Published online Nov 19, 2026. doi: 10.5498/wjp.123323
Revised: June 22, 2026
Accepted: July 13, 2026
Published online: November 19, 2026
Processing time: 166 Days and 22.6 Hours
Patients with mild Alzheimer’s disease (AD) frequently suffer from comorbid anxiety and depression, which exacerbate neuropsychiatric symptoms, reduce quality of life, and increase caregiver burden. Conventional pharmacological treatments often inadequately address these multifaceted issues.
To evaluate the impact of a multicomponent, nonpharmacological care program on the neuropsychiatric symptoms, quality of life, caregiver burden, cognitive function, and sleep quality in patients with mild AD experiencing comorbid anxiety and depression.
A retrospective analysis was conducted on 200 individuals diagnosed with mild AD and exhibited symptoms of anxiety and depression [Geriatric Anxiety In
At 3 months, the multicomponent group showed the following markedly superior outcomes than the conventional group: Lower NPI total symptom score (P = 0.004) and caregiver distress (P = 0.020); Lower GAI-SF (P = 0.003) and GDS-15 (P = 0.003); Higher ADCS-ADL (P < 0.001) and QOL-AD (P < 0.001); Lower ZBI (P = 0.004); Higher MMSE (P = 0.004) and lower ADAS-cog (P = 0.024); and lower PSQI (P < 0.001).
The multicomponent, nonpharmacological care program is associated with improved neuropsychiatric symptoms, anxiety, depression, quality of life, caregiver burden, cognitive function, and sleep quality in patients with mild AD experiencing anxiety and depression.
Core Tip: This study evaluates a multicomponent nonpharmacological care program (cognitive rehabilitation, occupational therapy, art/doll therapy, exercise training, and speech therapy) in mild Alzheimer’s disease patients with comorbid anxiety and depression. Compared to conventional care, the program significantly improved neuropsychiatric symptoms, quality of life, caregiver burden, cognitive function, and sleep quality. The findings support a holistic, nondrug approach for this specific population.
- Citation: Chen YF, Zhu Y, Li BX, Zhang JN. Impact of multicomponent, nonpharmacological care program for mild Alzheimer’s disease with anxiety and depression. World J Psychiatry 2026; 16(11): 123323
- URL: https://www.wjgnet.com/2220-3206/full/v16/i11/123323.htm
- DOI: https://dx.doi.org/10.5498/wjp.123323
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline and neuropsychiatric symptoms[1,2]. Mild AD represents an early stage where interventions may slow progression. However, management is particularly challenging when anxiety and depression cooccur, as these symptoms exacerbate functional impairment and caregiver burden[3,4].
Conventional care for mild AD relies primarily on pharmacological treatments (e.g., cholinesterase inhibitors) combined with basic health education and routine activities. Although these approaches may partially improve cognitive symptoms, they inadequately address neuropsychiatric comorbidities or quality of life[5,6]. Single domain, nonpharmacological care (e.g., cognitive training alone) have shown limited effects on patients with mixed anxiety depression[7,8].
Multicomponent, nonpharmacological care programs, which integrate cognitive stimulation, physical exercise, psychological support, and caregiver training, have been explored in general dementia populations[9,10]. However, several important gaps remain. First, most previous multicomponent studies included heterogeneous samples (mixed dementia types, varying severity, or without screening for anxiety/depression). Second, the intensity and composition of inter
The novelty of this study lies in: (1) A well-defined target population patients with mild AD experiencing comorbid anxiety [Geriatric Anxiety Inventory-Short Form (GAI-SF) ≥ 3] and depression [Geriatric Depression Scale-15 (GDS-15) ≥ 6]; (2) A highly standardized, multicomponent intervention covering five therapeutic domains; and (3) A broad evalu
A retrospective study was performed on 200 patients with mild AD who were treated at Shaoxing 7th People’s Hospital between January 2024 and December 2025. The inclusion criteria were as follows: (1) Aged between 60 years and 85 years; (2) AD diagnosis in accordance with the standards set by the National Institute of Neurological and Communicative Disorders and Stroke and the AD and Related Disorders Association[11]; (3) Mild dementia, indicated by a score of 0.5 or 1 on the Clinical Dementia Rating Scale (CDR); (4) Presence of anxiety and depressive symptoms, scoring ≥ 3 on the GAI-SF and ≥ 6 on the GDS-15; (5) Having a fixed primary caregiver (family member or formal caregiver); and (6) Complete medical records. The exclusion criteria were as follows: (1) Comorbid neurological diseases; (2) Severe organic diseases; (3) Severe mental illness; (4) Severe hearing, vision, or language impairments; (5) Recent treatment with psychotropic medications; and (6) Caregivers with severe mental illness, cognitive impairment, or those who did not fully cooperate with the care and follow-up.
