**5. Other interventions**

#### **5.1. Behavioural therapy**

Traditionally, behavioural therapy has been based on principles of conditioning and learning theory using strategies aimed at suppressing or eliminating challenging behaviours. More recently, positive programming methodologies [79] have used non-aversive methods in helping to develop more functional behaviours. Moniz-Cook suggests that behavioural analysis is often the starting point of most other forms of therapeutic intervention in this area [80] and can be wholly consistent with person-centred care. Behavioural therapy requires a period of detailed assessment in which the triggers, behaviours and reinforcers are observed and their relationships made clear to the patient. The therapists use chart or diary to collect information about the behavioural symptoms, and interventions are based on an analysis of these findings.

For Emerson, planning an intervention should be focussed on three key features: identifying the individual's preferences; changing the context in which the behaviour occurs; and using reinforcement strategies and schedules that reduce the behaviour [63, 81].

A few studies showed the efficacy of behavioural in the context of dementia [63, 82]. There is some evidence of successful reductions in wandering, incontinence and other forms of stereotypical behaviours [83].

#### **5.2. Animal-assisted therapy**

**4.5. Bright-light therapy**

482 Update on Dementia

**4.6. Activity therapy**

movements [63, 73].

**4.7. Snoezelen multi-sensory stimulation**

attentional and intellectual demands [76].

**5. Other interventions**

**5.1. Behavioural therapy**

Bright light therapy (BLT) consists of exposure to daylight or specific wavelengths of light using polychromatic polarised light, laser, light-emitting diodes, fluorescence lamps, dichroic lamps or very bright, full-spectrum light. Four studies tested the effect of BLT on behavioural symptoms [66–69]. Two studies compared the effect of morning BLT and afternoon/evening BLT with normal light [66, 67]. Other studies compared one single type of BLT with usual light [66], and no differences were found between morning and evening. Limited evidence of

Activity therapy (AT) implicates recreation activities such as dance, sport and drama. It was found that physical exercise can have health benefits for dementia patients, reducing the number of falls and improving mental health, sleep [63, 70] and mood [71]. In addition, it was found that daytime exercise aided to decrease daytime agitation and night-time restlessness [63, 72]. Perrin described an interesting approach to dance therapy: he employed a form of dance known as 'jabadeo', which allows the patients to engage with each other in interactive

Snoezelen is a multi-sensory setting for implementation of several sensory-based tools. Snoezelen offers sensory stimuli to primary senses of hearing, touch, sight, smell and taste, by the use of music, odour of essential oils, lighting effects and tactile surfaces [74]. Several studies define snoezelen approach as a support therapy for dementia patients [75]. The goals of such therapy are to promote positive behaviours and to reduce maladaptive behaviours [76, 77].

Over the past decade, the clinical application of Snoezelen has been extended from the field of learning disability to dementia care. Its use resides in providing a sensory environment that capitalizes on the residual sensorimotor abilities of dementia patients. Moreover, encouraging results were obtained in the area of promoting adaptive behaviours [78]. In practice, snoezelen capitalize on the residual sensorimotor abilities of dementia sufferers and present a few

Traditionally, behavioural therapy has been based on principles of conditioning and learning theory using strategies aimed at suppressing or eliminating challenging behaviours. More recently, positive programming methodologies [79] have used non-aversive methods in helping to develop more functional behaviours. Moniz-Cook suggests that behavioural analysis is often the starting point of most other forms of therapeutic intervention in this area

reduction in agitation and aggression among those receiving BLT was found [67, 70].

Animal-assisted therapy (AAT) most commonly involves interaction between a patient and a trained animal, facilitated by a human handler, with a therapeutic goal such as providing relaxation and pleasure, or incorporating activities into physical therapy or rehabilitation. The therapeutic effect has been described by Baun and McCabe with reference to the stage of dementia and the positive effect on caregivers [84]. A review showed that AAT may ameliorate NPS in patients with dementia [85].

#### **5.3. Home adaptation therapy**

Home modifications for patients with dementia should promote safety for the patient and peace of mind for the caregiver. The modifications allow patients with dementia to receive ongoing care in the least restrictive environment possible and may be implemented as the need arises [86]. Home modifications for patients with dementia are associated with improved caregiver effectiveness and less caregiver upset [87].

#### **5.4. Assistive technologies**

In recent years, there have been significant innovations in the application of assistive technol‐ ogies (ATs) to support healthcare for patients with dementia. These technologies can be used by the patients with dementia, by the caregivers, and can run automatically (the so-called 'ambient intelligence') [88].

AT applications have the potential to support aging in place for patients with dementia, and they range from internet-based information and support groups to robotic companions comprising also the use of smartphones to report symptoms [89–91].

Several studies describe the responses of caregivers and patients with dementia (PWD) to technology [92–94]. In general, the objective of AT is to allow people to remain more inde‐ pendent and reside at home safely [91–93]. In an another study, it was found that involving the patients with dementia in the process of developing technological applications enhanced usability and acceptability and contributed to a sense of empowerment [95].
