We included 160 out of 1916 papers screened. Supervised person-centred care, communication
skills (SES = –1.8 to –0.3) or modified dementia care mapping (DCM) with implementing plans (SES = –1.4
to –0.6) were all efficacious at reducing clinically significant agitation in care home residents, both
immediately and up to 6 months afterwards. In care home residents, during interventions but not at
follow-up, activities (SES = –0.8 to –0.6) and music therapy (SES = –0.8 to –0.5) by protocol reduced mean
levels of agitation; sensory intervention (SES = –1.3 to –0.6) reduced mean and clinically significant
symptoms. Advantages were not demonstrated with ‘therapeutic touch’ or individualised activity.
Aromatherapy and light therapy did not show clinical effectiveness. Training family carers in behavioural
or cognitive interventions did not decrease severe agitation. The few studies reporting activities of daily
living or quality-of-life outcomes found no improvement, even when agitation had improved. We identified
two health economic studies. Costs of interventions which significantly impacted on agitation were
activities, £80–696; music therapy, £13–27; sensory interventions, £3–527; and training paid caregivers in
person-centred care or communication skills with or without behavioural management training and DCM,
£31–339. Among the 11 interventions that were evaluated using the Cohen-Mansfield Agitation Inventory
(CMAI), the incremental cost per unit reduction in CMAI score ranged from £162 to £3480 for activities,
£4 for music therapy, £24 to £143 for sensory interventions, and £6 to £62 for training paid caregivers in
person-centred care or communication skills with or without behavioural management training and DCM.
Health and social care costs ranged from around £7000 over 3 months in people without clinically
significant agitation symptoms to around £15,000 at the most severe agitation levels. There is some
evidence that DEMQOL-Proxy-U scores decline with Neuropsychiatric Inventory agitation scores.
A multicomponent intervention in participants with mild to moderate dementia had a positive monetary
net benefit and a 82.2% probability of being cost-effective at a maximum willingness to pay for a
quality-adjusted life-year of £20,000 and a 83.18% probability at a value of £30,000.