On the basis of the care programs they actually received, the 200 patients with AD were categorized into a conventional group (n = 104) and a multicomponent group (n = 96). The conventional group received conventional AD care programs, and the multicomponent group received the multicomponent, nonpharmacological care program. This study was examined and endorsed by the Medical Ethics Committee of Shaoxing 7th People’s Hospital. Considering the retrospective nature of the study and in line with relevant ethical guidelines, the Ethics Committee granted a waiver of informed consent. All procedures were conducted in strict accordance with the Declaration of Helsinki to ensure the protection of the participants’ privacy, rights and interests.
The conventional group received standard pharmacological treatments and basic nursing care. The particular items are as follows.
Pharmacological treatment: The patients were orally administered donepezil hydrochloride Tablets (approval No. H20223260, produced by Shijiazhuang Pharmaceutical Group Ouyi Pharmaceutical Co., Ltd., Hebei Province, China) at a dose of 5 mg once daily for a continuous period of 12 weeks.
Health education: Prior to treatment, the responsible nurse provided one-on-one oral education to the patients and their primary caregivers. The educational content included disease knowledge, medication guidance, and follow-up plans (once a month).
Lifestyle and safety guidance: Written educational materials, covering dietary recommendations, activity suggestions, sleep hygiene, and safety precautions, were provided to the patients and caregivers.
The multicomponent group received the multicomponent, nonpharmacological care program in addition to standard pharmacological treatment for 12 weeks. The care was conducted at a day hospital using a group format, twice weekly, from 9:00 to 15:30 (including lunch and snack times), each session lasting 5 hours. Twenty-four sessions were provided, amounting to 120 hours of care. All care contents were executed in accordance with standardized operating manuals and regularly supervised by the research team. The program contained the following main parts.
Cognitive rehabilitation and cognitive stimulation: Aimed at enhancing patients’ attention, memory, and executive function through multichannel stimulation: (1) Computer-assisted cognitive training: Included preparatory courses to familiarize patients with computer operations, followed by memory and attention games with dynamically adjusted difficulty based on patient capabilities; (2) Logical games and reading: Activities included simplified chess and cross
Occupational therapy and activities of daily living training: Focused on maintaining and improving basic and instrumental activities of daily living (ADLs): (1) Simulated daily life exercise: Involving the patient in practical operations, such as making dumplings and steamed buns and organized competitions, and encouraging them to win; (2) Gardening activities: Arranged for light work such as weeding and watering plants to reduce anxiety by participating in outdoor activities; and (3) Home environmental adaptation guidance: Proposed improvements to the living environment to facilitate orientation and safety for patients.
Art therapy and doll therapy: Emphasized nonverbal expression and emotional interaction to improve mood and reduce agitation: (1) Art therapy: Inviting patients to express their inner emotions by engaging in activities such as painting and handicraft making; emphasizing stimulating cognition and emotion rather than high-quality art production; and (2) Doll therapy: Giving some people-shaped dolls to the patients to imitate role-playing activities, such as hugging or feeding, giving warmth, to help stimulate their thinking abilities and reduces restlessness.
Exercise training and physical therapy: Improving physical fitness, balance, cerebral blood flow, and reducing fall risk: (1) Physical fitness training: Conducting aerobic exercises, such as running, cycling, Aerobic exercise, and Tai Chi, suitable for the patient’s actual condition; (2) Balancing and power exercise: Individualized balancing and resistance exercises under the guidance of physical therapists; and (3) Group activities: Organized group walks and stretching sessions to improve social interactions and oral expression.
Speech therapy: Addressing common language communication difficulties in patients with mild AD through situational simulations and communication strategy training to improve expressive and receptive language skills in daily life scenarios. A standardized operation procedure (SOP) was strictly followed for all intervention contents. The SOP explicitly specified the operational workflow, core requirements, and fixed weekly time allocation for each module: Cognitive rehabilitation (1.5 hours/session), occupational therapy (1 hour/session), art/doll therapy (1 hour/session), exercise training (1 hour/session), and speech therapy (0.5 hours/session), matching the total 5-hour per session design. Before intervention, all therapists received 2 weeks of centralized uniform training, covering SOP interpretation, com
Assessments were conducted at baseline and 3 months using the Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE), AD Assessment Scale-Cognitive Subscale (ADAS-cog), GAI-SF, GDS-15, Pittsburgh Sleep Quality Index (PSQI), AD Cooperative Study ADL (ADCS-ADL), Quality of Life-AD (QOL-AD), and Zarit Caregiver Burden Interview (ZBI). All outcome assessments were conducted by trained research nurses who were fully independent of the intervention team and not involved in patient care or intervention implementation. Assessors were formally blinded to group allocation. Patients and caregivers were instructed not to disclose their assigned care program during evaluations. All assessment forms omitted group identifiers.
