Nonpharmacological Interventions to Reduce Behavioral and Psychological Symptoms of Dementia: A Systematic Review

Table 1

Summary of nonpharmacological interventions studies to reduce behavioral and psychological symptoms of dementia (BPSD).

Author	Country	Intervention		Place	Assessment	Symptoms treated	Comments
() Woods and Dimond (2002) [5]	(Canada) USA	Touch therapy	57	Long term care facilities	(i) Agitated Behaviors Rating Scale-modified; (ii) Memory and Behavior Checklist	Manual manipulation (restlessness) and vocalization
() Holmes et al. (2006) [24]	UK	Music therapy	32	Home care or nursing home facility	DCM	Apathy
() Svansdottir and Snaedal (2006) [25]	Iceland	Music therapy	38	Nursing homes and geriatric wards	BEHAVE-AD	Agitation, aggressiveness, and anxiety	Positive effects mostly disappeared 4 weeks after the end of intervention
() Garland et al. (2007) [26]	Australia	Simulated family presence/preferred music	30	Nursing home		Shadowing and repetitive questioning
() Lin et al. (2007) [27]	China	Aromatherapy	140	Care and attention homes	(i) Cohen-Mansfield Inventory; (ii) NPI	Physically agitated behaviors and verbally agitated behaviors
() Gitlin et al. (2008) [28]	USA	Activities program	60	Community	(i) Agitated Behaviors in Dementia Scale; (ii) Revised Memory and Behavior Problem Checklist	Shadowing and repetitive questioning; Agitation; Argumentative behaviors
() Burns et al. (2009) [29]	UK	Light therapy	48	Nursing care setting	Cohen-Mansfield Inventory	Physically agitated behaviors; Sleep disturbance
() Cerga-Pashoja et al. (2010) [22]	UK	Physical exercises	146	Community-dwelling individuals	NPI	BPSD in general
() van der Ploeg et al. (2010) [30]	Australia	Activities		Aged care facilities	Cohen-Mansfield Inventory	Physically agitated behaviors
() Burns et al. (2011) [31]	UK	Aromatherapy	81	Care homes	(i) Pittsburgh Agitation Scale; (ii) NPI	Agitation	No statistical difference between melissa aromatherapy × medication × placebo
() Kolanowski et al. (2011) [32]	USA	Activities program	128	Nursing homes	(i) Cohen-Mansfield Inventory; (ii) Passivity in Dementia Scale	Agitation and anxiety	Findings indicate that activities customized may help reduce agitation and passivity throughout the day and not just during the treatment
() Sung et al. (2012) [33]	Taiwan	Music therapy	60	Home care facility	(i) Cohen-Mansfield Inventory; (ii) Rating of Anxiety in Dementia	Anxiety and wellbeing
() O’Connor et al. (2014) [11]	Australia	Activities program	160	Community	NPI-C	—	No results; (protocol study)
() Brunelle-Hamann et al. (2015) [34]	Canada	Cognitive rehabilitation	15	—	NPI-12	Delusions	Small sample might have limited the power of the study and increased the likelihood of type 1 errors
() Chen et al. (2014) [23]	Taiwan	Combination of nonpharmacological interventions	92	Residential care facility	NPI	Hallucinations, delusion, and agitation	Not randomized controlled design; The increased interaction between participants and the research staff might have caused a confounding effect in the “therapeutic” effects
() Lowery et al. (2014) [15]	UK	Physical exercises	131	Community mental health or primary clinical service	NPI	BPSD, except hallucinations and delusions	Physical exercise tailored to participant-carer dyads had no significant effect in BPSD but had statistical difference in caregiver burden
() Neville et al. (2014) [35]	Australia	Physical exercises (aquatic exercises)	11	Residential aged care facilities	(i) The Psychological Wellbeing in Cognitively Impaired Persons Scale; (ii) Revised Memory and Behavior Problem Checklist	Psychological wellbeing	Small sample size; No control group
() O’Connor et al. (2014) [11]	Australia	Activities	180	Community	NPI-C	—	No results; (protocol study)
(9) Dowling et al. (2007) [36]	USA	Light therapy	70	Nursing homes	NPI	Agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders
() Yang et al. (2015) [21]	Taiwan	Aromatherapy	189	Retirement homes for veterans and long term care facilities	Cohen-Mansfield; Inventory	Agitation

DCM: Dementia Care Mapping; NPI: Neuropsychiatric Inventory; NPI-C: Neuropsychiatric Inventory Clinician; BEHAVE-AD: Behavioral Pathology in Alzheimer’s Disease Rating Scale.