针对广泛的身体健康结果进行更大规模的试验。根据 SMD 和 RR，可以推荐营养补充剂作为治疗营养不良的干预措施。临床医生在使用乙酰胆碱酯酶抑制剂治疗患者时应谨慎，因为它显示出中等的减重效果。对于共病疼痛的治疗，推荐使用感觉刺激和社会心理干预。临床医生在使用乙酰胆碱酯酶抑制剂治疗患者时应谨慎，因为它显示出中等的体重减轻效果。对于共病疼痛的治疗，推荐使用感觉刺激和社会心理干预。临床医生在使用乙酰胆碱酯酶抑制剂治疗患者时应谨慎，因为它显示出中等的体重减轻效果。对于共病疼痛的治疗，推荐使用感觉刺激和社会心理干预。