***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: Long-term effects of multisensory stimulation were assessed using a “ Snoezelen ” room on older residents with dementia . Thirty patients were r and omly assigned to 3 groups : multisensory stimulation environment ( MSSE ) group , individualized activities ( activity ) group , and control group . The MSSE and activity groups participated in two 30-minute weekly individualized intervention sessions over 16 weeks . Pre- , mid- , posttrial , and 8-week follow-up behavior , mood , cognitive , and functional impairment in basic activities of daily living were registered . Items included in the physically nonaggressive behavior factor improved significantly in post- versus pretrial in the MSSE group compared to the activity group , with no significant differences between MSSE and control groups . The MSSE and activity groups demonstrated behavior improvements and higher scores on the Cohen-Mansfield agitation inventory , verbal agitated behavior factor , and Neuropsychiatric Inventory – Nursing Home , with no significant differences between groups . The MSSE could have long-term positive effects on such neuropsychiatric symptoms in older people with dementia Background : Individuals with dementia often experience poor quality of life ( QOL ) due to behavioral and psychological symptoms of dementia ( BPSD ) . Music therapy can reduce BPSD , but most studies have focused on patients with mild to moderate dementia . We hypothesized that music intervention would have beneficial effects compared with a no-music control condition , and that interactive music intervention would have stronger effects than passive music intervention . Methods : Thirty-nine individuals with severe Alzheimer 's disease were r and omly and blindly assigned to two music intervention groups ( passive or interactive ) and a no-music Control group . Music intervention involved individualized music . Short-term effects were evaluated via emotional response and stress levels measured with the autonomic nerve index and the Faces Scale . Long-term effects were evaluated by BPSD changes using the Behavioral Pathology in Alzheimer 's Disease ( BEHAVE-AD ) Rating Scale . Results : Passive and interactive music interventions caused short-term parasympathetic dominance . Interactive intervention caused the greatest improvement in emotional state . Greater long-term reduction in BPSD was observed following interactive intervention , compared with passive music intervention and a no-music control condition . Conclusion : Music intervention can reduce stress in individuals with severe dementia , with interactive interventions exhibiting the strongest beneficial effects . Since interactive music intervention can restore residual cognitive and emotional function , this approach may be useful for aiding severe dementia patients ’ relationships with others and improving QOL . The registration number of the trial and the name of the trial registry are UMIN000008801 and “ Examination of Effective Nursing Intervention for Music Therapy for Severe Dementia Elderly Person ” respectively Limited effective strategies exist to alleviate or treat disruptive behaviors in people with Alzheimer 's disease . Fifty-one residents of a long-term care facility with Alzheimer 's disease were r and omly assigned to one of three intervention groups . A multiple time series , blinded , experimental design was used to compare the effectiveness of therapeutic touch , simulated therapeutic touch , and usual care on disruptive behavior . Three forms of disruptive behavior comprised the dependent variables : physical aggression , physical nonaggression , and verbal agitation . Physical nonaggressive behaviors decreased significantly in those residents who received therapeutic touch compared with those who received the simulated version and the usual care . No significant differences in physically aggressive and verbally agitated behaviors were observed across the three study groups . The study provided preliminary evidence for the potential for therapeutic touch in dealing with agitated behaviors by people with dementia . Research ers and practitioners must consider a broad array of strategies to deal with these behaviors BACKGROUND Music therapy is a potential non-pharmacological treatment for the behavioral and psychological symptoms of dementia , but although some studies have found it to be helpful , most are small and uncontrolled . METHODS This case-control study was carried out by qualified music therapists in two nursing homes and two psychogeriatric wards . The participants were 38 patients with moderate or severe Alzheimer 's disease ( AD ) assigned r and omly to a music therapy group and a control group . RESULTS The study showed a significant reduction in activity disturbances in the music therapy group during a 6-week period measured with the Behavior Pathology in Alzheimer 's Disease Rating Scale ( BEHAVE-AD ) . There was also a significant reduction in the sum of scores of activity disturbances , aggressiveness and anxiety . Other symptoms rated by subscales of the BEHAVE-AD did not decrease significantly . Four weeks later the effects had mostly disappeared . CONCLUSIONS Music therapy is a