Title: Clinical Governance and Practice Development

An evidence summary

This study will highlight the health management issues faced by the nurses in tackling the behavior problem of the dementia patient.

1.Why change is needed [or]The case for action

Depression and anxiety are the most common symptoms of dementia patients. Individuals with anxiety and depression are most likely to witness a worsened stage when they are also affected by dementia. However, it can be said that Cognitive-Behavioral Therapy (CBT) might fail to work adequately on all dementia patients, however, some might also witness benefits from it. The greater the level of cognitive impairment, the more difficult it might be to deal with the individual level of functioning. This form of therapy cannot be considered to be appropriate only when an individual is diagnosed with dementia at the first stage (Chiang et al., 2017). However, it is effective only when the person develops the symptoms of anxiety and depression along with dementia.

The use of anti-depressants as well as anti-anxiety drugs in patients with dementia have yielded variable results. However, there should be an attempt made to find out an alternative therapy of treatment so that it becomes easier to tackle the symptoms of anxiety as well as depression accordingly (Lee et al., 2019). It will also lower the level of stress and thus there will be wider availability of treatment options for dementia patients. The patients of dementia who are found to witness different symptoms of anxiety and depression must be provided with an improved level of access to the psychological therapies so that it becomes easier to take control of the situation during the initial stage. The patients must be provided with the choice as well as there should be an expansion of access to the individuals who are to be provided with such therapies. Care should also be taken to advise and guide the carer of the patient so that the computerized delivery of CBT can be made effectively. Further, this therapy can be considered to be applicable in a wider range of settings and thus the patients must be provided with the chance to control the therapy (Goodkind et al., 2016). It is also necessary to check that the changes in the CBT can be made only by tackling the responses and making the entire process interactive so that it becomes easier to use.

1. Review questions

What is the effect of cognitive-behavioral therapy on the behavioral problem of dementia patients compared to music therapy within the first two months?

2. Methods

The best available evidence of this study is found in Google Scholar.

Inclusion criteria for studies

Population	Dementia patient
Interventions	Anxiety and depression
Comparisons	Music therapy
Outcomes	Effectiveness of cognitive-behavioral therapy
Types of study	A systematic review, randomized controlled trials, Empirical review, Case Study

Search strategy

A search strategy has been conducted in Google scholar using the below-mentioned search string:

a. Effect of Cognitive-Behavioral Therapy on dementia patients

b. Cognitive Behavior Therapy superior over music therapy

c. Cognitive Behavior therapy ideal for dementia patients in the first two months

4.Results

Two systematic reviews along with one meta-analysis, one case study, one randomized controlled trial, and one empirical review were the crucial source of evidence of this particular study.

Citation	Study Design	Sampling setting	Evidence	Findings of the study
Hopkinson et al. (2018) Cognitive-behavioral therapy for depression, anxiety, and stress in caregivers of dementia patients: A systematic review and meta-analysis	Systematic review and meta-analysis	N=25 (Subgroup analysis among eight CBT sessions were conducted)	Level 2	CBT sessions were found to be effective like the other therapies in lowering depression and stress among dementia patient
Mjørud et al. (2017) Living with dementia in a nursing home, as described by persons with dementia: a phenomenological hermeneutic study	Empirical review	N=12 (Interviews were carried out among the patient)	Level 2	There should be a proper level of interaction which is found in CBT rather than the music therapy
Meichsner et al. (2019) Telephone-based cognitive-behavioral intervention improves dementia caregivers’ quality of life	Randomized Controlled Trails	N= 273 (Participants were sent questionnaires through e-mails)	Level 2	The effectiveness of CBT is more effective than music therapy and improvements were observed in the patients.
Carrion et al. (2018) Cognitive therapy for dementia patients: a systematic review	Systematic review	N=1496 records (Database searching has been carried out)	Level 2	The functional emotions as well as the psychosocial tasks are found to be more effective in dealing with dementia patients.
Kashimura et al. (2019) Cognitive Behavioral Therapy for Improving Mood in an Older Adult with Mild Cognitive Impairment: A Case Report	Case Study	N=1(Oner person was assessed before and after CBT)	Level 2	Changes were observed in the mood and the behavior of the patient after CBT.

5. The evidence

The review that is based on this study was found out using Google Scholar. Five studies were published from 2017 to 2019.

Setting: The studies were carried out in the US, Germany, Norway, Japan, and Netherland. The dementia patients who were at the centers as well as their residence were taken into consideration for carrying out the study.

