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In people with dementia, massage therapy and pet therapy reduce agitation compared with usual care or placebo

Leng M, Zhao Y, Wang Z Comparative efficacy of non-pharmacological interventions on agitation in people with dementia: A systematic review and Bayesian network meta-analysis. Int J Nurs Stud. 2020 Feb;102:103489.

Review questions

In people with dementia, do nondrug interventions reduce agitation? Are some nondrug interventions better than others?


Agitation is common in people with dementia. Signs of agitation include pacing, restlessness, irritability, and sometimes physical or verbal outbursts. Agitation can be distressing for people with dementia and their caregivers.

Interventions that prevent or decrease agitation may reduce distress. This review looks at how different nondrug interventions compare with one another for managing agitation in people with dementia.

How the review was done

The researchers did a systematic review of studies available up to January 2019. They found 65 randomized controlled trials.

The key features of the studies were:

  • all people had dementia;
  • most people were 60 years of age or older;
  • nondrug interventions were compared with a control intervention (mostly usual care or placebo);
  • nondrug interventions included music therapy, personally tailored interventions (i.e., interventions based on a person’s abilities and interests), massage therapy (typically hand or foot massage), aromatherapy, physical exercise interventions, reminiscence therapy, light therapy, animal-assisted interventions (e.g., participating in dog-related activities like petting, brushing, and feeding), pet robot interventions, dementia-care mapping, and horticultural therapy; and
  • people were treated for 5 days to 15 months.

What the researchers found

Compared with control interventions (also see Table below):

  • massage therapy reduced agitation by a moderate amount;
  • personally tailored interventions, animal-assisted interventions, and pet robot interventions reduced agitation by a small amount; and
  • other nondrug interventions did not reduce agitation.

In an analysis that lets you compare interventions that were not directly compared with one another in the individual studies:

·         massage therapy reduced agitation compared with light therapy, music therapy, or reminiscence therapy; and

·         other nondrug interventions did not differ from one another.


In people with dementia, massage therapy, animal-assisted interventions, personally-tailored interventions, and pet robot interventions reduce agitation by a small-to-moderate amount.

Nondrug interventions vs control* for reducing agitation in people with dementia


Number of trials (number of people per trial)

Effect† of intervention

Music therapy

16 trials (16 to 100 people)

No effect

Personally tailored interventions

14 trials (21 to 349 people)

Small reduction in agitation

Massage therapy

8 trials (35 to 56 people)

Moderate reduction in agitation


6 trials (28 to 72 people)

No effect

Physical exercise interventions

5 trials (27 to 116 people)

No effect

Reminiscence therapy

4 trials (24 to 304 people)

No effect

Light therapy

4 trials (48 to 94 people)

No effect

Animal-assisted interventions

4 trials (40 to 88 people)

Small reduction in agitation

Pet robot interventions

3 trials (24 to 275 people)

Small reduction in agitation

Dementia-care mapping

3 trials (192 to 435 people)

No effect

Horticultural therapy

2 trials (13 to 20 people)

No effect

*Most studies compared nondrug interventions with usual care or placebo; some compared different nondrug interventions.

†Amount of reduction in agitation was small (standardized mean difference [SMD] between groups ≥0.2 and <0.5) or moderate (SMD ≥0.5 and <0.8).

Related Topics


A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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