Neuropsychiatric symptoms: NPI contains 12 main items and calculates the total score by adding up the points for these items (ranging from 0 to 144); High scores signify great overall severity of behavioral and psychological symptoms in patients. The caregiver distress score is measured by summing the distress items scores across 12 factors; a score range of 0-60 is used. The Cronbach’s alpha coefficient of this scale is 0.82[12]. GAI-SF includes five items with the scale ranging from 0 to 5 points after being rated on a “yes/no” basis. The higher the score, the more severe the anxiety. The Cronbach’s α reliability coefficient is 0.81[13]. GDS-15 has 15 questions and is scored on a scale of 0 to 15 points High scores indicate severe depressive symptoms; The Cronbach’s α reliability coefficient of this scale is 0.81[14].
Quality of life: ADCS-ADL includes 23 items, with a total scoring ranging from 0 to 78. High scores indicate great ADL capabilities, and the Cronbach’s α coefficient is 0.89[15]. QOL-AD contains 13 items, with a total score ranging from 13 to 65. High scores denote good quality of life, and the Cronbach’s α reliability coefficient is 0.82[16].
Caregiver burden: ZBI contains 22 items, with a total score ranging from 0 to 88. High scores reflect a great level of caregiver burden, and the Cronbach’s α reliability coefficient for this scale is 0.90[17].
Cognitive function: MMSE contains five parts: Orientation, memory, attention and calculation, language, and visuospatial skills. It is composed of 30 questions. Score ranges from 0 to 30; low scores indicate a poor level of cognition. The Cronbach’s alpha reliability of the MMSE is 0.912[18]. ADAS-cog consists of three parts: Memory, language and praxis, and orientation. It has 10 questions scored from 0 to 70 points; those who score high have evident impaired cognition. The Cronbach’s α reliability coefficient of this scale is 0.843[19].
Sleep quality: PSQI contains 19 items comprising seven components: Subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component is scored on a scale from 0 to 3, with a total score ranging from 0 to 21. High scores indicate poor sleep quality. The Cronbach’s α coefficient for this scale is 0.82[20].
Statistical analyses were conducted using SPSS software (version 29.0; developed by SPSS Inc., Chicago, IL, United States). A two-tailed P value of < 0.05 was deemed statistically significant. Continuous variables were verified for normal distribution using Shapiro-Wilk test and reported as means ± SD. Group comparisons for continuous variables were conducted with independent samples t-tests. Categorical variables were presented as n (%) and compared between groups by utilizing χ2 tests.
As indicated in Table 1, no statistically significant differences were observed between the conventional and multicomponent groups in any of the baseline characteristics, including patient age, gender, body mass index, years of schooling, marital status, CDR score, caregiver age, identity, and years of schooling (all P > 0.05).
| Parameter | Conventional group (n = 104) | Multicomponent group (n = 96) | t/χ2 value | P value |
| Patients | ||||
| Age (years) | 74.12 ± 4.84 | 73.68 ± 5.13 | 0.616 | 0.539 |
| Gender | 0.071 | 0.790 | ||
| Male | 42 (40.38) | 37 (38.54) | ||
| Female | 62 (59.62) | 59 (61.46) | ||
| BMI (kg/m2) | 23.15 ± 2.87 | 22.94 ± 3.05 | 0.486 | 0.627 |
| Years of schooling (years) | 10.24 ± 3.16 | 10.12 ± 3.31 | 0.279 | 0.781 |
| Marital status | 0.876 | 0.831 | ||
| Unmarried | 5 (4.81) | 6 (6.25) | ||
| Married | 84 (80.77) | 73 (76.04) | ||
| Divorced | 5 (4.81) | 7 (7.29) | ||
| Widowed | 10 (9.62) | 10 (10.42) | ||
| CDR score | 0.064 | 0.800 | ||
| 1 | 61 (58.65) | 58 (60.42) | ||
| 0.5 | 43 (41.35) | 38 (39.58) | ||
| Caregivers | ||||
| Age (years) | 51.63 ± 15.25 | 52.17 ± 14.76 | 0.253 | 0.801 |
| Identity | 0.100 | 0.752 | ||
| Family members | 94 (90.38) | 88 (91.67) | ||
| Formal caregivers | 10 (9.62) | 8 (8.33) | ||
| Years of schooling (years) | 9.21 ± 3.02 | 9.53 ± 3.08 | 0.752 | 0.453 |
Table 2 summarizes the NPI scores. At baseline, the total symptom scores and caregiver distress subscale scores were comparable between the two groups (P = 0.800 and P = 0.486, respectively). After 3 months, the multicomponent group exhibited a significantly lower total symptom score (26.73 ± 7.92) compared with the conventional group (30.15 ± 8.47), with a mean difference of 3.42 (t = 2.943, P = 0.004). Similarly, the caregiver distress subscale score in the multicomponent group (9.94 ± 2.98) was markedly lower than that in the conventional group (11.05 ± 3.61) at 3 months (t = 2.352, P = 0.020). Table 3 presents the changes in anxiety and depression levels. Baseline GAI-SF and GDS-15 scores did not differ significantly between the groups (P = 0.110 and P = 0.154, respectively). At 3 months, the multicomponent group achieved a lower GAI-SF score (2.94 ± 0.66) compared with the conventional group (3.18 ± 0.41), and the difference was statistically significant (t = 3.048, P = 0.003). The GDS-15 score at 3 months was significantly lower in the multicomponent group (8.04 ± 2.18) than in the conventional group (8.89 ± 1.82), with t = 3.018 and P = 0.003.
