**2. Methods**

and represents one of the major causes of disability, dependency, burden and stress of

This condition also leads to severe social consequences: decreased quality of life and wellbeing, increased family burdens and healthcare demand and longer term utilization of care facilities that generate very significant impacts on healthcare services demand and conse‐ quently costs [5]. The symptoms of dementia are grouped under three main headings: cog‐ nitive aspects, functional aspects and neuropsychiatric symptoms (NPSs). Dementia is a disease characterized by a cognitive decline involving one or more cognitive domains (memory and learning, executive function, language, complex attention, perceptual-motor, social cognition, etc.) [6]. The deficits must correspond to a decline from previous level of function and could be severe enough to interfere with daily functions and independence. Memory impairment is one of the main cognitive issues that contribute to the inability to live independently [4, 7, 8]. In the early stages of AD, it limits memory processes and re‐ duces older people's autonomy in performing more complex daily activities, and it concur‐ rently causes deterioration of emotional control, social behaviour and motivation [4, 6].

The functional aspects can be described in two broad classes: (1) basic activities of daily living or BADL [9, 10] and (2) instrumental activities of daily living or IADL [11]. BADLs are physical tasks essential to maintaining the independence and include the ability to go to the toilet, feed, dress, groom, bathe and ambulate. IADLs are activities typically more cognitively demanding than BADL and include the ability to successfully use the telephone, shop, prepare food, do the housekeeping and laundry, manage medications and finances and use transportation outside of the home (e.g., driving a car, using public transit or riding in a taxi). In the early stage of dementia, most patients are independent with BADL, but they begin to need help with some IADLs [12]. In the moderate phase, cooking, housework and shopping require direct assistance, and BADL require assistance for set-up and safety. Moreover, the presence of NPS could increase anger, frustration and difficulty in communicating needs [13]. As dementia enters the severe stage, independence is progressively lost and caregivers must offer consistent

NPS are common features of Alzheimer's disease (AD) [18, 19] and are one of the major risk factors for institutionalization [20]. NPS may be correlated to AD independently of cognitive impairment severity or emerge in the course of the illness being a significant cause of a more rapid cognitive decline [21]. It was found that over 80% of AD patients had NPS in the history of the illness [21, 22]. Four separate neuropsychiatric syndromes were identified: hyperactive, psychotic, affective and apathetic [19, 23]. In particular, agitation, euphoria, disinhibition, irritability and aberrant motor behaviour were defined as hyperactive syndrome; delusions, hallucinations and night-time disturbances as psychotic syndrome; depression and anxiety as

Currently, there is no effective disease-modifying cure, and treatment is directed mainly to

affective syndrome, and apathy and eating abnormalities as apathetic syndrome.

direct care with most if not all BADL [14–17].

manage the symptoms of dementia [24].

caregivers increasing institutionalization among older people worldwide [4].

478 Update on Dementia

A narrative review was performed using qualitative data and best-practice recommendations in the research literature [32, 33]. The searches were performed in the MEDLINE, PubMed, EMBASE, CINAHL and PsycINFO databases.

The search queries included 'dementia', 'non-pharmacological treatment' and 'cognitive rehabilitation', and were limited to English language articles.

The inclusion/exclusion criteria used for this review protocol are the following.

Inclusion criteria were as follows: (1) age ≥60 years, (2) diagnosis of dementia according to the criteria of the National Institute on Aging-Alzheimer's Association (NIAAA) [34], (3) use of non-pharmacological tools to treat the cognitive and functional impairment in dementia and (4) acceptable clinical measures of cognitive impairment, disability, quality of life and global clinical assessments.

Exclusion criteria were as follows: (1) no English editing (because we had no resources for translation) and (2) diagnosis of non-dementia.

Quality of study reporting was assessed using the Standards for the Reporting of Diagnostic accuracy studies in dementia (STARDdem) [35].
