Author(s), date; country | Setting | Study Design (control where applicable) | Study participants (dementia type where reported) | Aims | Intervention: dosage; frequency; duration; group/individual | Interventionist (training) | Measurement tools (frequency of use) | Main findings (unintended outcomes) |
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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 | 1Â 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 | 1Â 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 | 1Â 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 | 1Â h; 2 x week; 4 weeks; individual | Accredited music therapist | Neuropsychiatric Inventory-Caregivers; Cohen-Mansfield Agitation Inventory (baseline and weekly (up to 24Â 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 | 20Â 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: 90Â 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 |