| Parameter | Conventional group (n = 104) | Multicomponent group (n = 96) | t value | P value |
| Total symptom scores | ||||
| Baseline | 35.84 ± 9.21 | 36.19 ± 10.07 | 0.253 | 0.800 |
| 3 months | 30.15 ± 8.47 | 26.73 ± 7.92 | 2.943 | 0.004 |
| Caregiver distress subscale | ||||
| Baseline | 13.42 ± 3.88 | 13.82 ± 4.16 | 0.699 | 0.486 |
| 3 months | 11.05 ± 3.61 | 9.94 ± 2.98 | 2.352 | 0.020 |
| Parameter | Conventional group (n = 104) | Multicomponent group (n = 96) | t value | P value |
| GAI-SF scores | ||||
| Baseline | 3.82 ± 0.37 | 3.91 ± 0.42 | 1.604 | 0.110 |
| 3 months | 3.18 ± 0.41 | 2.94 ± 0.66 | 3.048 | 0.003 |
| GDS-15 scores | ||||
| Baseline | 9.47 ± 1.65 | 9.82 ± 1.83 | 1.433 | 0.154 |
| 3 months | 8.89 ± 1.82 | 8.04 ± 2.18 | 3.018 | 0.003 |
Figure 1 displays the ADCS-ADL scores. Initially, no significant difference was found between the two groups (P = 0.646). Following 3 months of intervention, the multicomponent group exhibited a substantially higher ADCS-ADL score (65.47 ± 6.33) compared with the conventional group (60.82 ± 7.51), and the intergroup difference was highly significant (t = 4.716, P < 0.001).
Table 4 reports the QOL-AD scores. The baseline scores were similar between the groups (P = 0.710). At 3 months, the multicomponent group had a significantly higher QOL-AD score (33.25 ± 4.89) compared with the conventional group (29.69 ± 5.63), with t = 4.753 and P < 0.001, indicating a better quality of life in patients receiving the multicomponent, nonpharmacological care program.
| Parameter | Conventional group (n = 104) | Multicomponent group (n = 96) | t value | P value |
| Baseline | 30.15 ± 5.41 | 29.87 ± 5.16 | 0.372 | 0.710 |
| 3 months | 29.69 ± 5.63 | 33.25 ± 4.89 | 4.753 | < 0.001 |
Figure 2 shows the ZBI scores. The two groups had comparable baseline caregiver burden (P = 0.776). By the 3-month follow-up, the multicomponent group exhibited a notably lower ZBI score (26.13 ± 8.88) compared with the conventional group (29.98 ± 9.56), and the difference was statistically significant (t = 2.937, P = 0.004).
Table 5 summarizes the cognitive function outcomes. Baseline MMSE and ADAS-cog scores did not differ markedly between the groups (P = 0.725 and P = 0.616, respectively). After 3 months, the multicomponent group demonstrated a higher MMSE score (21.06 ± 2.67) compared with the conventional group (19.92 ± 2.81), with t = 2.935 and P = 0.004. The ADAS-cog score in the multicomponent group (21.92 ± 6.25) was notably lower than that in the conventional group (24.03 ± 6.77) at 3 months (t = 2.282, P = 0.024), indicating better cognitive performance in the multicomponent group.
| Parameter | Conventional group (n = 104) | Multicomponent group (n = 96) | t value | P value |
| MMSE scores | ||||
| Baseline | 20.28 ± 2.52 | 20.41 ± 2.48 | 0.353 | 0.725 |
| 3 months | 19.92 ± 2.81 | 21.06 ± 2.67 | 2.935 | 0.004 |
| ADAS-cog scores | ||||
| Baseline | 23.15 ± 6.42 | 22.68 ± 6.96 | 0.502 | 0.616 |
| 3 months | 24.03 ± 6.77 | 21.92 ± 6.25 | 2.282 | 0.024 |
Table 6 presents the PSQI scores. No significant baseline difference was found between the two groups (P = 0.764). At 3 months, the multicomponent group had a markedly lower PSQI score (9.88 ± 2.78) compared with the conventional group (12.23 ± 3.27), and the reduction was notably significant (t = 5.462, P < 0.001), suggesting a greater improvement in sleep quality with the multicomponent, nonpharmacological care program.
