Skip to main content
    • Aa
    • Aa

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

  • Daniel W. O'Connor (a1), David Ames (a2), Betina Gardner (a1) and Madeleine King (a3)

Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically oriented paradigms (learning theory, unmet needs and altered stress thresholds).

Method: English language reports published or in press by December 2006 were identified by means of database searches, checks of previous reviews and contact with recognized experts. Papers were appraised with respect to study design, participants' characteristics and reporting details. Because people with dementia often respond positively to personal contact, studies were included only if control conditions entailed similar levels of social attention or if one treatment was compared with another.

Results: Only 25 of 118 relevant studies met every specification. Treatment proved more effective than an attention control condition in reducing behavioral symptoms in only 11 of the 25 studies. Effect sizes were mostly small or moderate. Treatments with moderate or large effect sizes included aromatherapy, ability-focused carer education, bed baths, preferred music and muscle relaxation training.

Conclusions: Some psychosocial interventions appear to have specific therapeutic properties, over and above those due to the benefits of participating in a clinical trial. Their effects were mostly small to moderate with a short duration of action. This limited action means that treatments will work best in specific, time-limited situations. In the few studies that addressed within-group differences, there were marked variations in response. Some participants benefited greatly from a treatment, while others did not. Interventions proved more effective when tailored to individuals' preferences.

Corresponding author
Correspondence should be addressed to: Professor Daniel O'Connor, Aged Mental Health Research Unit, Kingston Centre, Warrigal Road, Cheltenham, Victoria 3192, Australia. Phone: +61 (03) 9265 1700 Fax: +61 (03) 9265 1711. Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

D. G. Altman , K. F. Schulz , D. Moher , M. Egger and F. Davidoff (2001). The revised CONSORT statement for reporting randomised trials: explanation and elaboration. Annals of Internal Medicine, 134, 663694.

L. Ayalon , A. M. Gum , L. Feliciano and P. A. Arean (2006). Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia. Archives of Internal Medicine, 166, 21822188.

S. Baillon , E. Van Diepen , R. Prettyman , J. Redman , N. Rooke and R. Campbell (2004). A comparison of the effects of Snoezelen and reminiscence therapy on the agitated behaviour of patients with dementia. International Journal of Geriatric Psychiatry, 19, 10471052.

C. G. Ballard , J. T. O'Brien , K. Reichelt and E. K. Perry (2002). Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. Journal of Clinical Psychiatry, 63, 553558.

N. Bharani and M. Snowden (2005). Evidence-based interventions for nursing home residents with dementia-related behavioral symptoms. Psychiatric Clinics of North America, 28, 9851005.

S. C. Burgener , M. Jirovec , L. Murrell and D. Barton (1992). Caregiver and environmental variables related to difficult behaviors in institutionalized, demented elderly persons. Journal of Gerontology, 47, P242249.

L. D. Burgio , A. Stevens , K. L. Burgio , D. L. Roth , P. Paul and J. Gerstle (2002). Teaching and maintaining behavior management skills in the nursing home. Gerontologist, 42, 487496.

L. Camberg (1999). Evaluation of simulated presence: a personalized approach to enhance well-being in persons with Alzheimer's disease. Journal of the American Geriatrics Society, 47, 446452.

M. E. Clark , A. W. Lipe and M. Bilbrey (1998). Use of music to decrease aggressive behaviors in people with dementia. Journal of Gerontological Nursing, 24 (7), 1017.

J. Cohen (1988). Statistical Power Analysis for the Behavioral Sciences (2nd edn). Hillsdale, NJ: Lawrence Earlbaum.

J. Cohen-Mansfield (1986). Agitated behaviours in the elderly II: preliminary results in the cognitively deteriorated. Journal of the American Geriatrics Society, 34, 722727.

J. Cohen-Mansfield (2001). Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique. American Journal of Geriatric Psychiatry, 9, 361381.

J. Cohen-Mansfield and P. Werner (1998). The effects of an enhanced environment on nursing home residents who pace. Gerontologist, 38, 199208.

P. P. De Deyn , I. R. Katz , H. Brodaty , B. Lyons , A. Greenspan and A. Burns (2005). Management of agitation, aggression and psychosis associated with dementia: a pooled analysis including three randomized, placebo-controlled double-blind trials in nursing home residents treated with risperidone. Clinical Neurology and Neurosurgery, 107, 497508.

J. C. Dunn , B. Thiru-Chelvam and C. H. M. Beck (2002). Bathing: pleasure or pain? Journal of Gerontological Nursing, 28 (11), 613.

K. Garland , E. Beer , B. Eppingstall and D. W. O'Connor (2007). A comparison of two treatments of agitated behavior in nursing home residents with dementia: simulated presence and preferred music. American Journal of Geriatric Psychiatry, 15, 514521.

R. W. Groene (1993). Effectiveness of music therapy 1:1 intervention with individuals having senile dementia of the Alzheimer's type. Journal of Music Therapy, 30, 138157.

M. Haupt and A. Kurz (1993). Predictors of nursing home placement in patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 8, 741746.

C. Holmes and C. Ballard (2004). Aromatherapy in dementia. Advances in Psychiatric Treatment, 10, 296300.

A. M. Kolanowski , M. Litaker and L. Buettner (2005). Efficacy of theory-based activities for behavioral symptoms of dementia. Nursing Research, 54, 219228.

J. Opie , C. Doyle and D. W. O'Connor (2002). Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventions. International Journal of Geriatric Psychiatry, 17, 613.

H. Ragneskog , G. Bråne , I. Karlsson and M. Kihlgren (1996). Influence of dinner music on food intake and symptoms common in dementia. Scandinavian Journal of Caring Sciences, 10, 1117.

R. Remington (2002). Calming music and hand massage with agitated elderly. Nursing Research, 51, 317323.

R. L. Rosnow and R. Rosenthal (1996). Computing contrasts, effect sizes, and counternulls on other people's published data: general procedures for research consumers. Psychological Methods, 1, 331340.

L. S. Schneider (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 15251538.

K. Sherratt , A. Thornton and C. Hatton (2004). Emotional and behavioural responses to music in people with dementia: an observational study. Aging and Mental Health, 8, 233241.

P. D. Sloane (2004). Effect of person-centred showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. Journal of the American Geriatrics Society, 52, 17951804.

M. Snowden , K. Sato and P. Roy-Byrne (2003). Assessment and treatment of nursing home residents with depression or behavioral symptoms associated with dementia: a review of the literature. Journal of the American Geriatrics Society, 51, 13051317.

L. Teri (1998). Treatment for agitation in dementia patients: a behavior management approach. Psychotherapy, 35, 436443.

L. Teri (2000). Treatment of agitation in AD: a randomized, placebo-controlled clinical trial. Neurology, 55, 12711278.

D. W. Thomas , R. J. Heitman and T. Alexander (1997). The effects of music on bathing cooperation for residents with dementia. Journal of Music Therapy, 34, 246259.

R. W. Toseland , M. Diehl , K. Freeman , T. Manzanares , M. Naleppa and P. McCallion (1997). The impact of validation group therapy on nursing home residents with dementia. Journal of Applied Gerontology, 16, 3150.

R Verkaik , J. C. M. Van Weert and A. L. Francke (2005). The effects of psychosocial methods on depressed, aggressive and apathetic behaviors of people with dementia: a systematic review. International Journal of Geriatric Psychiatry, 20, 301314.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 16
Total number of PDF views: 146 *
Loading metrics...

Abstract views

Total abstract views: 665 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 29th June 2017. This data will be updated every 24 hours.