Agitation is a common symptom in dementia. Nearly half of patients with dementia will have agitation symptoms every month and a vast majority will have persistent agitation for long periods.It reduce the quality of life significantly. Citalopram , Mirtazapine and analgesics seems to have some beneficial effect.Psychotropic use is discouraged ( antipsychotics and benzodiazepines) as it cause excess mortality and is often ineffective.
The previous systematic review on this topic was done in 2004 and found that sensory interventions were effective. This review looked at evidence for non pharmacological interventions in agitation in people with dementia. Comprehensive search identified 33 RCTs.
Following were the effective interventions
Activities: Activities in care homes reduce agitation. No evidence for activities in severe agitation or outside care home settings. No evidence for long-term effect
Music therapy: Music therapy is effective in reducing agitation. Effect is often immediate.No evidence for severe agitation or outside care homes
Sensory interventions: Massage and multi sensory approaches ( touch, light, auditory stimulation) were effective in acre homes. No conclusive evidence for longterm benefits.
Person centred care: Communication skills training and dementia care mapping training (analysis of behaviour and triggers and interventions to address these) for staff reduce agitation significantly. Supervision of staff is a key element here.
Limitations:. Most studies addressed agitation in care homes, and effect of such interventions at home is not known. Though authors excluded studies where all participants received medications for behavioural symptoms, cannot assess whether medication use was uneven in different arms.
Strength: Most comprehensive review on this topic.
Conclusions: Non pharmacological interventions are effective in reducing agitation in dementia in care home settings.
Comments: Most of these effective interventions are easily adoptable by care homes. Most care homes may be already having all these interventions.
Summary of the article:
Non-pharmacological interventions for agitation in dementia:systematic review of randomised controlled trials. Gill Livingston, Lynsey Kelly, Elanor Lewis-Holmes, Gianluca Baio, Stephen Morris, Nishma Patel, Rumana Z. Omar, Cornelius Katona and Claudia Cooper.BJP 2014, 205:436-442.