| Parameter | Conventional group (n = 104) | Multicomponent group (n = 96) | t value | P value |
| Baseline | 12.78 ± 3.05 | 12.91 ± 3.12 | 0.301 | 0.764 |
| 3 months | 12.23 ± 3.27 | 9.88 ± 2.78 | 5.462 | < 0.001 |
This study sought to assess the impact of a multicomponent, nonpharmacological care program on patients with mild AD who also experience anxiety and depression. The intervention focuses on various aspects including neuropsychiatric symptoms, quality of life, caregiver burden, cognitive function, and sleep quality. Our findings indicate that this approach may offer additional benefits compared with conventional care.
One of the key areas where the multicomponent, nonpharmacological care program demonstrated an advantage was in reducing neuropsychiatric symptoms. The patients receiving this intervention showed improved overall symptom scores and reduced distress for caregivers. The potential mechanisms behind these improvements are likely multifaceted, although they were not directly tested in this study. According to the literature, multicomponent, nonpharmacological care programs such as cognitive stimulation therapy and physical exercise may help alleviate symptoms by enhancing brain plasticity and promoting neurogenesis. Cognitive stimulation involves activities that challenge the brain, thereby improving cognitive reserve and resilience against AD pathology. Similarly, previous studies showed that physical exercise can decrease inflammation and oxidative stress, which are known contributors to neuropsychiatric symptoms. Structured social interactions within the care program can offer emotional support and reduce feelings of isolation, further alleviating symptoms[21,22].
The anxiety and depression score in the multicomponent group was notably lower than those in the conventional group. These improvements might be due to the integration of psychological support and relaxation techniques into the care program. Providing a supportive environment allows patients to express their own worries and difficulties and obtain appropriate guidance from professionals, thereby alleviating their anxiety. For example, relaxation techniques such as mindfulness meditation and deep breathing exercises can reduce cortisol levels, which could contribute to alleviating anxiety and depression. Regular physical activity promotes the secretion of endorphins to naturally lift our spirits. These combined effects contribute to a positive mental state and improved emotional well-being[23,24].
The quality of life is a critical outcome measure for patients with AD, especially those exhibiting symptoms such as anxiety or depression. Multicomponent nursing care plans enhance patients’ capacity for self-care in their daily lives and raise their general level of life. This improvement could be attributed to enhanced cognitive functioning and reduced neuropsychiatric symptoms. Improved cognitive performance allows patients to maintain independence in daily activities, which positively impacts their sense of autonomy and self-worth. Minimizing neuropsychiatric manifestations can alleviate the burden on patients with their lives, giving them additional opportunities to participate in society and enjoy life. Social participation can help individuals feel a sense of belonging in society and find their values[25,26].
Caregiver burden represents a critical concern in AD management, affecting the caregiver’s health and the patient’s care quality. Our results suggest that the multicomponent, nonpharmacological care program can effectively reduce caregiver burden. Several hypothetical mechanisms from earlier studies may explain this reduction. Training and education of care providers help them acquire some basic techniques in dealing with problematic behavior. Many disciplinary collaborations provide multidisciplinary medical care, distributing responsibilities among several individuals to avoid increased burden individually. Finally, improvements in patients’ neuropsychiatric symptoms and quality of life reduce the quantity of caring work required from caregivers[27,28].
Cognitive function is a primary target in AD management. Our study found that the multicomponent, nonpharmacological care program had a positive impact on cognitive performance. Prior research suggests that cognitive stimulation, physical exercise, and social interaction in the program may generate this effect. Cognitive stimulation therapy activates several areas of the brain to help improve neuroplasticity and compensate for deficits. Similarly, physical activities can increase blood flow and deliver additional nutrients to neurons across the body to support their work. Social interactions can promote cognitive functions such as memory and attention to enhance overall cognition. These components work synergistically to slow cognitive decline and improve cognitive reserve[9,29].
Insomnia is prevalent in the elderly with dementia and adds to their feelings of loneliness and negativity. The multicomponent, nonpharmacological care program demonstrated effectiveness in improving sleep quality. Previous studies proposed several mechanisms underlying this improvement, including the regulation of circadian rhythms through structured daily routines and the promotion of relaxation techniques. Structured routines help establish consistent sleep patterns, and relaxation techniques decrease stress and anxiety, both of which disrupt sleep. Physical exercises also increase the duration of deep sleep or slow wave stage. Improved sleep quality enhances patients’ daytime functioning and contributes to overall health and well-being[10,30].
