International Psychogeriatrics

Review Article

Psychosocial treatments of behavior symptoms in dementia: a systematic review of reports meeting quality standards

Daniel W. O'Connora1 c1, David Amesa2, Betina Gardnera1 and Madeleine Kinga3

a1 Department of Psychological Medicine, Monash University, Melbourne, Australia

a2 National Ageing Research Institute, University of Melbourne, Melbourne, Australia

a3 Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia

ABSTRACT

Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically oriented paradigms (learning theory, unmet needs and altered stress thresholds).

Method: English language reports published or in press by December 2006 were identified by means of database searches, checks of previous reviews and contact with recognized experts. Papers were appraised with respect to study design, participants' characteristics and reporting details. Because people with dementia often respond positively to personal contact, studies were included only if control conditions entailed similar levels of social attention or if one treatment was compared with another.

Results: Only 25 of 118 relevant studies met every specification. Treatment proved more effective than an attention control condition in reducing behavioral symptoms in only 11 of the 25 studies. Effect sizes were mostly small or moderate. Treatments with moderate or large effect sizes included aromatherapy, ability-focused carer education, bed baths, preferred music and muscle relaxation training.

Conclusions: Some psychosocial interventions appear to have specific therapeutic properties, over and above those due to the benefits of participating in a clinical trial. Their effects were mostly small to moderate with a short duration of action. This limited action means that treatments will work best in specific, time-limited situations. In the few studies that addressed within-group differences, there were marked variations in response. Some participants benefited greatly from a treatment, while others did not. Interventions proved more effective when tailored to individuals' preferences.

(Received January 15 2008)

(Revised February 27 2008)

(Revised April 23 2008)

(Accepted April 30 2008)

(Online publication September 25 2008)

Correspondence:

c1 Correspondence should be addressed to: Professor Daniel O'Connor, Aged Mental Health Research Unit, Kingston Centre, Warrigal Road, Cheltenham, Victoria 3192, Australia. Phone: +61 (03) 9265 1700 Fax: +61 (03) 9265 1711. Email: daniel.oconnor@med.monash.edu.au.

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