What non-pharmacological interventions are effective in managing behavioral symptoms in patients with dementia?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Non-pharmacological (psychosocial) approaches are recommended as first-line interventions for managing behavioural and psychological symptoms of dementia (BPSD) . Before initiating any treatment for distress, a structured assessment should be conducted to explore possible reasons for the distress and to check for and address clinical or environmental causes, such as pain, delirium, or inappropriate care ,.

  • General Interventions: Psychosocial and environmental interventions should be offered to reduce distress ,. These interventions should be tailored to the person's preferences, skills, and abilities, with monitoring of response and adaptation of the care plan as needed . People living with dementia should continue to access psychosocial and environmental interventions for distress even while taking or after stopping antipsychotics ,.
  • Agitation and Aggression: Offer personalised activities to promote engagement, pleasure, and interest for individuals experiencing agitation or aggression ,. Specific non-pharmacological interventions associated with substantial reductions in agitation include massage therapy, animal-assisted intervention, and personally tailored interventions . If challenging behaviour requires urgent treatment (when the person is a danger to themselves or others) and underlying causes have been addressed, advise moving the person to a safe, low-stimulation environment and using verbal and non-verbal de-escalation techniques (e.g., active listening, pictures, symbols) .
  • Depression and Anxiety: For people with mild to moderate dementia who have mild to moderate depression and/or anxiety, psychological treatments should be considered ,. Non-drug interventions have been found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder . Effective interventions include cognitive stimulation, massage and touch therapy, multidisciplinary care, occupational therapy, exercise combined with social interaction and cognitive stimulation, and reminiscence therapy .
  • Sleep Problems: For individuals with sleep problems, consider a personalised multicomponent sleep management approach ,. This approach should include sleep hygiene education, exposure to daylight, exercise, and personalised activities ,.

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