Person-centered non-pharmacological interventions for agitation in dementia: a meta-analysis with subgroup analysis by behavioral subtypes

Agitation is a highly prevalent and distressing symptom in individuals with dementia, often leading to increased caregiver burden and institutionalization. While antipsychotic medications are frequently used to manage these behaviors, they carry significant risks of adverse effects, including increased mortality. Consequently, clinical guidelines prioritize non-pharmacological, person-centered interventions—strategies tailored to an individual's life history, preferences, and remaining cognitive abilities. This meta-analysis aimed to evaluate the overall efficacy of these personalized approaches and, for the first time, assess whether their effectiveness varies across specific behavioral subtypes: physical aggressive agitation, physical non-aggressive agitation, and verbal agitation.

The researchers synthesized data from six randomized controlled trials (RCTs) involving 846 participants. The meta-analysis found that person-centered non-pharmacological interventions significantly reduced overall agitation compared to control conditions. When the researchers performed subgroup analyses to investigate specific behaviors, they found a statistically significant reduction in verbal agitation (e.g., screaming, repetitive questioning). However, the interventions did not reach statistical significance in reducing physical aggressive or physical non-aggressive agitation.

These findings reinforce the role of person-centered care as a first-line strategy for managing agitation in dementia. The clear, consistent benefit for verbal agitation suggests that even relatively simple, personalized social or sensory interventions can be highly effective for this specific symptom. Conversely, the lack of significant impact on physical agitation, combined with high statistical heterogeneity, indicates that physical behaviors may be driven by different, more complex underlying needs—such as untreated pain or environmental discomfort—that require more targeted, specialized assessment and intervention strategies. This study highlights the need for future research to move beyond aggregate agitation scores and focus on developing tailored interventions for specific behavioral profiles.