Non-pharmacologic Interventions for Agitation in Dementia: a Systematic Review and Meta-analysis

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OBJECTIVE: The purpose of this study was to systematically review the literature regarding the effectiveness of nonpharmacological interventions for agitation in older adults with dementia.

METHODS: Seven electronic databases (to 2004) were searched, and randomized clinical trials employing nonpharmacologic interventions for agitation in dementia published in English or Korean were selected. In addition, the reference lists from relevant review articles and all eligible studies were searched to identify other trials. Interventions were categorized into seven types: sensory intervention, social contact, activities, environmental modification, caregiver training, combination therapy, and behavioral therapy. Studies were abstracted, and data were pooled by intervention category.
 
RESULTS: Fourteen studies (n = 586) were included. Sensory interventions were statistically significantly effective in reducing agitation (standardized mean difference: SMD -1.07; 95% confidence interval (CI) -1.76 to -0.38, p = 0.002), while social contact (SMD -0.19; CI -0.71 to 0.33), activities (SMD -0.20; CI -0.71 to 0.31), environmental modification (weighted mean difference: WMD 1.90; CI -2.82 to 6.62), caregiver training (SMD 0.21; CI -0.15 to 0.57), combination therapy (WMD 1.85; CI -1.78 to 5.48), and behavioral therapy interventions (SMD -0.27; CI -0.72 to 0.19) were not significantly effective in reducing agitation. These results were consistent among higher quality studies.
 
CONCLUSION: This systematic review indicated that among the seven types of nonpharmacological interventions available for agitation in older adults with dementia, only sensory interventions had efficacy in reducing agitation. More trials are needed to confirm this finding and future research should use more rigorous methods.
Authors:

Konga EH, Evans LK, Guevara JP