Language and communication non-pharmacological interventions in patients with Alzheimer's disease: a systematic review. Communication intervention in Alzheimer

Alzheimer's disease considerably compromises communication skills. Language changes become more prominent as the disease progresses. Deterioration of language and cognition reduces the ability of holding conversations, which has a negative impact on social interaction. OBJECTIVE To conduct a systematic review of the literature for articles reporting interventions focused on the language and communication of people with Alzheimer's disease (AD) without use of medication. METHODS We performed a search using the keywords Alzheimer's disease, language, communication, cognition, cognitive intervention, rehabilitation and therapy, and their corresponding Portuguese and Spanish terms, on the SciELO, LILACS, PubMed and PsychINFO databases. We analyzed intervention studies published from 1993 to 2016 that involved stimulation of language skills and/or communication with pre-and post-intervention quantitative results, and whose samples included at least 50% with a diagnosis of probable AD. Studies were analyzed and classified into four levels of evidence, according to the criteria described in the literature. RESULTS Twenty-eight articles were included. The majority of the designs had medium-to-low scientific evidence. Most interventions showed benefits for at least one language or communicative skill. Eight types of interventions emerged from the analysis of the studies. Further research with higher levels of evidence is recommended in the investigation of interventions focused on language and communication skills of patients with dementia. CONCLUSION Studies with high levels of evidence on the topic investigated are only being conducted on a small scale. Two intervention techniques seem potentially effective: lexical-semantic approaches and interventions that work with different cognitive skills (including language).