The number of people with dementia is rising rapidly with increased longevity. Although dementia’s core symptom is cognitive deterioration, agitation is common, persistent and distressing. Nearly half of all people with dementia have agitation symptoms every month, including 30% of those living at home.1 Four-fifths of those with clinically significant symptoms remain agitated over 6 months,2 and 20% of those initially symptom-free develop symptoms over 2 years.2 Agitation in dementia is associated with poor quality of life,3 because it is unpleasant, impedes activities and relationships, causes helplessness and anger in family and paid caregivers,4 and predicts nursing home admission,5 where the agitated behaviour adversely influences the environment.4 Several reviews, including our previous systematic review,6 considered all neuropsychiatric symptoms’ management together. We found direct behavioural management therapies (BMT) with the person with dementia and specific staff education had lasting effectiveness, but this may be limited to affective symptoms.7 A recent meta-analysis of family caregiver interventions for overall neuropsychiatric symptoms in dementia found an effect size of 0.23, but did not consider which symptoms improved.