Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series

BMJ Open. 2017 Mar 16;7(3):e012759. doi: 10.1136/bmjopen-2016-012759.


Objective: To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD).

Design: Systematic overview of reviews.

Data sources: PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015).

Eligibility criteria: Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD.

Data extraction: Eligible studies were selected and data extracted independently by 2 reviewers.The AMSTAR checklist was used to assess the quality of the SRs.

Data analysis: Extracted data were synthesised using a narrative approach.

Results: 38 SRs and 129 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (25 SRs, 66 primary studies) that encompassed: shiatsu and acupressure, aromatherapy, massage/touch therapy, light therapy, sensory garden and horticultural activities, music/dance therapy, dance therapy, snoezelen multisensory stimulation therapy, transcutaneous electrical nerve stimulation; (2) cognitive/emotion-oriented interventions (13 SRs; 26 primary studies) that included cognitive stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 22 primary studies); (4) Multicomponent interventions (3 SR; four primary studies); (5) other therapies (5 SRs, 15 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions.

Conclusions: A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.

Keywords: Alzheimer's disease; BPSD; Behavioral and psychological symptoms in dementia; Non-pharmacological intervention.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anxiety / etiology
  • Anxiety / therapy
  • Cognitive Behavioral Therapy / methods*
  • Complementary Therapies / methods*
  • Dementia / complications
  • Dementia / psychology
  • Dementia / therapy*
  • Home Care Services
  • Humans
  • Phototherapy / methods*
  • Physical Therapy Modalities*
  • Psychomotor Agitation / etiology
  • Psychomotor Agitation / therapy
  • Review Literature as Topic*