Participants: The participants of all the four studies except Carrion et al. (2018) included the dementia patient. However, the study that has been carried out by Carrion et al. (2018) included the records that were found through database searching. The results of the search strategy have been analyzed accordingly and thus different checklists were also used to analyze it.

Intervention and Comparison: All the studies were related to the effectiveness of the CBT in dementia patients who have shown higher symptoms of anxiety and depression in their early stages. Further, comparisons were also made with music therapy and it has been found that CBT is more effective in dementia patients if it is undertaken by analyzing the symptoms of the patients.

The evidence that was collected from this study has been grouped under the below-mentioned headings:

Reality Trials

The dementia patients were asked to undergo several trials and presentations before providing them the CBT. This is generally done to improve the patience level of the patient and to increase the understanding of the patient’s environment accordingly. Further, it can be said that as the duration of CBT varied from six weeks to 1 year, it is also the responsibility of the caregivers to pay an improved level of attention to the patient.

Effectiveness of CBT

CBT is considered to be effective rather than music therapy because music therapy does not involve the interaction or the conversation of the patient and the counselors and thus it might not be effective for all patients. However, CBT involves the process of interaction and thus the moods and the behaviors of the patients can be judged easily.

Improvement in the dementia patient

There has been an improvement in the patient after the application of the CBT therapy and thus this indicated that there are higher chances of improvement in the overall health of the patient. Attempts have also been made to ease the work process of the caregivers who were involved with the therapy as well as managing the patients during the crucial period. However, in some cases, it has been found that the CBT treatment could not be considered to be effective when the patient has already turned into a chronic stage. There could not be any further modifications made in the lifestyle or the behavioral pattern of the patient after providing the CBT therapy.

5. Research gaps

There should be proper attempts made to carry out a rigorous study to evaluate the effectiveness of CBT rather than the music therapy in dementia patients within the first two months. Although, several studies have been conducted by different authors and the study group and the population of all the studies varied, yet certain gaps that are to be considered in the five research paper that was chosen for the study are discussed below:

Impact of CBT on dementia patients

The effectiveness of CBT could be measured only in depressed and anxious patients who have also shown symptoms of depression. However, all the research papers did not focus on the provision of CBT to dementia patients only at the initial stage and thus their results could be considered as ambiguous.

Length of the outcome measured

The length of the outcome of all the studies varied and it is not clear in all cases that at what stage or during which period, a dementia patient must be provided with the CBT. However, the role played by the family members during the implementation of the CBT has not been discussed in all the studies effectively. The actual duration of treatment of the dementia patient with the help of CBT therapy has not been highlighted in the studies effectively.

References

Carrion, C., Folkvord, F., Anastasiadou, D., & Aymerich, M. (2018). Cognitive therapy for dementia patients: a systematic review. Dementia and geriatric cognitive disorders, 46(1-2), 1-26.

Chiang, K. J., Tsai, J. C., Liu, D., Lin, C. H., Chiu, H. L., & Chou, K. R. (2017). Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials. PloS one, 12(5), e0176849.

Goodkind, M. S., Gallagher‐Thompson, D., Thompson, L. W., Kesler, S. R., Anker, L., Flournoy, J., … & O’Hara, R. M. (2016). The impact of executive function on response to cognitive behavioral therapy in late‐life depression. International journal of geriatric psychiatry, 31(4), 334-339.

Hopkinson, M. D., Reavell, J., Lane, D. A., & Mallikarjun, P. (2019). Cognitive behavioral therapy for depression, anxiety, and stress in caregivers of dementia patients: A systematic review and meta-analysis. The Gerontologist, 59(4), e343-e362.

Kashimura, M., Nomura, T., Ishiwata, A., Kitamura, S., & Tateno, A. (2019). Cognitive Behavioral Therapy for Improving Mood in an Older Adult with Mild Cognitive Impairment: A Case Report. Journal of Nippon Medical School, 86(6), 352-356.

Lee, M., Ryoo, J. H., Chung, M., Anderson, J. G., Rose, K., & Williams, I. C. (2019). Effective interventions for depressive symptoms among caregivers of people with dementia: A systematic review and meta-analysis. Dementia, 1471301218822640.

Meichsner, F., Töpfer, N. F., Reder, M., Soellner, R., & Wilz, G. (2019). Telephone-based cognitive behavioral intervention improves dementia caregivers’ quality of life. American Journal of Alzheimer’s Disease & Other Dementias®, 34(4), 236-246.

Mjørud, M., Engedal, K., Røsvik, J., & Kirkevold, M. (2017). Living with dementia in a nursing home, as described by persons with dementia: a phenomenological hermeneutic study. BMC health services research, 17(1), 93.