| Hawranik et al.15
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51 participants |
Therapeutic Touch (TT) versus Usual Care (UC). |
2 weeks |
After 5 days post interventions, both groups (TT and UC) showed improvements in both the physically aggressive behaviors (χ2=24.53, P <0.001) and physically nonaggressive behaviors (χ2=28.18, P <0.0001). However, both the physically aggressive and nonaggressive behaviors increased during the 2-week period after the completion of the interventions (χ2=10.63, P <0.01; incidence ratio=0.29, CI 0.13, 0.65 and χ2=11.03, P <0.01, respectively.
Physically nonaggressive behaviors in the UC group were 2.3 times higher than in the TT group (CI.66, 7.81). |
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| Woods et al.16
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57 participants |
Therapeutic Touch (TT) versus Usual Care (UC). |
3 days |
Statistically significant change was evident in the TT group when compared with the UC group, particularly in the frequency and intensity of behavioral symptoms, which demonstrated that TT offers a clinically more relevant decrease in behavioral symptoms of dementia.
Both restlessness, t(36)=−2.435, P=0.020, and vocalization, t(36)=−2.261, P −0.030, were significantly improved in the TT group compared with the UC group. |
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| Gitlin et al.13
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60 participants (with 60 caregivers) |
8 sessions of Tailored Activity Program (TAP) versus wait-list control |
4 months period. |
Outcome measures included behavioral occurrences, activity engagement, and quality of life in dementia patients together with the objective and subjective burden and skill enhancement in caregivers.
Compared with controls, TAP intervention caregivers reported reduced frequency of odd behaviors (P=0.010; Cohen’s d=0.72), specifically for shadowing (P=0.003, Cohen’s d=3.10) and repetitive questioning (P=0.23, Cohen’s d=1.22); greater activity engagement (P=0.029, Cohen’s d=0.61. Fewer TAP intervention caregivers also reported agitation (P=0.014, Cohen’s d=0.75) or argumentation (P=0.010, Cohen’s d=0.77).
Caregiver benefits included fewer hours doing things (P =0.005, Cohen’s d=1.14) and being on duty (P=0.001, Cohen’s d=1.01), greater mastery (P=0.013, Cohen’s d=0.55), self-efficacy (P=0.011, Cohen’s d=0.74). |
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| O'Connor et al.17
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64 participants |
Dermally-applied, neuro-physiologically active, high purity 30% lavender oil versus inactive control (Jojoba) oil. |
Three exposures over 1week period with a four-day washout period in-between. |
First 30 min post-exposure: Mean (s.d.) for Lavender: Behavior −14.5 (10.8); Positive affect −7.0 (10.1); Negative affect 0.9 (3.9), and for Control: Behavior 16.0 (10.4); Positive affect 6.4 (9.9); Negative affect 1.0 (3.9).
Second 30 min post-exposure: Mean (s.d.) for Lavender: Behavior 14.4 (10.6); Positive affect 6.7 (10.2); Negative affect 0.7 (3.9) and for Control: Behavior 15.5 (10.7); Positive affect 6.3 (9.6); Negative affect 0.9 (3.8)
Lavender oil showed no significant beneficial effects over inactive control oil in treating agitation behaviors in dementia people. The decreased agitated behaviors noted in the lavender oil group were believed to be evident before exposure to the lavender. |
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| Livingston et al.18
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33 studies |
Music therapy; sensory interventions; light therapy; communication skills training; dementia care mapping; aromatherapy; cognitive–behavioural therapy and stimulation therapy exercise |
Varies with intervention (from 30 min and up to 6 months) |
Comparison of interventions outcomes were estimated using standardised effect sizes (SES) with 95% confidence intervals.
Training care-home staffs in communication skills, person-centred care and dementia care mapping with supervision during implementation were significantly effective for reducing severe agitation immediately (SES=0.3–1.8) and for up to 6 months afterwards (SES=0.2–2.2).
Sensory intervention and music therapy also decreased overall agitation.
