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Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series
  1. Iosief Abraha1,
  2. Joseph M Rimland1,
  3. Fabiana Mirella Trotta1,
  4. Giuseppina Dell'Aquila1,
  5. Alfonso Cruz-Jentoft2,
  6. Mirko Petrovic3,
  7. Adalsteinn Gudmundsson4,
  8. Roy Soiza5,
  9. Denis O'Mahony6,
  10. Antonio Guaita7,
  11. Antonio Cherubini1
  1. 1Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
  2. 2Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain
  3. 3Department of Internal Medicine (Geriatrics), Ghent University, Ghent, Belgium
  4. 4Landspitali University Hospital Reykjavik, Reykjavik, Iceland
  5. 5Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
  6. 6Department of Medicine, University College Cork, Cork, Ireland
  7. 7‘Golgi Cenci’ Foundation, Milan, Italy
  1. Correspondence to Dr Iosief Abraha; iosief_a{at}


Objective To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD).

Design Systematic overview of reviews.

Data sources PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009–March 2015).

Eligibility criteria Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD.

Data extraction Eligible studies were selected and data extracted independently by 2 reviewers.

The AMSTAR checklist was used to assess the quality of the SRs.

Data analysis Extracted data were synthesised using a narrative approach.

Results 38 SRs and 142 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (12 SRs, 27 primary studies) that encompassed: acupressure, aromatherapy, massage/touch therapy, light therapy and sensory garden; (2) cognitive/emotion-oriented interventions (33 SRs; 70 primary studies) that included cognitive stimulation, music/dance therapy, dance therapy, snoezelen, transcutaneous electrical nerve stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 32 primary studies) and (4) other therapies (5 SRs, 12 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. Music therapy was effective in reducing agitation (SMD, −0.49; 95% CI −0.82 to −0.17; p=0.003), and anxiety (SMD, −0.64; 95% CI −1.05 to −0.24; p=0.002). Home-based behavioural management techniques, caregiver-based interventions or staff training in communication skills, person-centred care or dementia care mapping with supervision during implementation were found to be effective for symptomatic and severe agitation.

Conclusions A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.

  • Non-pharmacological intervention
  • Alzheimer's disease
  • Behavioral and psychological symptoms in dementia
  • BPSD

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  • Contributors IA, JMR, AC, RS, AC-J and DO conceived and designed the study. The manuscript of this protocol was drafted by IA, JMR, AC, RS, AC-J, AdG and BHM and revised by MP, AnG, FMT and GDA. IA and JMR designed the search strategies; IA, JMR, FMT and GDA performed the search, screening and assessment independently. AC arbitrated disagreements during the review. All authors contributed to data analysis and critical revision of the paper; additionally every author approved the final version.

  • Funding The research leading to these results has received funding from the European Union Seventh Framework programme (FP7/2007-2013) under grant agreement no. 305930 (SENATOR).

  • Disclaimer The funders had no role in the study design, data collection and analysis, the decision to publish or the preparation of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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