The clinical meaningfulness of our findings varies by domain: (1) High clinical significance: Improvements in ADCS-ADL [+ 4.65 points; exceeding the 3-point minimal clinically important difference (MCID) for mild AD][15], QOL-AD, and PSQI (sleep quality: -2.35 points, surpassing the 2-point MCID for PSQI in older adults with cognitive impair
Some limitations exist in this study. Despite the absence of statistically significant differences in measured baseline variables, the retrospective design inevitably carries a risk of selection bias. The patients who were able and willing to attend the 120 hours day hospital program may differ systematically from those receiving conventional care in ways not captured by our medical records. For example, high motivation, strong family support, good socioeconomic status, or great disease awareness could independently contribute to improvements in anxiety, depression, caregiver burden, and quality of life. Such unmeasured or residual confounding factors cannot be excluded. Therefore, our findings should be interpreted as associations rather than causal effects. Future prospective, randomized controlled trials are needed to confirm these results while controlling for these potential confounders. Owing to the short follow-up time, we cannot evaluate the long-term impacts. Prospective, large-scale cohort studies and long-term follow-ups are needed to verify these results and evaluate the sustainability of the observed advantages in detail. Determining which parts of the multiple care measures are most effective for the patient and establishing a new individualized nursing plan must be conducted in the future. Studies must focus on the effects of personalized care plans combined with new technologies, such as digital healthcare applications, on enhancing the efficacy of the multicomponent, nonpharmacological care program for AD.
The multicomponent, nonpharmacological care program showed potential for improving several dimensions of life across people with mild AD who display anxiety or depression. By addressing the neuropsychiatric symptoms, quality of life, caregiver’s burden, cognitive function, and sleep problem, this holistic approach provides comprehensive solutions or alternatives to people with mild AD in need of care. Additional research is warranted to confirm these results and refine the intervention for wide application in clinical settings.
This study proposes a multicomponent, nonpharmacological care program that showed some effects on patients with mild AD accompanied by anxiety and depressive symptoms. The intervention improves the symptom of neuropsychiatry, decreases anxiety and depression level, enhance quality of life, relieves caregiver burden, promotes cognitive function, and alleviates sleep disorders. This overall approach can serve as an additional measure in conjunction with regular treatments; it provides a comprehensive support system for patients and their caregivers. Further prospective studies are necessary to confirm these observations and assess the long-term effectiveness of this care model. Integrating personalized care plans and leveraging emerging technologies may further optimize outcomes for individuals affected by mild AD.
| 1. | Atri A, Dickerson BC, Clevenger C, Karlawish J, Knopman D, Lin PJ, Norman M, Onyike C, Sano M, Scanland S, Carrillo M. Alzheimer's Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer's Disease and Related Disorders (DETeCD-ADRD): Executive summary of recommendations for primary care. Alzheimer's Dement. 2025;21:1-32. [RCA] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 34] [Cited by in RCA: 45] [Article Influence: 45.0] [Reference Citation Analysis (0)] |
| 2. | 2024 Alzheimer's disease facts and figures. Alzheimers Dement. 2024;20:3708-3821. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 1949] [Cited by in RCA: 1896] [Article Influence: 948.0] [Reference Citation Analysis (3)] |
| 3. | Tay LX, Ong SC, Tay LJ, Ng T, Parumasivam T. Economic Burden of Alzheimer's Disease: A Systematic Review. Value Health Reg Issues. 2024;40:1-12. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 5] [Cited by in RCA: 82] [Article Influence: 41.0] [Reference Citation Analysis (0)] |
| 4. | Soni U, Singh K, Jain D, Pujari R. Exploring Alzheimer's disease treatment: Established therapies and novel strategies for future care. Eur J Pharmacol. 2025;998:177520. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 22] [Reference Citation Analysis (0)] |
| 5. | Narasimhan S, Holtzman DM, Apostolova LG, Cruchaga C, Masters CL, Hardy J, Villemagne VL, Bell J, Cho M, Hampel H. Apolipoprotein E in Alzheimer's disease trajectories and the next-generation clinical care pathway. Nat Neurosci. 2024;27:1236-1252. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 52] [Reference Citation Analysis (0)] |
