Table 2

Effects of interventions as reported in the included systematic reviews

Intervention and comparison interventionNumber of participants included in the meta-analysis (studies)Measure of ADLEffect measure (expressed as SMD or MD)Statistically significantQuality of the evidence (GRADE)
Non-pharmacological interventions
Exercise programmes vs usual care (postintervention)166 studies (289 participants)MultipleSMD 0.68 (0.08 to 1.27)Yes⊕⊕○○
Low1a,3
Dyadic interventions vs control308 studies (988 participants)MultipleSMD 0.37 (0.05 to 0.69)Yes⊕⊕○○
Low1b,2
Validation therapy vs usual care (1 year)241 study (88 participants)UnclearReview stated effect on ADL was not significant (data not reported)No⊕⊕○○
Low1c,3
Psychological treatments for depression and anxiety vs usual care (postintervention (6 weeks/8–12 months))252 studies (313 participants)MultipleSMD −0.13 (−0.35 to 0.09)No⊕⊕○○
Low1b,3
Case management vs usual care (6 months)263 studies (318 participants)MultipleSMD −0.03 (−0.25 to 0.19)No⊕⊕○○
Low1d,3
Music therapy vs control (postintervention)B296 studies (195 participants)MultipleSMD 0.05 (−0.23 to 0.34)No⊕⊕○○
Low1e,3
Cognitive stimulation vs no cognitive stimulation (postintervention)314 studies (260 participants)MultipleSMD 0.21 (−0.05 to 0.47)No⊕⊕○○
Low1f,3
Cognitive training vs control (postintervention)134 studies (107 participants)MultipleSMD 0.00 (−0.38 to 0.38)No⊕⊕○○
Low1g,3
Light therapy vs control (at 1 year)151 study (94 participants)NI-ADLsMD −5.0 (−11.16 to 1.16)
Data not available for conversion to SMD
No⊕⊕○○
Low1h,3
Aromatherapy vs placebo (postintervention)171 study (63 participants)Barthel ScaleMD −0.50 (−1.79 to 0.79)
Data not available for conversion to SMD
No⊕⊕○○
Low1i,3
Nutritional intervention vs controlA (postintervention (3 months))213 studies (1262 participants)MultipleNot pooled
The individual trials reported no significant differences between the groups
No⊕⊕⊕○
Moderate1j
Pharmacological interventions
Acetylcholinesterase inhibitors and memantine vs placebo at end point2712 studies (4661 participants)ADCS/ADL subscaleDonepezil 5 mg MD 1.0 (−0.53 to 2.53) SMD 0.18 (−0.10 to 0.46)
Donepezil 10 mg MD 1.03 (0.21 to 1.85) SMD 0.18 (0.03 to 0.32)
Galantamine 24 mg MD 0.68 (0.04 to 1.32) SMD 0.15 (0.04 to 0.25)
Rivastigmine 12 mg MD 1.8 (0.20 to 3.40) SMD 0.19 (0.02 to 0.36)
Memantine 20 mg MD 1.02 (0.27 to 1.78) SMD 0.11 (0.02 to 0.21)
Yes⊕⊕⊕○
Moderate1k
Latrepirdine vs placebo (postintervention)143 studies (1243 participants)ADCS-ADL ScaleMD 1.00 (−1.15 to 3.15)
SMD 0.06 (−0.06 to 0.17)
No⊕⊕○○
Low1l,2
Melatonin vs placebo (6 weeks)181 study (86 participants)NI-ADLsMD −2.0 (−7.50 to 3.50)
SMD −0.15 (−0.58 to 0.27)
No⊕⊕⊕○
Moderate3
Pharmacotherapies for sleep vs placebo (melatonin, trazodone) (postintervention (2–8 weeks))222 studies (193 participants)MultipleNot pooled
The individual trials reported no significant differences between the groups
No⊕⊕⊕○
Moderate3
Statins vs placebo (3 months)233 studies (1109 participants)MultipleNot pooled
The individual trials reported no significant differences between the groups
No⊕⊕⊕⊕
High
Selegiline vs placebo (8–17 weeks)337 studies (810 participants)MultipleSMD 0.27 (95% CI 0.13 to 0.41)Yes⊕⊕○○
Low1m,2
Nimodipine vs placebo (6 months)343 studies (1228 participants)MultipleSMD −0.12 (95% CI −0.23 to 0.00)No⊕⊕⊕○
Moderate1m
Lecithin vs placebo (6 months)351 study (63 participants)PADL ScaleThe trial reported no significant differences between the groupsNo⊕⊕⊕○
Moderate3
Alternative therapies
Huperzine A vs placebo (12 weeks)322 studies (70 participants)ADL ScaleMD −8.82 (−11.47 to −6.16)C
SMD −1.48 (−2.02 to −0.95)
Yes⊕⊕○○
Very low3,4
Gingko biloba vs placebo (endpoint)287 studies (2530 participants)MultipleSMD −0.36 (−0.44 to −0.28)DYes⊕⊕○○
Very low2,4
Acupuncture vs herbal mixture (8 weeks)191 study (104 participants)Not reportedES=0.29, not significantNo⊕⊕○○
Very low3,4
Vitamins B supplementation vs control (postintervention (6–18 months))203 studies (481 participants)MultipleSMD 0.13 (−0.05 to 0.31)No⊕⊕⊕○
Moderate1n
  • A. Note the nutritional interventions included daily oral nutritional supplementation, medical food (Souvenaid) and a health and nutrition promotion programme for physicians, caregivers and people with dementia.

