• Jennifer A Watt, Zahra Goodarzi, Areti Angeliki Veroniki, Vera Nincic, Paul A Khan, Marco Ghassemi, Yuan Thompson, Andrea C Tricco, and Sharon E Straus.
• St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada (J.A.W., A.C.T., S.E.S.).
• Ann. Intern. Med. 2019 Nov 5; 171 (9): 633-642.

BackgroundBoth pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia.PurposeTo summarize the comparative efficacy of pharmacologic and nonpharmacologic interventions for treating aggression and agitation in adults with dementia.Data SourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO between inception and 28 May 2019 without language restrictions; gray literature; and reference lists scanned from selected studies and systematic reviews.Study SelectionRandomized controlled trials comparing interventions for treating aggression and agitation in adults with dementia.Data ExtractionPairs of reviewers independently screened studies, abstracted data, and appraised risk of bias.Data SynthesisAfter screening of 19 684 citations, 163 studies (23 143 patients) were included in network meta-analyses. Analysis of interventions targeting aggression and agitation (148 studies [21 686 patients]) showed that multidisciplinary care (standardized mean difference [SMD], -0.5 [95% credible interval {CrI}, -0.99 to -0.01]), massage and touch therapy (SMD, -0.75 [CrI, -1.12 to -0.38]), and music combined with massage and touch therapy (SMD, -0.91 [CrI, -1.75 to -0.07]) were clinically more efficacious than usual care. Recreation therapy (SMD, -0.29 [CrI, -0.57 to -0.01]) was statistically but not clinically more efficacious than usual care.LimitationsForty-six percent of studies were at high risk of bias because of missing outcome data. Harms and costs of therapies were not evaluated.ConclusionNonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia.Primary Funding SourceAlberta Health Services Critical Care Strategic Clinical Network. (PROSPERO: CRD42017050130).

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