| 6. | Irfan B, Ankouni G, Reader J, Seraji-Bozorgzad N, Giordani B, Bakulski K, Bhaumik A, Hampstead BM, Rahman-Filipiak A. Alzheimer's Disease and Related Dementias in Muslim Women: Recommendations for Culturally Sensitive Care. J Alzheimers Dis. 2024;99:857-867. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 7] [Cited by in RCA: 8] [Article Influence: 4.0] [Reference Citation Analysis (0)] |
| 7. | Hampel H, Li G, Mielke MM, Galvin JE, Kivipelto M, Santarnecchi E, Babiloni C, Devanarayan V, Tkatch R, Hu Y, Kurzman R, Cho M, Vandercappellen J, Nakamura Y, Bell J, Mattke S, Toschi N. The impact of real-world evidence in implementing and optimizing Alzheimer's disease care. Med. 2025;6:100695. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 10] [Cited by in RCA: 13] [Article Influence: 13.0] [Reference Citation Analysis (0)] |
| 8. | Frederiksen KS, Lanctôt KL, Weidner W, Hahn-Pedersen JH, Mattke S. A Literature Review on the Burden of Alzheimer's Disease on Care Partners. J Alzheimers Dis. 2023;96:947-966. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 17] [Reference Citation Analysis (0)] |
| 9. | Quail Z, Carter MM, Wei A, Li X. Management of cognitive decline in Alzheimer's disease using a non-pharmacological intervention program: A case report. Medicine (Baltimore). 2020;99:e20128. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 36] [Cited by in RCA: 23] [Article Influence: 3.8] [Reference Citation Analysis (1)] |
| 10. | Blackman J, Swirski M, Clynes J, Harding S, Leng Y, Coulthard E. Pharmacological and non-pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer's disease: A systematic review. J Sleep Res. 2021;30:e13229. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 79] [Cited by in RCA: 95] [Article Influence: 19.0] [Reference Citation Analysis (1)] |
| 11. | McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984;34:939-944. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 18439] [Cited by in RCA: 19609] [Article Influence: 466.9] [Reference Citation Analysis (1)] |
| 12. | Wang T, Xiao S, Li X, Wang H, Liu Y, Su N, Fang Y. Reliability and validity of the Chinese version of the neuropsychiatric inventory in mainland China. Int J Geriatr Psychiatry. 2012;27:539-544. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 44] [Cited by in RCA: 62] [Article Influence: 4.4] [Reference Citation Analysis (0)] |
| 13. | Byrne GJ, Pachana NA. Development and validation of a short form of the Geriatric Anxiety Inventory--the GAI-SF. Int Psychogeriatr. 2011;23:125-131. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 153] [Reference Citation Analysis (0)] |
| 14. | Lucas-Carrasco R. Spanish version of the Geriatric Depression Scale: reliability and validity in persons with mild-moderate dementia. Int Psychogeriatr. 2012;24:1284-1290. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 23] [Cited by in RCA: 27] [Article Influence: 1.9] [Reference Citation Analysis (0)] |
| 15. | Cintra FCMDC, Cintra MTG, Nicolato R, Bertola L, Ávila RT, Malloy-Diniz LF, Moraes EN, Bicalho MAC. Functional decline in the elderly with MCI: Cultural adaptation of the ADCS-ADL scale. Rev Assoc Med Bras (1992). 2017;63:590-599. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 6] [Cited by in RCA: 17] [Article Influence: 1.9] [Reference Citation Analysis (0)] |
| 16. | Thorgrimsen L, Selwood A, Spector A, Royan L, de Madariaga Lopez M, Woods RT, Orrell M. Whose quality of life is it anyway? The validity and reliability of the Quality of Life-Alzheimer's Disease (QoL-AD) scale. Alzheimer Dis Assoc Disord. 2003;17:201-208. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 292] [Cited by in RCA: 332] [Article Influence: 14.4] [Reference Citation Analysis (0)] |
| 17. | Chattat R, Cortesi V, Izzicupo F, Del Re ML, Sgarbi C, Fabbo A, Bergonzini E. The Italian version of the Zarit Burden interview: a validation study. Int Psychogeriatr. 2011;23:797-805. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 65] [Cited by in RCA: 81] [Article Influence: 5.4] [Reference Citation Analysis (0)] |
| 18. | Brugnolo A, Nobili F, Barbieri MP, Dessi B, Ferro A, Girtler N, Palummeri E, Partinico D, Raiteri U, Regesta G, Servetto G, Tanganelli P, Uva V, Mazzei D, Donadio S, De Carli F, Colazzo G, Serrati C, Rodriguez G. The factorial structure of the mini mental state examination (MMSE) in Alzheimer's disease. Arch Gerontol Geriatr. 2009;49:180-185. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 25] [Cited by in RCA: 31] [Article Influence: 1.8] [Reference Citation Analysis (0)] |
