• Michael A Rapp, Thomas Mell, Tomislav Majic, Yvonne Treusch, Johanna Nordheim, Mechthild Niemann-Mirmehdi, Hans Gutzmann, and Andreas Heinz.
• Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Berlin, Germany; Social and Preventive Medicine, Department of Health and Sports Sciences, University of Potsdam, Potsdam, Germany. Electronic address: michael.rapp@uni-potsdam.de.
• J Am Med Dir Assoc. 2013 Sep 1;14(9):690-5.

ObjectiveTo test the effect of a complex guideline-based intervention on agitation and psychotropic prescriptions.Design, Setting, ParticipantsCluster randomized controlled trial (VIDEANT) with blinded assessment of outcome in 18 nursing homes in Berlin, Germany, comprising 304 dementia patients.InterventionTraining, support, and activity therapy intervention, delivered at the level of each nursing home, focusing on the management of agitation in dementia. Control group nursing homes received treatment as usual.MeasurementsLevels of agitated and disruptive behavior (Cohen-Mansfield agitation inventory [CMAI]) as the primary outcome. Number of neuroleptics, antidepressants, and cholinesterase inhibitors (ChEIs) prescribed in defined daily dosages (DDDs).ResultsOf 326 patients screened, 304 (93.3%) were eligible and cluster-randomized to 9 intervention (n = 163) and 9 control (n = 141) nursing homes. Data were collected from 287 (94.4%) patients at 10 months. At 10 months, compared with controls, nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI (adjusted mean difference, 6.24; 95% CI 2.03-14.14; P = .009; Cohen's d = 0.43), received fewer neuroleptics (P < .05), more ChEIs (P < .05), and more antidepressants (P < .05).ConclusionComplex guideline-based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia. At the same time, increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline-based pharmacotherapy.Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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