Aromatherapy, exercise and light therapy failed to show any significant efficacy. |
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| Abraha et al.19, 20
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38 secondary studies (extracted from 142 primary studies). |
Sensory stimulation interventions; cognitive/emotion-oriented interventions; and other therapies (exercise therapy, animal-assisted therapy) |
Varies (up to 12 months) |
Outcome measured were (1) multi-domain scales (Neuropsychiatric Inventory (NPI), Brief Psychiatric Rating Scale, BPRS), (2) scales specific to agitation (Cohen-Mansfield Agitation Inventory, CMAI) and (3) scales specific to depression or anxiety (Cornell Scale for Depression in Dementia, CSDD).
Music therapy demonstrated efficacy in reducing agitation (SMD, −0.49; 95% CI −0.82 to −0.17; P=0.003), and anxiety (SMD, −0.64; 95% CI −1.05 to −0.24; P=0.002).
Home-based behavioral management techniques, caregiver-based interventions or staff training in communication skills, person-centred care or dementia care mapping with supervision during implementation were found to be effective for symptomatic and severe agitation. |
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| Vink et al.21
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91 participants |
Music therapy intervention compared with general day (recreational) activities |
4 months |
Both interventions resulted in short-term decrease in agitation. Although the music therapy reduced agitation behaviour much better, their difference was not statistically significant (F = 2.885, P = 0.090) and disappeared completely after adjustment for Global Deterioration Scale stage (F = 1.500; P = 0.222). |
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| Jutkowitz et al.22
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19 studies (3566 participants) |
Dementia care mapping (DCM); Person-centered care (PCC); Clinical protocols to reduce the use of antipsychotic and other psychotropic drugs; and Emotion-oriented care. |
Varies (2 weeks to 20 months) |
DCM (standardized mean difference −0.12, 95% confidence interval (CI)=−0.66 to 0.42), PCC (standardized mean difference −0.15, 95% CI=−0.67 to 0.38), and Protocols to reduce antipsychotic and other psychotropic use (Cohen-Mansfield Agitation Inventory mean difference −4.5, 95% C=−38.84 to 29.93).
Insufficient strength of evidence to conclude that behavioral management techniques or interventions are any more effective than the usual care in improving agitation and aggression in dementia populations. |
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| Acharya et al.9
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23 participants |
Electroconvulsive therapy (ECT) |
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Outcome measures included Cohen-Mansfield Agitation Inventory (CMAI)-short form, Neuropsychiatric Inventory (NPI)-Nursing Home Version, Cornell Scale for Depression in Dementia (CSDD), and the Clinical Global Impression Scale (CGI) at baseline, during, and after ECT sessions, and within 72 h before discharge.
Regression analyses revealed a significant decrease from baseline to discharge on the CMAI (F (4, 8)=13.3; P=0.006) and NPI (F(4, 31)=14.6; P<0.001). There was no statistically significant change in scores on the CSDD. The CGI scores on average changed from a rating of ‘markedly agitated/aggressive’ at baseline to ‘borderline agitated/aggressive’ at discharge. |
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| Yang et al.11
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186 participants |
Aroma-acupressure (A-a) and Aromatherapy (A) interventions versus Control group. |
4 weeks |
The differences in agitation were assessed using Cohen-Mansfield Agitation Inventory (CMAI) scale and the Heart Rate Variability (HRV) index.
The CMAI scores were significantly lower in the aroma-acupressure and aromatherapy groups compared with the control group in the post-test and post-three-week assessments
On the basis of the HRV and the CMAI, aroma-acupressure showed better improvement at reducing agitation, inhibit the sympathetic nervous system, and activate the parasympathetic nervous system compared with aromatherapy. |
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Group Pre-test mean±s.d. Post-test mean Post 3 weeks β (95% CI) P value
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A-a group (n=56) 54.58±11.01 43.24±10.00 51.21±11.95 16.74 (13.71−19.77) 0.00* |
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A group (n=73) 41.81±7.89 41.08±8.24 39.80±7.27 4.01 (1.19−6.83) 0.01* |
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Control group (n=57) 37.68±4.12 41.72±5.08 42.13±5.53 Reference — |
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Time — — — — — |
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Post-test — — — 3.96 (2.22−5.71) <0.01 |
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Post-3-week — — — 4.39 (2.64−6.13) <0.01 |
