What non-pharmacological interventions are effective in managing behavioral symptoms in patients with dementia?

Non-pharmacological (psychosocial) approaches are recommended as first-line interventions for managing behavioural and psychological symptoms of dementia (BPSD) ¹. Before initiating any treatment for distress, a structured assessment should be conducted to explore possible reasons for the distress and to check for and address clinical or environmental causes, such as pain, delirium, or inappropriate care ¹,².

• General Interventions: Psychosocial and environmental interventions should be offered to reduce distress ¹,². These interventions should be tailored to the person's preferences, skills, and abilities, with monitoring of response and adaptation of the care plan as needed ¹. People living with dementia should continue to access psychosocial and environmental interventions for distress even while taking or after stopping antipsychotics ¹,².
• Agitation and Aggression: Offer personalised activities to promote engagement, pleasure, and interest for individuals experiencing agitation or aggression ¹,². Specific non-pharmacological interventions associated with substantial reductions in agitation include massage therapy, animal-assisted intervention, and personally tailored interventions ¹. If challenging behaviour requires urgent treatment (when the person is a danger to themselves or others) and underlying causes have been addressed, advise moving the person to a safe, low-stimulation environment and using verbal and non-verbal de-escalation techniques (e.g., active listening, pictures, symbols) ¹.
• Depression and Anxiety: For people with mild to moderate dementia who have mild to moderate depression and/or anxiety, psychological treatments should be considered ¹,². Non-drug interventions have been found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder ¹. Effective interventions include cognitive stimulation, massage and touch therapy, multidisciplinary care, occupational therapy, exercise combined with social interaction and cognitive stimulation, and reminiscence therapy ¹.
• Sleep Problems: For individuals with sleep problems, consider a personalised multicomponent sleep management approach ¹,². This approach should include sleep hygiene education, exposure to daylight, exercise, and personalised activities ¹,².