Behavior management approach for agitated behavior in Japanese patients with dementia: a pilot study

Junko Sato,¹ Shutaro Nakaaki,² Katsuyoshi Torii,¹ Mizuki Oka,² Atsushi Negi,¹ Hiroshi Tatsumi,³ Jin Narumoto,⁴ Toshi A Furukawa,⁵ Masaru Mimura<sup>2

1</sup>Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, ²Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, ³Department of Health Science, Faculty of Psychological and Physical Science, Aichi Gakuin University, Nagoya, ⁴Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, ⁵Department of Health Promotion and Human Behavior (Cognitive-Behavioral Medicine), Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan

Background: Agitated behaviors are frequently observed in patients with dementia and can cause severe distress to caregivers. However, little evidence of the efficacy of nonpharmacological interventions for agitated behaviors exists for patients with dementia. The present pilot study aimed to evaluate a behavioral management program developed by the Seattle Protocols for patients with agitated behaviors in Japan.
Methods: Eighteen patients with dementia (Alzheimer’s disease, n = 14; dementia with Lewy bodies, n = 4) participated in an open study testing the effectiveness of a behavioral management program. The intervention consisted of 20 sessions over the course of 3 months. The primary outcomes were severity of agitation in dementia, as measured using the Agitated Behavior in Dementia scale (ABID) and the Cohen-Mansfield Agitation Inventory (CMAI).
Results: The behavioral management program resulted in significant reductions in total scores on both the ABID and CMAI. Although both physically agitated and verbally agitated behavior scores on the ABID improved significantly, symptoms of psychosis did not improve after the intervention.
Conclusion: The behavioral management technique may be beneficial to distressed caregivers of patients with dementia. In the future, a well designed study to develop the behavioral management program more fully is needed.

Keywords: Alzheimer’s disease, dementia with Lewy bodies, agitated behavior, behavioral management, Agitated Behavior in Dementia scale