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Clinician Article

Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials.



  • Livingston G
  • Kelly L
  • Lewis-Holmes E
  • Baio G
  • Morris S
  • Patel N, et al.
Br J Psychiatry. 2014 Dec;205(6):436-42. doi: 10.1192/bjp.bp.113.141119. (Review)
PMID: 25452601
Read abstract Read evidence summary Read full text
Disciplines
  • Psychiatry
    Relevance - 7/7
    Newsworthiness - 6/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 6/7
  • Neurology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Geriatrics
    Relevance - 6/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 6/7

Abstract

BACKGROUND: Agitation in dementia is common, persistent and distressing and can lead to care breakdown. Medication is often ineffective and harmful.

AIMS: To systematically review randomised controlled trial evidence regarding non-pharmacological interventions. Method We reviewed 33 studies fitting predetermined criteria, assessed their validity and calculated standardised effect sizes (SES).

RESULTS: Person-centred care, communication skills training and adapted dementia care mapping decreased symptomatic and severe agitation in care homes immediately (SES range 0.3-1.8) and for up to 6 months afterwards (SES range 0.2-2.2). Activities and music therapy by protocol (SES range 0.5-0.6) decreased overall agitation and sensory intervention decreased clinically significant agitation immediately. Aromatherapy and light therapy did not demonstrate efficacy.

CONCLUSIONS: There are evidence-based strategies for care homes. Future interventions should focus on consistent and long-term implementation through staff training. Further research is needed for people living in their own homes.


Clinical Comments

General Internal Medicine-Primary Care(US)

This systematic review is well designed, without bias of publication. Unfortunately, the trials included are small and very heterogeneous.

General Internal Medicine-Primary Care(US)

An excellent synopsis of the literature for non-pharmacologic interventions for agitation in patients with dementia. Dementia care mapping (assessing a patient`s behaviors, factors improving well-being, and potential triggers) seemed effective in both the short and long term. The information will be helpful when counseling family members who have patients who are demented and agitated.

Internal Medicine

I suspect most internists don`t follow this literature.

Neurology

In my opinion, such intervention is necessary but quite time-consuming and not particularly effective.

Neurology

Everyone will agree that by and large pharmacologic therapy in agitation is mediocre at best, although it`s quite useful sometimes. This paper fills a void. That cognitive-behavioural and behavioural therapies are not usually effective may be obvious to some, but it will be news to many more. The principle that unmet needs is more often the cause of agitation and not brain disease proved startling. Trouble is that to implement this methodology means meaningful training to large quantities of staff in countries where funds are not abundant, much less people skilled in training others.

Psychiatry

The absence of effective therapies for preventing or halting dementia, combined with the multiple adverse outcomes associated with symptomatic drug treatments for agitation, highlights the importance of non-drug therapies. This up-to-date overview is a useful contribution.

Psychiatry

This is very well presented and written.

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