Nonpharmacologic interventions superior for dementia-related aggression/agitation

  • Watt JA & al.
  • Ann Intern Med
  • 15 Oct 2019

  • International Clinical Digest
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Takeaway

  • Multidisciplinary care, massage plus touch therapy, and music plus both massage and touch therapy were more clinically efficacious than usual care for treating aggression and agitation in adults with dementia.

Why this matters

Key results

  • Majority of trials:
    • Enrolled patients having mean age ≥80 years (63.0%).
    • Were conducted in nursing homes, skilled nursing facilities (65.1%).
    • Studied interventions lasting
  • With usual care as comparator, greater reductions in aggression and agitation (standardized mean difference; 95% credible interval) seen with:
    • Multidisciplinary care (–0.5; –0.99 to –0.01).
    • Massage and touch therapy (–0.75; –1.12 to –0.38).
    • Music combined with massage and touch therapy (–0.91; –1.75 to –0.07).
  • Recreation therapy was statistically more efficacious than usual care (–0.29; –0.57 to –0.01) but not clinically so.
  • Cannabinoids and dextromethorphan-quinidine were superior to placebo or usual care in some subgroups.

Study design

  • Systematic review, network meta-analysis of 163 randomised controlled trials comparing interventions for aggression and agitation in 23,143 adults with dementia.
  • Main outcome: aggression and agitation.
  • Funding: Alberta Health Services Critical Care Strategic Clinical Network.

Limitations

  • High risk for bias in nearly half of studies.
  • No evaluation of harms, costs of therapies.