Table 1 Study key characteristics

MUSIC THERAPY INTERVENTIONS

Gold, 2014; United Kingdom

1 NHS inpatient unit for advanced stage dementia

Service audit

9 people with advanced dementia; displaying distress behaviours

Increase social connection; increase positive moods and behaviours; reduce negative moods and behaviours

45–60 min; 1 x week; 4 months; group

Accredited music therapist, healthcare assistant supporting

Analysis of ward staff care notes (day of intervention and control)

Increase in positive and decrease in negative moods and behaviours reported for 8/9 patients. No correlation to severity of dementia. (negative impact for 1 patient)

Melhuish, 2013; United Kingdom

1 NHS dementia assessment unit

Pilot project evaluation

22 people with severe dementia

Improve wellbeing, engagement, relationships

1 h; 1 x week; 10 weeks; group

Accredited music therapist, support from ward staff

Analysis of session notes (post each session)

Positive impact on wellbeing, relationship and engagement (on some occasions increased anxiety or agitation during the group); attendance increased over time

Suzuki et al., 2004; Japan

1 dementia special care unit of a geriatric hospital

Case-controlled study (active control)

23 people with dementia; 8 males (12 AD; 11 VD)

Changes in cognition and behaviour, reduction of stress hormone levels

1 h; 2 x week; 8 weeks; group

3 music therapists and 3 nurses (training not stated)

MMSE; N type Mental States Scale and N type ADL; Multidimensional Observation Scale for Elderly Subjects (Pre and 1-week post study period). Pre and post session 1, 8 and 16: Salivary chromogranin A (CgA)

Reduced stress biomarkers, continued to fall throughout study period; reduction in irritability; short term improvement in language, no change in overall cognition

Thomspon et al., 2023; United Kingdom

2 NHS inpatient mental health dementia units

Mixed methods, retrospective, observational study

37 people with dementia

Evaluate impact on distress behaviours

1 h; 1 x week; 1 year; group

Accredited music therapist

Routinely collected ward data (day of intervention and control)

Reduction in staff reported incidents of disruptive and aggressive behaviour on days with in-person music therapy

Thornley, Hirjee and Vasudev, 2016; Canada

1 acute inpatient psychiatric unit

Pilot randomised controlled trial (active control)

16 people with moderate to severe dementia; displaying distressing behaviours and agitation (11 AD, 3 VD, 2 Dementia with Lewy Bodies)

Establish feasibility and acceptability, reduce behavioural and psychological symptoms of dementia

1 h; 2 x week; 4 weeks; individual

Accredited music therapist

Neuropsychiatric Inventory-Caregivers; Cohen-Mansfield Agitation Inventory (baseline and weekly (up to 24 h post intervention) for 4 weeks)

No reduction in agitation, distress behaviours, or difference to active control

MULTISENSORY INTERVENTIONS

Hope, 1998; United Kingdom

Department of old age psychiatry

Mixed-methods study

29 people with dementia; 8 male

Response to multisensory equipment; short and medium term influences on behaviour

As needed; individual

Ward staff (training as needed)

Qualitative behavioural observations; response to equipment (Likert scale); ‘Interact’ scale (frequency and changes in behaviour); pulse rate measure (pre and post intervention)

Majority increased positive mood, relaxation and interactive behaviour; no effect on behaviour post session; no change to heart rate (minority increased agitation)

Mitchell et al., 2015; USA

1 geriatric psychiatric unit

Repeated measures design

13 people with dementia; mild to moderate agitation; 4 male

Reduction in mild to moderate agitation

15–30 min; single use, with repeat visits allowed after 48 h; individual

Staff nurse (training not stated)

PAS; PRN medication post-intervention (pre and post intervention)

Significant reduction in agitation post intervention and 1-hour follow-up, except for aggression subscale

Spaull, Leach and Frampton, 1998; United Kingdom

1 male continuing care ward of a psychiatric unit

Modified single case design

4 people with advanced dementia; 3 displaying behavioural disturbances; all male (2 AD, 2 multi-infarct dementia)

Changes in immediate behaviour, adaptive functioning and wellbeing

20 min; 3 x week; 4 weeks; individual

Occupational therapist (training not stated)

Modified Behaviour Rating Scale and Dementia Care Mapping (pre and post intervention) Short Form Adaptive Behaviour Scale (pre and post study period)

Increased interactive behaviour during sessions, no lasting effect; reduction in unadaptive behaviour post session; no change in wellbeing

Staal et al., 2007; USA

1 geriatric psychiatric unit

Randomised controlled trial (active control)

24 people with moderate to severe dementia; displaying behavioural disturbances; 8 male

Reduction in agitation and apathy, improvement in ADLs

25–30 min; 6 sessions; frequency not stated; individual

Not stated

Global Deterioration Scale; PAS; Multi-level Assessment Instrument - physical health subscale; Scale for the Assessment of Negative Symptoms in Alzheimer’s Disease; Katz Index of ADL; Refined ADL Assessment Scale; MMSE; prescribed antipsychotic medication (pre and post study period)

