title: Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia.
abstract: OBJECTIVE
  The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia.
  
  
  METHODS
  Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria.
  
  
  RESULTS
  A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed.
  
  
  CONCLUSIONS
  Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research (only nine level-1 studies were identified). More high-quality investigation is needed.
authors.affiliation: Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London, UK, N19 5LW. g.livingston@ucl.ac.uk
authors.forename: Gill
authors.initials: G
authors.lastname: Livingston
authors.forename: Kate
authors.initials: K
authors.lastname: Johnston
authors.forename: Cornelius
authors.initials: C
authors.lastname: Katona
authors.forename: Joni
authors.initials: J
authors.lastname: Paton
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
mesh_terms: D001521:Behavior Therapy; D017028:Caregivers / Q000193:education*; D015928:Cognitive Behavioral Therapy; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D010353:Patient Education as Topic; D009629:Person-Centered Psychotherapy; D011613:Psychotherapy / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000592:standards / Q000706:statistics & numerical data; D012107:Research Design / Q000592:standards; D016896:Treatment Outcome