Evidence Table 10. Efficacy of Nonpharmacologic Intervention for Behavioral Problems Related to Dementia: Systematic Reviews

AuthorN RCT InterventionOutcomesResults Quality and Comments
Forbes 1998151 1 RCT + 2 randomized trialsMusic, skills training, visual barriers, exercise, light therapy, pet therapy, sensory integration, reality orientation, hand massage, therapeutic touch, life review, white noiseSocial interaction; agitation; wandering; physical aggression; day/night disturbance; self-care; eating problemsNone of the included studies met our inclusion criteria.Good
132 pts1 strong trial (planned walking + conversation)Improved communicative function P = .007All strong and moderate studies conducted in long term care facilities; we included only trial with moderate or strong validity and random allocation with control group
1 mod trial (attention focused group)Improve activities participation P ≤.001
1 mod trial (functional skills training)Improved self-care ability P = .04
Opie et al., 1999155 4 RCTsSensory integration (1 RCT)General agitation (4 RCTs)Activities program plus caregiver educationImprove physical aggression P = significantGood
215 ptsActivities (1 RCT)Physical aggression (1 RCT)Activities programNo effect on general agitation P = NSOnly 1 RCT used multi-disciplinary team met our inclusion criteria with no fatal methodology flaw
Caregiver education (2 RCTs)Multidisplinary teamImproved general agitation P = significant
Multidisciplinary team (1 RCT)Caregiver educationNo effect on general agitation P = NS
Koger and Brotons, 2000160 0 RCTs Music therapy ---- No RCT was found Good
Neal and Briggs, 2000161 2 RCTsValidation therapy 2–4 times wk for 36–52 wksCognitive (MSQ, PGCMS)MSQWMD:-1.8 (99% CI, -9.7 to +6.1)NSGood
102Functional: MOSESPGCMSWMD: 1.1 (95% CI, -7.5 to +5.3)NSBoth studies conducted in long term care facility; dementia was moderate to severe in 1 RCT and at least moderate in the second
Behavioral: CMAI, MOSES, MSBSSelf-care MOSESWMD: -1.1 (99% CI, -4.9 to +2.7)NS
Verbal agitation CMAIWMD: 3.9 (99% CI, -4.1 to +11.9)NS
Withdrawal MOSESWMD: 1.6 (99% CI, -6.0 to +2.8)NS
Confusion MOSESWMD: 3.0 (99% CI, -2.8 to +8.8)NS
Social behavior MSBSWMD: 1.1 (99% CI, -10.3 to +8.1)NS
Spector et al., 2000162 2 RCTsReminiscence therapy 30 min 2–5 times weekly for 4–5 weeksCognitive CAPE, MMSE,Information/orientation CAPEWMD: 0.05 (95% CI, -4.37 to +4.77)NSGood
15Behavior CAPE BDIBehavioral CAPEWMD: -3.3 (95% CI, -14.2 to +7.60)NSClinical setting and dementia severity not specified; in 1 RCT, patients had moderate to severe dementia
Spector et al., 2000163 6 RCTsReality orientation 30–60 minutes 2–5 times weekly for 4–21 weeksCognitive multiple scalesCognitiveSMD: -0.59 (95% CI, -0.95 to -0.22)SignificantGood
125Behavior multiple scalesBehaviorSMD: -0.64 (95% CI, -1.20 to -0.08)SignificantClinical setting and dementia severity not specified; patients in 1 RCT had severe cognitive impairment, other trial had mild dementia. Patients in 1 RCT were institutionalized

From: Appendix B. Evidence Tables

Cover of Screening for Dementia
Screening for Dementia [Internet].
Systematic Evidence Reviews, No. 20.
Boustani M, Peterson B, Harris R, et al.

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