Improved independence in ADL; reduction in apathy and agitation; no change in medication

MASSAGE INTERVENTIONS

Schaub et al., 2018; Switzerland

1 specialised geriatric psychiatry service

Randomised controlled trial (standard care)

40 people with dementia; experiencing agitation; 20 male

Reduce agitation and biological markers for stress

Hand massage: 16–20 min; 7 massages over 3 weeks; individual

11 nurses and 3 care assistants (2 h group training)

Cohen-Mansfield Agitation Inventory, Salivary Cortisol, Alpha-amylase (before, during (Cohen-Mansfield Inventory only) and after 1st, 4th and 7th massage)

Non-significant reduction in stress biomarkers following repeated sessions; no difference in agitation, agitation increased towards end of afternoon for both groups

Suzuki et al., 2010; Japan

1 specialist dementia unit

Controlled trial (standard care)

28 people with dementia (24 AD, 4 cerebrovascular dementia)

Changes in physical and mental function, behavioural and psychological symptoms of dementia, and stress levels

Tactile massage therapy: 30 min; 5 x week; 6 weeks; individual

Ward nurses (2-day tactile massage training with refresher)

MMSE; Gottfried-Brane-Steen Scale; Behaviour Pathology in Alzheimer’s Disease Rating Scale (Pre and post study period). Salivary CgA (Immediately before and after first and last massage session)

No significant change in cognition; reduction in emotional function in IG and intellectual function in CG; significant improvement in aggression in IG; significant reduction in stress biomarkers in IG

MULTICOMPONENT INTERVENTIONS

Arno and Frank, 1994; not stated

1 female inpatient psychiatric dementia unit

Case study

8 people with moderate or advanced dementia; all female

Improve quality of life

Structured movement and sensory stimulation: 90 min; 1 x week; 9 weeks; group

Nurse leader and coleader (training not stated)

Non standardised group evaluation (post intervention)

Development of group cohesion and norms, apparent reduction in anxiety and changes in social interactions, maintenance of functional abilities. No lasting effect.

Pitkänen et al., 2019; Finland

1 acute psychogeriatric unit

Bench-mark controlled trial (standard care)

175 people with dementia; 79 male (125 AD, 19 VD, 7 other, 18 not specified)

Measure impact on neuropsychiatric symptoms, ADLs and use of psychotropic medications

Music intervention and physical exercise: biweekly music groups and physical exercise group; 45 min; daily individual music and exercise activities; 30 min; 2 years; group and individual

Ward staff (t8 training sessions over 5.5 days)

Neuropsychiatric Inventory, MMSE, Barthel Index, Alzheimer’s Disease Cooperative Study-ADL; demographic information; medication use (on admission and before discharge)

No significant differences between groups. Potential reduction in anxiety in IG compared to CG, but sleep and nighttime behaviour improved less in IG than CG

TECHNOLOGY-BASED INTERVENTIONS

Hung et al., 2018; Canada

1 older adult mental health unit

Mixed methods study

4 people with dementia; displaying responsive behaviours; 1 male (AD, VD, Parkinson’s dementia)

Feasibility and acceptability in this setting, prevent responsive behaviours, engage in meaningful activities, and improve quality of care

iPad simulated presence therapy intervention: individual

Ward staff (training not stated)

Observation and video recordings of care interactions (during intervention)

Positive changes in mood and reduction in anxiety, reduced resistance and increased active involvement in care interventions (video with too many people causing negative response)

Vahia et al., 2017; USA

1 Senior Behaviour Health Inpatient Unit

Longitudinal, open label study

36 people with dementia; varying stages of cognitive impairment; 14 male

Reduce agitation, feasibility of intervention with this population, and relationship between severity of dementia and app use

Supervised use of tablets with range of patient-preferred apps installed: as needed; individual

Nurses and study volunteers (training not stated)

App usage and length of engagement; reduction in agitation on a scale of 1–5 (post intervention)

All patients tolerated tablet use; median use 3x during stay; patients with mild cognitive impairment used more complex apps for longer than those with severe impairment, and staff reported greater reduction in agitation; no adverse events

EXERCISE INTERVENTIONS

Fleiner et al., 2017; Germany

3 specialised dementia care units in department of geriatric psychiatry

Randomised controlled trial (active control)

70 people with moderate dementia; 33 male (26 AD, 9 VD, 32 mixed type, 3 other)

Reduction of neuropsychiatric signs and symptoms, and use of psychotropic medication

Structured exercise intervention: 4 × 20 min sessions; 3 x week; 2 weeks; group

Not stated

Alzheimer’s Disease cooperative study-clinical global impression of change; Neuropsychiatric Inventory; Cohen-Mansfield Agitation Inventory; dosage of antipsychotic medication (Pre and post study period)

Reduction neuropsychiatric signs and symptoms for both groups, IG significantly greater reduction in agitation, lability and verbal aggression, but not physical aggression; no relation to dementia type; no difference in medication dosage