safe and effective method for treating agitation and anxiety in moderately severe and severe AD . This is in line with the results of some non-controlled studies on music therapy in dementia BACKGROUND Over recent years multi-sensory stimulation ( MSS ) has become an increasingly popular approach to care and is used in several centres throughout Europe . This popularity could be explained by the limited alternatives available to staff and a widely held belief that MSS is a friendly and highly humane approach . A r and omized controlled trial was therefore essential to evaluate the effectiveness and extent of the benefits of MSS . AIM To assess whether MSS is more effective in changing the behaviour , mood and cognition of older adults with dementia than a control of activity ( playing card games , looking at photographs , doing quizzes , etc . ) . METHODS A total of 136 patients from three countries [ United Kingdom ( UK ) , the Netherl and s and Sweden ] were r and omized to MSS or activity groups . Patients participated in eight 30-minute sessions over 4 weeks . Ratings of behaviour and mood were taken before , during and after sessions to investigate immediate effects . Pre- , mid- , post-trial and follow-up assessment s were taken to investigate any generalization of effects to cognition and behaviour and mood at home/on the ward or at the day hospital . RESULTS There were limited short-term improvements for both the MSS and activity groups immediately after sessions , and limited short-term improvements between the groups during sessions . There were no significant differences between the groups when assessing change in behaviour , mood or cognition at home/on the ward or at the day hospital . In the UK , however , behaviour at the day hospital for both groups remained stable during the trial but deteriorated once the sessions had stopped , and active/disturbed behaviour at home improved but likewise deteriorated once sessions had stopped . CONCLUSIONS Overall , MSS was found to be no more effective than an activity in changing the behaviour , mood or cognition of patients with dementia in the short- or long-term OBJECTIVE Preliminary data suggest that morning bright light might improve symptoms of agitation , a serious problem in patients with dementia . The authors exp and on an earlier pilot study by evaluating the effect of bright light therapy on agitated behavior in a large sample of patients with severe dementia . METHODS Ninety-two patients were r and omly assigned to morning bright light , morning dim red light , or evening bright light .  Agitation was rated by research staff who observed the patients every 15 minutes throughout the treatment period and by caregivers at one time-point before and one time-point after treatment . RESULTS Morning bright light delayed the acrophase of the agitation rhythm by over 1.5 hours . Bright light was associated with improved caregivers ' ratings but had little effect on observational ratings of agitation . CONCLUSION Although the result that light shifted the peak of the agitated behavior might be generalizable to patients with milder forms of AD , the fact that agitation was not ameliorated might not be . Because the suprachiasmatic nucleus ( SCN ) of patients with severe AD is likely to be more degenerated , and the circadian activity rhythms deteriorate as the disease progresses , it is still possible that patients with more intact SCNs , that is , patients with mild or moderate AD , might benefit from light treatment even more than those with severe AD Although musical interventions have recently gained popularity as a non-pharmacological treatment in dementia , there is still insufficient evidence of their effectiveness . To investigate this issue , a single-center r and omized controlled trial was conducted with forty-eight patients with Alzheimer 's disease or mixed dementia to compare the effects of music versus cooking interventions in the emotional , cognitive , and behavioral domain , as well as on professional caregiver distress . Each intervention lasted four weeks ( two one-hour sessions a week ) . Multi-component evaluations ( with blind assessors ) were conducted before , during , and after the interventions to assess their short and long-term effects ( up to four weeks post interventions ) . Analyses revealed that both music and cooking interventions led to positive changes in the patients ' emotional state and decreased the severity of their behavioral disorders , as well as reduced caregiver distress . However , no benefit on the cognitive status of the patients was seen . While results did not demonstrate a specific benefit of music on any of the considered measures , the present study suggests the efficacy of two pleasant non-pharmacological treatments in patients with moderate to severe dementia . Our findings highlight the potential of such interventions in improving the well-being of patients living in residential care  , as well as reducing caregiver distress OBJECTIVES To develop and evaluate the psychometric properties of a new measure of agitation , the Agitated Behavior in Dementia scale ( ABID ) . The ABID consists of 16 items design ed specifically to evaluate frequency of and caregiver reaction to common