Erin Jackson

Ms. Kucik
Independent Research II GT
3 April 2017
Meta-Analysis
List of Studies:
Auchus, A.P., et al. "Galantamine Treatment of Vascular Dementia." Neurology, vol. 69,
no. 5, 31 July 2007, pp. 448-58, www.neurology.org/content/69/5/448.short.

Jimbo, Daiki, et al. "Effect of Aromatherapy on Patients with Alzheimer's Disease."

Psychogeriatrics, vol. 9, no. 4, Dec. 2009, pp. 173-79,
onlinelibrary.wiley.com/doi/10.1111/j.1479-8301.2009.00299.x/full.

Kanamori, M., et al. "A Day Care Program and Evaluation of Animal-Assisted Therapy
for the Elderly with Senile Dementia." American Journal of Alzheimer's Disease and
Other Dementias, vol. 16, no. 4, July-Aug. 2004, pp. 234-39,
file:///Users/ErinJackson/Downloads/Pet%20Therapy%20(1).pdf.

Mu, Jun, et al. "Hyperbaric Oxygen Therapy Promotes Neurogenesis: Where Do We

Stand?" Medical Gas Research, vol. 1, no. 14, 27 June 2011,
www.ncbi.nlm.nih.gov/pmc/articles/PMC3231808/.

Nordgren, Lena, and Gabriella Engstrom. "Effects of Animal-Assisted Therapy on

Behavioral and Psychological Symptoms in Dementia: A Case Report." American
Journal of Alzheimer's Disease & Other Dementias, vol. 27, no. 8, 25 Oct. 2012,
journals.sagepub.com/doi/full/10.1177/1533317512464117.

Okada, Kaouro, et al. "Effects of Music Therapy on Autonomic Nervous System

Activity, Incidence of Heart Failure Events, and Plasma Cytokine and Catecholamine
Levels in Elderly Patients with Cerebrovascular Disease and Dementia." J Stage,
www.jstage.jst.go.jp/article/ihj/50/1/50_1_95/_pdf.

Orgogozo, Jean-Marc, et al. "Efficacy and Safety of Memantine in Patients with Mild to
Moderate Vascular Dementia. Stroke, vol. 33, no. 7, 1 July 2002, pp. 1834-39,
stroke.ahajournals.org/content/33/7/1834.

Rider, Hanne Mette O., et al. "Individual Music Therapy for Agitation in Dementia: An
Exploratory Randomized Controlled Trial." Aging & Mental Health, vol. 17, no. 6, 1
Aug. 2013, pp. 667-78, www.ncbi.nlm.nih.gov/pmc/articles/PMC4685573/.

Shi, Guang-Xia, et al. "Acupuncture for Vascular Dementia: A Pragmatic Randomized

Clinical Trial." Scientific World Journal, vol. 2015, Sept. 2014,
www.hindawi.com/journals/tswj/2015/161439/.
Method

Materials
I used various studies to conduct my meta-analysis. I ensured that I used a minimum of
one study for each therapy. I was searching for studies on both pharmacologic and
nonpharmacologic treatments including memantine, cholinesterase inhibitors and alternative
therapies. I used studies for various therapies that would fall under pharmacologic and
nonpharmacologic therapies. All of the studies I used were from peer reviewed journals. I
attached a list of all the studies I used to do my research. I created a chart as a way to organize
my data.

Procedure
My first step was creating the categories for my chart. I focused on the symptoms
experienced before treatment, how much the patients improved, and the side effects and risks of
the treatment. I researched vascular dementia therapies such as memantine, cholinesterase
inhibitors, hyperbaric oxygen therapy, music therapy, acupuncture, aromatherapy and animal
assisted therapy. In my chart, I included the title of my studies to make my data easier to
organize and manage. I then looked for the age range of the patients, the length of the trial and
the sample size. I then recorded the symptoms experienced before treatment and the level of
improvement. I included the response rate and the side effects and risks of the therapies. I created
graphs to make it easier to analyze my results and organize my data.
Results:
Type of Study Name Sample Size Length of Age Range Symptoms Level of Response Side
Treatment Trial Experienced Improvement Rate Effects/Risks
before Percentage
treatment (Pharmaco
logic
Treatment
s)

Memantine Efficacy and 321 28 weeks Over 60 Memory Cognition 60% Adverse
Safety of (165 Problems improved Memantin Effects were
Memantine in memantine) Speech significantly e similar to the
Patients with Problems Memantine score 52% rate of the
Mild to (156 Declined improved by 0.4% Placebo adverse
Moderate Placebo) cognition Placebo score effects of the
Vascular declined by 1.6% placebo
Dementia Memantine was
most successful in 19 patients on
severely demented memantine
patients had to
discontinue
due to adverse
effects as
opposed to 20
on the placebo

