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Efficacy of theory-based activities for behavioral symptoms of dementia

Contact Information


Anna M. Kolanowski

activity interventions, behavioral symptoms, dementia


Background: Agitation and passivity are behavioral symptoms exhibited by 90% of nursing home residents with dementia. They account for many poor health outcomes, caregiver burden, and increased costs of long-term care. Objectives: This study tested the efficacy of recreational activities derived from the Need-driven Dementia-compromised Behavior (NDB) model: activities matched to skill level only; activities matched to style of interest only; and a combination of both (NDB-derived) for responding to the behavioral symptoms of dementia. Methods: Thirty participants were randomly assigned to 1 of 6 possible order-of-condition presentations in this crossover experimental design with repeated measures of dependent variables. Trained research assistants, blind to condition match, implemented each condition for 12 consecutive days. Measures of engagement (time on task and participation), affect, and behavioral symptoms (agitation and passivity) were taken from videotape recordings of each session. Mood was measured with the Dementia Mood Picture Test. The primary analysis method was mixed-model analysis of variance. Results: Significantly more time on task, greater participation, more positive affect, and less passivity were found under NDB-derived and matched to interest only treatments compared with the matched to skill level only treatment or baseline. Agitation and negative affect improved under all treatments compared with baseline. There was no significant change in mood. Discussion: The NDB-derived activities are tailored to meet individual needs and improve behavioral symptoms associated with dementia. These findings help to explain factors that produce behavioral symptoms and the mechanisms that underlie their successful treatment.


Kolanowski, A. M., Litaker, M., & Buettner, L. (2005). Efficacy of theory-based activities for behavioral symptoms of dementia. Nursing research, 54(4), 219–228.





Conent Area

Ann M Kolanowski

EWB-Related Construct

(3) Positive Affect

Study Design

Species or Study Population

(5) RCT

Sex (%Female)


Age (Mean, SD)

82.3, 7.5

Younger Controls?


Longitudinal Data?


Sample Size



Theory-Based Activities intervention

Ethnicity (%white)


Inclusion Criteria

(a) English speaking; (b) diagnosis of dementia that met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria; (c) had a Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) score of 24 or less; (d) had a willing informant who knew the participant well and who provided personality and other data; (e) had a stable dose of any psychoactive drug from prebaseline through final observation; and (f) exhibited behavioral symptoms as reported by staff and documented in the participant’s Minimum Data Set.

Exclusion Criteria

Exclusion criteria included history of psychiatric problems, alcoholism, diagnosis of Parkinson’s disease, or stroke; Hachinski score above 4 to rule out vascular dementia; an average score for both extraversion and openness on the NEO Five-Factor Inventory (NEO-FFI; Costa & McCrae, 1992) because these persons cannot be accurately classified on style of interest; a new psychoactive medication within the past 30 days; and an acute illness.

EWB Measures

Philadelphia Geriatric Center Affect Rating Scale

Non-EWB Behavioral

mini mental state examination (MMSE)
Wechsler Adult Intelligence Scale
Psychogeriatric Dependency Rating Scale (PGDRS)
NEO Five-Factor Inventory
Dementia Mood Picture Test
Cohen Mansfield Agitation Inventory

Physiological Measures


Brain IMaging Modality

Brain IMaging Paradigm


Brain Region/Circuit


Biological Measures


Other Neural Measures

Data Availability?


Data Avalability Details


Diagnostic Measures

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