  • B. Note that the meta-analysis conducted in the systematic review by Ueda and colleagues included randomised and non-randomised trials.

  • C. The authors report this outcome as an ADL Scale but do not specify the particular scale. A lower score in the meta-analysis was interpreted by the authors as an improvement in ADL function.

  • D. The authors reported this reduction in score as an improvement in function. Examination of the meta-analysis suggests that outcome measures were combined. Where outcome measures used higher scores to represent better function, the scores were multiplied by −1 so that all outcome measures were reporting in the same direction in the meta-analysis.

  • Note: Where MD was reported, the authors of the review calculated the SMD in RevMan.

  • GRADE footnotes.

  • 1aUnclear randomisation procedures in three studies. Unclear whether outcome assessor blinded in one study. Participants not blinded. Downgraded for risk of bias.

  • 1bUnclear whether outcome assessor blinded in one study. Participants not blinded. Downgraded for risk of bias.

  • 1cUnclear allocation concealment. Participants not blinded. Downgraded for risk of bias.

  • 1dUnclear allocation concealment in one study. Participants not blinded. Outcome assessors not blinded or status unclear in two studies. Selective reporting in one study. Downgraded for risk of bias.

  • 1eUnclear allocation concealment and blinding in two studies. Incomplete outcome data in two studies. Participants not blinded. Downgraded for risk of bias.

  • 1fUnclear allocation concealment, randomisation sequence generation, incomplete outcome data and details of blinding in two studies. Downgraded for risk of bias.

  • 1gRandomisation details unclear in all four studies. Details of incomplete outcome data and blinded outcome assessor unclear in single studies (×2). Participants not blinded. Downgraded for risk of bias.

  • 1hCluster randomisation by care home. Downgraded for risk of bias.

  • 1iUnclear allocation concealment and unclear risk due to incomplete outcome data. Downgraded for risk of bias.

  • 1jTwo of the three studies were rated as being of moderate quality while the remaining study was rated as strong. Downgraded for risk of bias.

  • 1kMixed quality of studies and variability in transparency of reporting. Downgraded for risk of bias.

  • 1lHigh risk of bias for incomplete outcome data and selective reporting in two studies. Unclear allocation concealment in one study. Downgraded for risk of bias.

  • 1mUnclear details of randomisation in all studies. Downgraded for risk of bias.

  • 1nUnclear selective reporting and unclear risk of bias in other areas reported for one study. Downgraded for risk of bias.

  • 2Mixed findings among studies, CIs do not overlap. Downgraded for inconsistency.

  • 3Total number of participants <400 in the analyses. Downgraded for imprecision.

  • 4Very serious risk of bias: unclear or high in majority of studies for most aspects of quality assessment. Downgraded (−2) for risk of bias.

  • ADCS, Alzheimer's disease co-operative study; ADL, activities of daily living; ES, effect size; NI-ADL, nurse informant activities of daily living; PADL, physical ADL; SMD, standardised mean difference; MD, mean difference.