(76% of
memantine
patients
experienced
adverse
effects
compared
 74% of
patients

Agitation (9
Memantine,
11 Placebo)

Confusion (8
Memantine, 9
Placebo)

Dizziness (10
Memantine, 5
Placebo)

Cholinesterase Galantamine 786 Patients 26 Weeks Onset 40-90 In the MRI Changes in ADCS- 38% 13% of
Inhibitors Treatment of (396 During scan, the ADL scores were Galantami patients on
Vascular Galantamine 72.38.9 patients had similar ne Galantamine
Dementia: A ) multiple large All scores 33% discontinued
Randomized 390 vessel infarct,a improved Placebo treatment b/c
Trial (Placebo) single The placebo adverse
strategically worked best for effects as
located those with single opposed to
infarcts, infarct dementia 6% with
multiple basal while galantamine placebo
ganglia and worked best for 24% of
white matter those with multiple patients on
lacunes or infarct dementia memantine
extensive worsened
ischemic white 26% of
matter lesions patients on
 involving at placebo
least 25% of worsened
the brain

Hyperbaric Hyperbaric Rats 4 weeks Age of rats Brain Significantly N/A HBOT may
Oxygen Oxygen unspecified infarcts leading increased amount promote the
Therapy Therapy to decreased of BrDU+/nestin+ proliferation
Promotes cognitive cells of cancer cells
Neurogenesis: function however there
Where do We Over- More BrdU+/b- is little
Stand? phosphorylatio tubulin+ cells were evidence that
n of CREB observed in the HBOT causes
cortex malignant
growths
Induced
neurogenesis in Causes
dementia patients oxidative
Increased oxygen stress in the
partial pressure body tissue
within the blood
and enhanced
restoration oxygen
supply after
ischemic stroke
HBOT did not
improve the
clinical outcomes
of stroke patients
HBOT could
extend the time
window and
efficiency of r-tPA
thrombosis after
 acute ischemic
stroke
Mays stimulate
angiogenesis (new
blood cells)

Music Effects 87 10 weeks Mean Age A common MT enhanced N/A No adverse

Therapy of Music 82.3 complication parasympathetic effects were
Therapy on (55 MT (One 45 of VaD is activity observed in
Autonomic 32 No MT) min Range Heart Rate Plasma adrenaline the study
Nervous Session 72.7-91.9 Variability and noradrenaline
System per week) (HRV) levels were lower
Activity...in Heart in MT group
Elderly conditions and Among cytokines,
Patients w/ health plasma interleukin
Dementia complications were significantly
such as stroke lower in MT group
can worsen
VaD

Individual 42 6 weeks 66-96 Agitation Patients became N/A No adverse

Music standard Mean age:81 Paranoia happier from effects were
Therapy for care Psychotic music therapy observed in
Agitation in Episodes They smiled more the study
Dementia 6 weeks often
music Became less
therapy aggressive
During standard
care, agitation
 slightly increased
During music
therapy, agitation
decreased
There was a
significant
difference in the
music therapy and
standard care
groups

Acupuncture Acupuncture 22 Control R- Onset: 80 Hypertension ADL score N/A No serious

for Vascular 22 acupunctu Trouble with significantly adverse
Dementia: A Randomized re Daily self-care decreased in effects were
Pragmatic Acupuncture 67.24 such as acupuncture noticed
Randomized 19 9.33 grooming, groups
Clinical Trial Nonrandomi dressing, For MMSE score 25% had
zed NR- showering and was significantly some
acupuncture Acupunct feeding. higher in pooled discomfort at
ure Lack of acupuncture than the site of
57.2110. independence control group needle
8 Acupuncture may injections
Control have improve
67.4510. cognitive status 20% had
14 and daily living some bruising
Aromatherapy Effect of 28 86.1 28 Days Problems with Patients were N/A Study
Aromatherapy 17(AD) control word exposed to 0.04 ml suggested that
on patients 3 (VAD) 28 days recognition, lemon, and 0.08 ml there were no
with 8 (Mixed) Aromatherapy vocal orders, rosemary oil from significant
Alzheimers 28 days wash figure 9-11 am side effects
Disease out recognition, They were then associated
understanding exposed to 0.08 ml with
everyday lavender and 0.04 aromatherapy.
concepts such ml orange essential
as mail oils from 7-9 pm