agitated behaviors in community-residing dementia patients . DESIGN The ABID was administered at the baseline assessment of a multi-site controlled treatment study to reduce agitation in Alzheimer 's Disease ( AD ) . Reliability was assessed by evaluating internal consistency and test-retest correlations . Validity was assessed by examining correlations with other constructs , including demographics , cognitive status , and overall behavioral disturbance . SETTING Twenty-one sites across the US , comprising the Alzheimer 's Disease Cooperative Study , contributed subjects to the investigation . PARTICIPANTS A total of 148 community-residing AD patients , living with a spouse or adult relative who acted as an informant . Mean age was 75 years , and mean Mini-Mental State Exam ( MMSE ) score was 13 . MEASUREMENTS Cognitive status was assessed using the MMSE . Behavioral disturbance was assessed using the Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for Alzheimer 's Disease , the Revised Memory and Behavior Problems Checklist , and the Cohen-Mansfield Agitation Inventory . RESULTS Reliability of the ABID was excellent , with internal consistency of 0.70 and test-retest reliability of 0.60 to 0.73 . Validity was confirmed by correlations with related measures and lack of correlation with unrelated constructs . CONCLUSIONS The ABID is brief , easy to administer , and provides objective ly anchored observations of problems . It is a promising measure for studies of community-residing AD patients A r and omized , controlled , single-blinded , between group study of 24 participants with moderate to severe dementia was conducted on a geriatric psychiatric unit . All participants received pharmacological therapy , occupational therapy , structured hospital environment , and were r and omized to receive multi sensory behavior therapy ( MSBT ) or a structured activity session . Greater independence in activities of daily living ( ADLs ) was observed for the group treated with MSBT and st and ard psychiatric inpatient care on the Katz Index of Activities of Daily Living ( KI-ADL ; P = 0.05 ) than st and ard psychiatric inpatient care alone . The combination treatment of MSBT and st and ard psychiatric care also reduced agitation and apathy greater than st and ard psychiatric inpatient care alone as measured with the Pittsburgh Agitation Scale and the Scale for the Assessment of Negative Symptoms in Alzheimer 's Disease ( P = 0.05 ) . Multiple regression analysis predicted that within the multi-sensory group , activities of daily living ( KI-ADL ) increased as apathy and agitation reduced ( R2 = 0.42 ; p = 0.03 ) . These data suggest that utilizing MSBT with st and ard psychiatric inpatient care may reduce apathy and agitation and additionally improve activities of daily living in hospitalized people with moderate to severe dementia more than st and ard care alone Background / Aims : Behavioural and psychological symptoms ( BPSD ) are frequent in people with Alzheimer ’s disease and cause considerable stress to patients and their carers . Antipsychotics have been widely used as a first-line treatment , result ing in an estimated 1,800 excess strokes and 1,600 excess deaths in the UK alone . Safe and effective alternatives are urgently needed . Based upon preliminary evidence from clinical trials , aromatherapy with melissa oil may be such an alternative , but initial studies have been modest in size , and adequate blinding has been problematic . Our objective was to assess the efficacy of melissa aromatherapy in the treatment of agitation in people with Alzheimer ’s disease in an adequately powered and robustly blinded r and omized controlled trial comparing it with donepezil , an anticholinesterase drug used with some benefit to treat BPSD . Methods and Findings : The study was a double-blind parallel-group placebo-controlled r and omized trial across 3 specialist old age psychiatry centres in Engl and . Participants had probable or possible Alzheimer ’s disease , were resident in a care home , had clinical ly significant agitation ( defined as a score of 39 or above on the Cohen Mansfield Agitation Inventory ) and were free of antipsychotics and /or anticholinesterase for at least 2 weeks . Participants were allocated to 1 of 3 groups : placebo medication and active aromatherapy ; active medication and placebo aromatherapy or placebo of both . Main Outcome : The primary outcome measure was reduction in agitation as assessed by the Pittsburgh Agitation Scale ( PAS ) at 4 weeks . This is an observational scale , and raters were required to wear nose clips to ensure that full blinding was maintained . 
    Output:
    
This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD , particularly when the intervention includes individualized and interactive music .
Bright light therapy has little and possibly no clinical ly significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation .
Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors .
Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD .
These types of studies may lead to the development of future intervention protocol s to improve the well-being and daily functioning of these patients , thereby avoiding residential care placement