Table 3.

Psychosocial interventions: main features and evidence of efficacy

Psychosocial interventions: cognitive and function oriented activities
Intervention	Features	Evidence of efficacy
Cognitive training	Stimulation of specific cognitive areas through individual or group sessions	Uncertain beneficial effect on memory in dementia [46, 55]
Cognitive rehabilitation	Intervention aimed at cognitive functions necessary for daily living activities deemed relevant for the person	In moderate dementia positive effects on stimulated cognitive function and on disability, delay of nursing home admission [56]
Cognitive stimulation therapy	Structured stimulation of cognitive functions, emotions and social skills, oriented to patient's well being	Improvement of cognitive abilities (comparable to cholinesterase inhibitors), social interaction and quality of life [57, 58]
Physical activity	Specific programs for different stages of cognitive deterioration, possible more effective if combined with cognitive tasks	Reduced decline of autonomy. Possible cognitive improvement associated with aerobic exercise. Non-consistent data on fall risk [59–67]
Occupational therapy	Intervention based on meaningful activities of daily life	Improvement of autonomy, quality of life, mood and caregiver’s stress. Short-term improvement of BPSD [68–70]

Psychosocial interventions: emotion, behaviour and sensory stimulation oriented activities
Intervention	Features	Evidence of efficacy
Systemic Intervention	Functional analysis of behaviour, including the identification of “unmet needs”. Person-centred-care	Comparable effectiveness to drug therapies on decreasing agitation. Improvement of quality of life [71–73]
Music-therapy Art therapy	Using music with a therapeutic purpose and for individually planned outcomes, including both active and receptive approaches [74–76] Using art as therapy, either referring to “art appreciation” programs or “making visual art” laboratories, aimed at enhancing well-being [77].	Effectiveness of music therapy on reducing agitation, depression, anxiety, overall behavioural problems, and increasing quality of life [78–81]; limited or no evidence on cognitive function [82] Little evidence on effectiveness of dance-therapy [83] Art therapy improves neuropsychiatric symptoms, social behaviour and self-esteem in small trials [77, 84, 85]
Animal-assisted therapy or activities carried out with the presence of people or objects	Using animals, familiar objects (dolls) or people (clown) for therapeutic purposes	Benefits of animal-assisted therapy on anxiety, depression and agitation. Limited evidence on the psychological wellbeing of doll-therapy [77, 86, 87]
Personally targeted activities	A wide range of activities and interventions that are important and meaningful to the person	Possible efficacy on BPSD [88, 89]
Multisensory stimulation	Use of multisensory environmental stimulation (snoezelen) or aroma. Therapeutic Garden (TG) providing sensory stimulation	Possible efficacy on apathy, agitation, wandering and mood in severe dementia (snoezelen). Uncertain effects of aromatherapy on agitation [90]. TG may reduce BPSD [30–32]

BPSD behavioural and psychological symptoms of dementia