All patients had

significant
improvements in
personal
orientation related
to cognitive
function

There nervous
system was
activated

Animal Effects of 1 8 weeks 84 Grabbing onto Immediately After N/A Able to dress
Assisted AAT on people AAT, Mrs Johnson herself at
Therapy Behavioral grabbed onto beginning on
and/or Repeated people, after 3 her own
Psychological questions and months grabbing initiative but 3
Symptoms: A sentences people was not months later
Case Report observed after AAT,
Not she needed
cooperating She became help dressing
with staff capable of taking herself
 initiative
Being Resisting
suspicious at being dressed
least once a increased
week from once a
week to daily
Restlessness immediately
after AAT
Experienced
distortion daily She became
more attention
Needed help w/ seeking after
hygienic AAT
procedures

A Day Care Total 7 12 weeks AAT Group Anxieties Helped maintain N/A No adverse
Program and 2 men 79.44 6.06 Phobias remain physical effects were
evaluation of 5 women (6 years Paranoia and mental observed
animal 5 AD sessions Control Hallucinations functioning
assisted 2 VAD biweekly) group 83.4 Aggressiveness Became more
therapy for Control 7.22 Diural rhythm independent
the elderly Group disturbances The scores for
with senile 4 men aggressiveness,
dementia 16 women anxieties and
phobias, and
caregiving burden
were lowered in
AAT group but
slightly increased
in control group
 I found that memantine and galantamine had relatively low success rates although their
response rates were a bit higher than the placebo. In both trials, both memantine and galantamine
caused side effects. Some patients had side effects so severe that they had to discontinue the
medication. My data suggests that alternative therapies have less side effects. Alternative
therapies seem to help with aggressiveness. All therapies seemed to help with preventing and
delaying further brain damage. Hyperbaric oxygen therapy helped to regenerate or create new
brain cells. All alternative therapies also helped with anxieties and phobias. Overall alternative
therapies offer more benefits with less side effects.

Discussion
My data suggests that alternative therapies are significantly more effective than
pharmacologic therapies. I observed less side effects in alternative therapies. Another difference
was that in alternative therapies, all patients were able to continue their treatment. In
pharmacologic treatments both the placebo and the medicine caused some patients to discontinue
their treatment because of adverse effects. I was surprised when animal assisted therapy had
more adverse effects in the case report. I was also taken aback when one animal assisted therapy
showed no side effects but the other did. However, I realized that the first study was a case report
and none of the adverse effects were severe. I also think that some symptoms were not
necessarily a result of animal assisted therapy, but symptoms of the disease that the therapy did
not treat.
Alternative therapies were more effective when it came to treating aggressiveness,
anxieties and phobias. In addition to treating symptoms, another goal of treatment is to prevent
further progression of VaD. While pharmacologic treatments prevented further damage.
Although music therapy did help with heart rate and other vascular symptoms. This suggests that
it would help prevent further brain damage in VaD. Other alternative therapies also helped with
preventing further brain damage.
My hypothesis was somewhat supported. It was not disproved but I do not have enough
evidence to say my hypothesis was completely supported. It is clear that alternative therapies are
better for treating VaD, but it is hard to judge which therapy would be best for each individual
patient. Every patient is different with varying symptoms and phobias. Some patients may be
afraid of animals so animal assisted therapy would not work for them. I still think animal assisted
therapy is a valuable treatment option because it improved the quality of life with all of the
patients who tried it. It also helped with independence, aggressiveness, anxieties, and phobias.
There were also limited severe side effects. All of these patients liked animals so animal assisted
therapy would not be effective for patients who do not like or are scared of animals. However
other alternative therapies also improved the patients quality of life.
The implications of my research are that alternative therapies should be used when
treating mild to moderate VaD because I do not think that the benefits outweigh the adverse
effects. I also think that animal assisted therapy, acupuncture, music therapy and aromatherapy
could all be beneficial since they help improve symptoms with minimal side effects. I think
medicine could be effective in treating severe VaD but loved ones need to approve the use of
pharmacologic treatments.
One problem that I encountered was that it was hard to support my hypothesis. I found
considerable evidence that alternative therapies were significantly better than pharmacologic
therapies since they had minimal side effects while improving symptoms. I did find that all
alternative therapies helped improve symptoms, prevent further brain damage, and cause less
severe side effects. I was also limited by the studies that were available to me. All of the studies I
used were relatively short term, with my longest being 28 weeks. This is a short time when I am
looking for the best long term treatment for vascular dementia. I was limited by cost and could
not control the time of the studies. All of the studies I used were free and as a student I could not
afford paid journal articles. Another issue with my data was that the most studies I had for any
category was two. This is a not a sufficient sample size to come to the most accurate conclusion
possible. I needed to have more studies to get the most complete and accurate data. However, I
was limited by time and cost.
After conducting my research, I still wonder how hyperbaric oxygen therapy can be made
more available to the public. I also wonder if there could be an initial treatment option. I am still
not sure how alternative therapies can be better implemented in hospitals and nursing homes and
how to make them more cost effective. I still think it is important to find an effective medicine
with minimal side effects.