| 19. | Jiang Y, Yang H, Zhao J, Wu Y, Zhou X, Cheng Z. Reliability and concurrent validity of Alzheimer's disease assessment scale - Cognitive subscale, Chinese version (ADAS-Cog-C) among Chinese community-dwelling older people population. Clin Neuropsychol. 2020;34:43-53. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 4] [Cited by in RCA: 14] [Article Influence: 2.3] [Reference Citation Analysis (0)] |
| 20. | Tsai PS, Wang SY, Wang MY, Su CT, Yang TT, Huang CJ, Fang SC. Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Qual Life Res. 2005;14:1943-1952. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 1059] [Cited by in RCA: 1010] [Article Influence: 48.1] [Reference Citation Analysis (2)] |
| 21. | Xie Z, Aghamoosa S, Ying G, Locke DE, Shandera-Ochsner A, Smith GE, Santos O, Grant JG, Shen C, Carriere LJ, de Wit L, Boots EA, Chandler MJ. Effects of care partner type on outcomes from a multicomponent behavioral intervention for mild cognitive impairment. Alzheimers Dement (N Y). 2026;12:e70222. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 1] [Reference Citation Analysis (0)] |
| 22. | Sapra M, Hagemann L, Luci K, Savla J. A mindfulness-based multicomponent caregiver intervention (PAACC): objectives, study design, and cohort description. Alzheimers Dement (N Y). 2025;11:e70064. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 4] [Reference Citation Analysis (0)] |
| 23. | Roach JC, Glusman G, Rapozo MK, Merrill DA, Bramen J, Hodes JF, Siddarth P, Meysami S, Elhelou SHK, Glatt RM, Edens L, Funk C, Kelly D, Shankle WR, Bredesen D, Raji CA, Hood L. Multidomain therapy for Alzheimer's disease: a scoping review of cognitive decline trials. Mol Neurodegener. 2025;20:125. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 3] [Cited by in RCA: 3] [Article Influence: 3.0] [Reference Citation Analysis (0)] |
| 24. | Novais T, Qassemi S, Cestac P, McCambridge C, Villars H, Zueras A, Decaudin B, Dambrine M, Huvent-Grelle D, Roche J, Schoenenburg S, Federico D, Nier AC, Krolak-Salmon P, Mouchoux C. Impact of pharmaceutical care integrated at a psychosocial intervention to reduce caregiver's burden in Alzheimer's disease or related dementias: Negative results at 18 months and difficulties to conduct PHARMAID RCT. Contemp Clin Trials Commun. 2023;33:101146. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 3] [Reference Citation Analysis (0)] |
| 25. | Torres-Castro S, Rabaneda-Bueno R, López-Ortega M, Gutiérrez-Robledo LM, Guzmán A. Multicomponent Staff Training Intervention to Improve Residential Dementia Care (PROCUIDA-Demencia): A Mixed-Methods 2-Arm Cluster Randomized Controlled Pilot and Clinical Outcomes Study. J Am Med Dir Assoc. 2022;23:350-358.e5. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 3] [Cited by in RCA: 13] [Article Influence: 2.6] [Reference Citation Analysis (0)] |
| 26. | Sun Y, Ji M, Leng M, Li X, Zhang X, Wang Z. Comparative efficacy of 11 non-pharmacological interventions on depression, anxiety, quality of life, and caregiver burden for informal caregivers of people with dementia: A systematic review and network meta-analysis. Int J Nurs Stud. 2022;129:104204. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 98] [Cited by in RCA: 136] [Article Influence: 34.0] [Reference Citation Analysis (0)] |
| 27. | Guzmán A, Orellana K, Ortega ML, Robledo LMG, Castro ST. Introducing a multicomponent staff training intervention to reduce antipsychotic medication: Care home management pre and post intervention views of systemic impact, and preliminary RE-AIM evaluation. Eval Program Plann. 2024;103:102399. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 2] [Cited by in RCA: 2] [Article Influence: 1.0] [Reference Citation Analysis (0)] |
| 28. | Brettschneider C, Buczak-Stec E, Luppa M, Zülke A, Michalowsky B, Rädke A, Bauer A, Brütting C, Kosilek RP, Zöllinger I, Döhring J, Williamson M, Wiese B, Hoffmann W, Frese T, Gensichen J, Kaduszkiewicz H, Thyrian JR, Riedel-Heller SG, König HH; AGEWELL. DE study group. Cost-effectiveness of a multicomponent intervention against cognitive decline. Alzheimers Dement (N Y). 2025;11:e70028. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 3] [Cited by in RCA: 3] [Article Influence: 3.0] [Reference Citation Analysis (0)] |
| 29. | Ziyad SR, Altulyan M, Alharbi M. SHMAD: A Smart Health Care System to Monitor Alzheimer's Disease Patients. J Alzheimers Dis. 2023;95:1545-1557. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 5] [Cited by in RCA: 1] [Article Influence: 0.3] [Reference Citation Analysis (0)] |
| 30. | Fang H, Cui F, Zhao Y, Qian Q, Yong A, Lan P, Huang C. Transforming Alzheimer's disease nursing: integrating holistic care, innovative interventions, and evidence-based practices for enhanced patient outcomes. Front Public Health. 2025;13:1624310. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 3] [Reference Citation Analysis (0)] |