Table 1.
Studies included in the review (n=8)
| Study | Country | Study design | Level of cognitive impairment | Sample | Therapy | Agitation scale | Main findings |
|---|---|---|---|---|---|---|---|
| Ancoli-Israel et al22 | USA | RCT | MMSE =5.7±5.6 | Institutionalized patients with severe AD (n=92; 63 women; mean ± SD =82.3±7.6, range 61–99) Treatment groups: E1: Morning bright light (n=30) E2: Evening bright light (n=31) C: Control (n=31) |
Light therapy N sessions: 10 (1/day, 120 minutes) Duration: 10 days Follow-up: 5 days |
CMAI9 ABRS31 |
CMAI: Caregiver ratings of agitation significantly decreased after treatment in all groups ABRS: No significant effects on observational rating in agitation |
| Burns et al24 | UK | Multicenter RCT | CDR =3 | Institutionalized AD patients (n=94; 56 women; age range 63–98) Treatment groups: E1: Aromatherapy (Melissa oil; n=32; 21 women, mean age =85.6) E2: Donepezil (n=31; 21 women; mean age =84.6)C: Placebo (n=31; 15 women; mean age =85.1) |
Aromatherapy N sessions: 2/day (1–2 minutes) Duration: 4 weeks (n=94) Follow-up: week 12 (n=81) |
PAS32 NPI30 |
No significant differences between aromatherapy, donepezil, and placebo groups at week 4 and 12 Improvements in all three groups in the PAS and NPI over 12 weeks |
| Dowling et al23 | USA | RCT | MMSE =7.0±7.0 | Institutionalized AD patients (n=70; 57 women; mean age ± SD =84.0±10.0, range 58–98) Treatment groups: E1: Morning bright light (n=29) E2: Afternoon bright light (n=24) C: Control (n=17) |
Light therapy N sessions: 1 hour/day (Monday–Friday) Duration: 10 weeks (50 hours) |
NPI-NH30 | Significant but possibly potentially not clinically relevant worsening on agitation/aggression after treatment |
| Hawraniket al25 | Canada | RCT | MMSE =5.5±6.6 | Residents of a long-term care facility with AD (n=51) Treatment groups: E1: Therapeutic Touch (TT; n=17; 10 women; mean age ± SD =83.3±8.3) E2: Simulated TT (n=16; 14 women; mean age ± SD =84.2±6.2) C: Usual care (n=18; 12 women; mean age ± SD =80.9±7.4) |
Therapeutic touch N sessions: 5 (1/day; 30–40 minutes) Duration: 5 days |
CMAI9 | Physical nonaggressive behaviors decreased in E1 (therapeutic touch) No differences across groups in physically aggressive and verbally agitated behaviors |
| Narme et al19 | France | RCT | Music group: MMSE =9.6±5.3 Cooking group: 10.8±8.4 |
Nursing home AD patients (n=37; 32 women) Treatment groups: E: Music (n=18; 15 women; mean age ± SD =86.7±6.4) C: Cooking (n=19; 17 women; mean age ± SD =87.5±6.0) |
Music therapy N sessions: 2/week (1 hour each) Duration: 4 weeks (8 hours total) Follow-up: 2 and 4 weeks |
CMAI9 | Music decreased severity of agitated behaviors during the treatment (fourth session) but not at the end (eighth session) or at follow-up |
| Sakamoto et al20 | Japan | RCT | CDR =3 | Patients with severe AD from group homes and a special dementia hospital (n=39) Treatment groups: E1: Passive music (n=13; 10 women; mean age ± SD =78.7±12.1) E2: Interactive music (n=13; 11 women; mean age ± SD =81.2±7.5) C: No-music control (n=13) |
Music therapy N sessions: 10 (1/week; 30 minutes) Duration: 10 weeks Follow-up: 3 weeks |
BEHAVE-AD29 | Reduction in behavioral and psychological symptoms following interactive music intervention. The interactive music intervention reduced aggressiveness toward caregivers. Effects disappeared at follow-up |
| Svansdottir and Snaedal21 | Iceland | Case-control study | GDS =5–7 | Nursing home patients with moderate or severe AD (n=38; age range 71–87) Treatment groups: E: Music therapy (n=20) C: Control (n=18) |
Music therapy N sessions: 18 (30 minutes). 3 times/week Duration: 6 weeks Follow-up: 4 weeks |
BEHAVE-AD29 | Significant reduction in activity disturbances in the music therapy group |
| Teri et al26 | USA | Multicenter RCT | BMT group: MMSE =12.0±7.0 Haloperidol group: MMSE =13.0±8.0 Trazodone group: MMSE =14.0±7.0 Placebo group: MMSE =13.0±8.0 |
AD outpatients (n=148) Treatment groups: E1: BMT (n=41, mean age ± SD =74.8±8.4) E2: Haloperidol (n=34; mean age ± SD =75.3±6.9) E3: Trazodone (n=37; mean age ± SD =73.2±6.6) C: Placebo (n=36; mean age ± SD =75.8±6.2) |
Behavioral Management Training (BMT) N sessions: 11 (8 weekly & 3 biweekly) Duration: 16 weeks |
CMAI9 ABID33 |
No significant differences on agitation across groups. Significantly fewer adverse events in the BMT group |
Abbreviations: AD, Alzheimer’s disease; ABID, Agitated Behavior Inventory for Dementia; ABRS, Agitated Behavior Rating Scale; BEHAVE-AD, Behavioral Pathology in Alzheimer’s Disease Rating Scale; BMT, Behavior Management Techniques; C, Control group; CDR, Clinical Dementia Rating Scale; CMAI, Cohen-Mansfield Agitation Inventory; E, Experimental group; GDS, Global Deterioration Scale; MMSE, Mini–Mental State Examination; NPI, Neuropsychiatric Inventory; NPI-NH, Neuropsychiatric Inventory-Nursing Home; PAS, Pittsburgh Agitation Scale; RCT, Randomized Controlled Trial; N sessions, Number of sessions.