***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Two controlled trials of aromatherapy to decrease agitation in persons with dementia have recently produced promising results . However , both studies combined the use of essential oils with massage . Thus , it is unclear if the effect of the aromatherapy intervention was the result of smelling or the cutaneous absorption of the oils . The purpose of this study was to determine whether smelling lavender oil decreases the frequency of agitated behaviors in patients with dementia . DESIGN The study design was within-subjects ABCBA ( A = lavender oil , B = thyme oil , C = unscented grapeseed oil ) : 4 weeks of baseline measurement , 2 weeks for each of the five treatment conditions ( 10-week total intervention time ) , and 2 weeks of postintervention measurement . Oil was placed every 3 hours on an absorbent fabric sachet pinned near the collarbone of each participant 's shirt . SETTING A long-term care facility specifically for persons with dementia . PARTICIPANTS Seven agitated nursing home residents with advanced dementia . MEASUREMENTS Agitation was assessed every 2 days using a modified Cohen-Mansfield Agitation Inventory . Olfactory functioning was assessed with structured olfactory identification and discrimination tasks , and with qualitative behavioral observation during those tasks . RESULTS Split-middle analyses conducted separately for each patient revealed no treatment effects specific to lavender , no treatment effects nonspecific to pleasant smelling substances , and no treatment effects dependent on order of treatment administration . There were no differences between participants with more and less intact olfactory abilities . CONCLUSION There is significant evidence in the neurologic and neuropsychologic literature that persons with dementia have impaired olfactory abilities . Concordant with this literature , this study found no support for the use of a purely olfactory form of aromatherapy to decrease agitation in severely demented patients . Cutaneous application of the essential oil may be necessary to achieve the effects reported in previous controlled studies This study was design ed to assess the olfactory impact of the essential oils of lavender ( Lav and ula angustifolia ) and rosemary ( Rosmarlnus officinalis ) on cognitive performance and mood in healthy volunteers . One hundred and forty-four participants were r and omly assigned to one of three independent groups , and subsequently performed the Cognitive Drug Research ( CDR ) computerized cognitive assessment battery in a cubicle containing either one of the two odors or no odor ( control ) . Visual analogue mood question naires were completed prior to exposure to the odor , and subsequently after completion of the test battery . The participants were deceived as to the genuine aim of the study until the completion of testing to prevent expectancy effects from possibly influencing the data . The outcome variables from the nine tasks that constitute the CDR core battery feed into six factors that represent different aspects of cognitive functioning . Analysis of performance revealed that lavender produced a significant decrement in performance of working memory , and impaired reaction times for both memory and attention based tasks compared to controls . In contrast , rosemary produced a significant enhancement of performance for overall quality of memory and secondary memory factors , but also produced an impairment of speed of memory compared to controls . With regard to mood , comparisons of the change in ratings from baseline to post-test revealed that following the completion of the cognitive assessment battery , both the control and lavender groups were significantly less alert than the rosemary condition ; however , the control group was significantly less content than both rosemary and lavender conditions . These findings indicate that the olfactory properties of these essential oils can produce objective effects on cognitive performance , as well as subjective effects on mood BACKGROUND Behavioral and psychological symptoms in dementia are frequent and are a major management problem , especially for patients with severe cognitive impairment . Preliminary reports have indicated positive effects of aromatherapy using select essential oils , but there are no adequately powered placebo-controlled trials . We conducted a placebo-controlled trial to determine the value of aromatherapy with essential oil of Melissa officinalis ( lemon balm ) for agitation in people with severe dementia . METHOD Seventy-two people residing in National Health Service ( U.K. ) care facilities who had clinical ly significant agitation in the context of severe dementia were r and omly assigned to aromatherapy with Melissa essential oil ( N = 36 ) or placebo ( sunflower oil ) ( N = 36 ) . The active treatment or placebo oil was combined with a base lotion and applied to patients ' faces and arms twice a day by caregiving staff . Changes in clinical ly significant agitation ( Cohen-Mansfield Agitation Inventory [ CMAI ] ) and quality of life indices ( percentage of time spent socially withdrawn and percentage of time engaged in constructive activities , measured with Dementia Care Mapping ) were compared between the 2 groups over a 4-week period of treatment . RESULTS Seventy-one patients completed the trial . No significant side effects were observed . Sixty percent ( 21/35 ) of the active treatment group and 14 % ( 5/36 ) of the placebo-treated group experienced a 30 % reduction of CMAI score , with an overall improvement in agitation ( mean reduction in CMAI score ) of 35 % in patients receiving Melissa balm essential oil and 11 % in those treated with placebo ( Mann-Whitney U test ; Z = 4.1 , p < .0001 ) . Quality of life indices also improved significantly more in people receiving essential