Table 3Summary of findings

InterventionStudies included in Systematic Reviews (SRs)Quality of data: Most recent search date Length of follow-up Consistency of findingsEstimate of benefit; overall level of evidenceStudy limitationsComments on feasibility and acceptability
Emotional Oriented Approaches
Reminiscence Therapy7 RCTsMost recent search date: March 2006
Follow-up: ≥ 4 weeks
Consistency of findings: Showed no benefit, except for depression in 1 small RCT
Neutral effect; lowEvidence is based on a small number of studies with very small sample sizes.Requires a master's level counselor for implementation. Patients and caregivers appear to enjoy the intervention.
Simulated Presence Therapy (SPT)1 RCT and 3 other studiesMost recent search date: February 2008
Follow-up: Not reported
Consistency of findings: No, studies showed mixed results
Inconclusive; lowIncluded studies were not quality rated. Variability in outcome measures used and in the administration of SPT. Findings are based on small sample sizes.Requires a master's level counselor for implementation.
Validation Therapy3 RCTs and 2 other studies with small samples (N=5) in eachMost recent search date: March 2006
Follow-up: 6 weeks to 12 months
Consistency in findings: No, studies showed mixed results.
Inconclusive; lowSmall sample sizes.Requires a master's level counselor for implementation. Included studies had high levels of intervention intensity.
Stimulation Oriented Approaches
AcupunctureNo studies met inclusion criteriaMost recent search date: February 2007Inconclusive; no studiesNARequires a certified therapist.
Aromatherapy1 RCT and 1 other studyMost recent search date: March 2008
Follow-up: ≤ 4 weeks
Consistency of findings: Yes
Positive effect on agitation; lowFindings are based on a small sample. Possible problems with heterogeneity and other confounding variables.May be easily implemented in a group setting without extensive training.
Light Therapy4 RCTs, 4 other studiesMost recent search date: December 2005
Follow-up: No follow-up to 1 week
Consistency of findings: No, studies showed mixed results
Positive effects on agitation and sleep; lowOverall findings are based on a small number of poor quality studies with very small sample sizes.Depends on the method of therapy administered.
Massage and Touch3 RCTsMost recent search date: July 2005
Follow-up: 1 hr post treatment to 5 days
Consistency of findings: Yes
Positive effects on agitation; lowStudy findings are based on small sample sizes and limited treatment duration.

Similar to calming music in preventing agitation. Support for massage compared to no treatment.
Depends on the type of therapy: A licensed massage therapist would be needed for some treatments; hand massage and touch therapy may be easier to implement. The increased stimulus could increase agitation and aggression in some individuals.
Music Therapy4 SRs that included 3 RCTsStudy designs: Mostly time series in which subjects served as their own controls; also RCTs and case studies
Quality rating: RCTs were poor
Data sparseness: Samples were small; the largest study had 39 subjects
Consistency of findings: Yes
Positive effects on agitation; lowLimitations: Well-conducted studies are lacking. Benefits appear to be short-term.Some music interventions are simple and low-cost (e.g., playing recorded music at mealtimes) and may be feasible for wide implementation. The increased stimulus could increase agitation and aggression in some individuals.
Snoezelen Multisensory Therapy6 RCTsMost recent search date: March 2008
Follow-up: ≤ 1 month
Consistency of findings: No, studies showed mixed results
Inconclusive; moderateVariability of intervention components in included studies.May be easily implemented in a group setting without extensive training.
Transcutaneous Electrical Nerve Stimulation (TENS)3 RCTsMost recent search date: December 2005
Follow-up: ≤ 6 weeks
Consistency of findings: Yes (data were pooled)
Neutral effect; lowIndividual studies consisted of small sample sizes.Would most likely require a trained OT or PT or master's level psychologist.
Behavior Management Techniques
Behavior Management Techniques7 RCTs plus 2 recent primary studies identified by peer reviewMost recent search date within SRs: January 2006
Follow-up: ≤9 months
Consistency of findings: No, studies showed mixed results
Mixed results across outcomes; lowInadequate blinding procedures; control groups primarily usual care rather than alternative interventions.Varies based on type of intervention; many interventions likely able to be implemented in VA settings, though individualization to patients is often needed. Likely requires master's level therapist or psychologist.
Other Psychosocial Interventions
Animal-assisted Therapy9 primary studies, no RCTsStudy design: Uncontrolled time series and non-randomized controlled trials
Quality rating: Not applicable to study design
Data sparseness: # participants ranged from 6 to 62 per study/length of follow-up ranged from same day of intervention to 4 weeks
Consistency of findings: No, studies showed mixed results
Positive effects on agitation, passivity, social interactions, and nutritional intake; very lowStudies were small and heterogeneous, and lacked methodological rigor.Among the therapies studied, fish aquariums and visiting dog therapy may be feasible for broad implementation in VA.
Exercise3 SRs: 18 RCTs and 17 other trialsMost recent search date: September 2007
Follow-up: 5 days to 24 months
Consistency in findings: No, studies showed mixed results
Positive effects on sleep; very low overall; moderate for outcome of sleepSmall sample sizes, variation in intervention intensity and duration, variation in baseline dementia severity. Poor methodology.Varies based on intensity of intervention, but some interventions (e.g., walking) could be accomplished without specialized training.
Targeted Behavioral Symptoms
WanderingSubjective barriers: No RCTs met inclusion criteriaMost recent search date: March 2009NA; no evidenceNANA
Various sensory stimulation therapies: 8 RCTs, 3 non-RCT parallel and cross-over studiesMost recent search date: October 2005
Follow-up: range 3 days to < 1 year (mean 6 weeks)
Consistency of findings: No, studies showed mixed results
Inconclusive; lowEvidence is based on a small number of studies within each intervention category. Quality of studies was poor, with limited methodological reporting.Music, exercise, and multisensory stimulation appear to be pleasant and enjoyable for patients. The increased stimulation could increase agitation and aggression in some individuals. These interventions are likely easy to implement in VA settings at low cost.
GPS tracking devices, boundary alarms, other monitoring devicesCase studies; cross-sectional studies; or single-group, pre- and post-test/post-test only studies. Search date through 2006.Improved patient safety; very lowStudies were small and lacked a control group.Costly and resource intensive, requiring training and technical support. Increases caregiver peace of mind.
Agitation7 RCTs and 7 randomized cross-over studies, plus 1 recent primary study identified by peer reviewFollow-up: Up to 2 months (study grouped follow-up < 2 mos. and > 2 mos.)
Consistency of findings: Yes (data were pooled)
Positive effects on agitation with sensory interventions and systematic individualized intervention; lowSmall number of studies for each type of therapy; variability in duration of treatment and measuring instruments.Aromatherapy, thermal bath, calming music, and hand massage are low-cost and have some evidence of benefit.
Inappropriate Sexual BehaviorNo SRs foundThere is no available evidence to support or refute the effectiveness of non-pharmacological treatments for inappropriate sexual behavioral among patients with dementia.NANANA

From: CONCLUSIONS

Cover of A Systematic Evidence Review of Non-pharmacological Interventions for Behavioral Symptoms of Dementia
A Systematic Evidence Review of Non-pharmacological Interventions for Behavioral Symptoms of Dementia [Internet].
O'Neil ME, Freeman M, Christensen V, et al.
Washington (DC): Department of Veterans Affairs (US); 2011 Mar.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.