balm oil ( Mann-Whitney U test ; percentage of time spent socially withdrawn : Z = 2.6 , p = .005 ; percentage of time engaged in constructive activities : Z = 3.5 , p = .001 ) . CONCLUSION The finding that aromatherapy with essential balm oil is a safe and effective treatment for clinical ly significant agitation in people with severe dementia , with additional benefits for key quality of life parameters , indicates the need for further controlled trials OBJECTIVE To determine the effectiveness of a brief agitation rating scale ( BARS ) derived from the Cohen-Mansfield Agitation Inventory ( CMAI ) . DESIGN Test of reliability and validity of a new test . SETTING The Lieberman Geriatric Health Centre , a skilled nursing facility . PARTICIPANTS Forty members of the Lieberman Geriatric Health Centre nursing staff , 232 residents , and a sample of 40 r and omly selected residents . MEASUREMENTS Observational agitation ratings by registered nurses and certified nurses ' assistants ; item to total correlations for the CMAI on each of the three shifts ; Pearson correlations between the 10-item BARS and the BEHAVE-AD and the BSSAD scales . RESULTS Internal consistency reliability for the BARS was .74 ( for the day shift ) , .82 ( evening shift ) , and .80 ( night shift ) , compared with .86 , .91 , and .87 for the full CMAI . Each of the 232 residents ' scores on the BARS was correlated with a total score from the CMAI separately on each shift . Correlations were of .95 , .94 , and .95 . Thus , across all shifts , the BARS accounted for approximately 90 percent of the variance of the total score of the CMAI . Concurrent validity of the BARS was supported by significant correlation with BEHAVE-AD and BSSD . CONCLUSIONS The BARS represents a brief and effective mechanism to assess the presence and severity of physically aggressive , physically non-aggressive , and verbally agitated behaviors in elderly nursing home residents Aromatherapy and massage could provide a useful addition to psychological therapeutic interventions with clients suffering from dementia . The effects of aromatherapy and massage on disturbed behaviour in four individuals with severe dementia were evaluated using a single-case research design . Each participant received 10 treatment sessions of aromatherapy , aromatherapy and massage combined , and massage alone . The effects on each individual 's behaviour in the hour following treatment were assessed against 10 ' no treatment ' control sessions . Reliable individualized disturbed behaviour scales were design ed . The effects of the treatments were mixed . The opinion of the staff providing treatment was that all participants benefited . On close scrutiny , only one of the participants benefited from the aromatherapy and massage to a degree that reached statistical significance . In two of the cases aromatherapy and massage led to an increase in agitated behaviour . The importance of the single case study approach with this client group is discussed Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing , behavioural rating , and various combinations of simpler psychometric and behavioural evaluations . The  Clinical Dementia Rating ( CRD )  , a global rating device , was developed for a prospect i ve study of mild senile dementia -- Alzheimer type ( SDAT ) . Reliability , validity , and correlational data are discussed . The CRD was found to distinguish unambiguously among older subjects with a wide range of cognitive function , from healthy to severely impaired A r and om controlled trial of the relaxing effects of an aromatherapy massage on disordered behaviour in dementia was conducted . Twenty‐one patients were r and omly allocated into one of three conditions , aromatherapy and massage ( AM ) , conversation and aromatherapy ( CA ) and massage only ( M ) . AM showed the greatest reduction in the frequency of excessive motor behaviour of all three conditions . This reached statistical significance between the hours of three and four pm ( p < 0.05 ) . Post hoc analysis suggested that at this time of day the AM consistently reduced motor behaviour when compared with CA ( p = 0.05 ) . This provides preliminary evidence of a measurable sedative effect  of aromatherapy massage on dementia within a robust scientific paradigm . Further research is recommended with an exp and ed sample size . Copyright © 2001 John Wiley & Sons , Thirteen older persons ( seven men and six women ) in residential care participated as subjects in this study . All participants had histories of confusion due to dementia and were identified by staff as being consistently resistant to medication administration as indicated by vocal outbursts , moving away , or physical combativeness . Subjects were exposed to four aroma interventions during medication administration : 1 ) lavender vera ( lavendula officinalis ) ; 2 ) sweet orange ( citrus aurantium ) ; 3 ) tea tree ( malaleuca alternifolia ) ; and 4 ) no aroma ( control ) . All medication administrations were videotaped for later data collection . Observers were trained to record frequency and duration of resistive behaviors during medication administration in all four interventions for each subject . Reliability between two observers was extremely high . Results showed no statistically significant differences across all aroma conditions for either resistive behavior or duration of administration . Also , there were no statistically significant differences based on gender . This study indicates that aromatherapy does not reduce combative , resistive behaviors in individuals with dementia . Research with a larger sample in future studies may yield other results 
    Output:
    
MAIN RESULTS The additional analyses conducted revealed a statistically significant treatment effect in favour of the aroma therapy intervention  on measures of agitation and neuropsychiatric symptoms .