were no reports on the long-term effects of this type of intervention after the initial period of agitation has passed. However, there are no reports on the long-term effects of this type of intervention after the initial period of agitation has passed. Tactile massage is a soft tissue massage that includes both touch and massage. The tactile massage method and its training courses were introduced in Japan in 2006, by the Japan Swedish Care Institute, and approximately 4000 people have completed the training course to date. Tactile massage is expected to help improve the QOL for elderly people with particularly severe dementia as well as for patients with speech impairments who are not able to communicate verbally. As reviewed, other researchers have reported the immediate effects of tactile massage during intervention among elderly people with dementia.13 The purpose of this study was to clarify the effects of a 6-week tactile massage on changes in physical and mental function, symptoms of BPSD, and stress levels over time among elderly patients with dementia. In addition to performing psychological testing, we examined the effects of tactile massage intervention on stress levels using pre and post 6-week salivary chromogranin A (CgA) levels as an index of stress. Research Methods The present study was conducted with elderly patients who had been diagnosed with dementia and were hospitalized in a specialist dementia ward (100 beds). The period of study was September 28, 2009 to November 6, 2009. Diagnosis was made by a specialist geriatric psychiatrist, using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition [DSM-IV]). Participants were divided into an intervention group receiving tactile massage and a control group receiving normal care with no tactile massage; 20 people were included in each group after matching for gender, age, dementia type, cognitive function, and ability to perform activities of daily living (ADLs). The intervention group received tactile massage 5 times a week for 6 weeks for a total of 30 times. The control group did not receive tactile massage but participated in regular activities, such as ordinary music therapy or occupational therapy. Tactile Massage Intervention Ward nurses and collaborating nurse researchers participated in a 2-day tactile massage training course in July 2009. After learning tactile massage techniques, they each performed 30 tactile massage sessions for a participant in the intervention group during the intervention. Tactile massage is a hand technique (Table 1) of the Japan Sweden Care Institute’s Tactile Care Course I. The Japan Care Institute registered the use of tactile massage as Tactile Care to obtain a Japanese trademark. This study used the technique for Tactile Care. However, we use the term tactile massage to unify terminology and because both methods use the same technique. A further session, conducted by a tactile care specialist trainer, was held immediately before the beginning of the period of study, to ensure that nurses’ hand techniques were consistent. A total of 30 sessions, each lasting approximately 30 minutes, between 16:00 and 17:00 hours, were conducted 5 times a week for 6 weeks in the intervention group. Tactile massage sessions were conducted away from other patients, in a quiet space or private room on a different ward. Ethical considerations were addressed by explaining the research to the family members representing elderly patients with severe dementia, and obtaining their written consent. At each session, if the patient refused to participate or was unwell, tactile intervention was not carried out. This study was Suzuki et al 681 approved by the ethics committee of Hamamatsu University School of Medicine. Evaluation methods Mini Mental State Examination The Mini Mental State Examination (MMSE) is an interviewbased screening test consisting of 30 items on the following 6 subscales: orientation, registration, attention and calculation, recall, language, and visual constriction. Each item17 is scored from 0 to 5, with a total score ranging from 0 to 30. Higher MMSE scores represent better functioning. The MMSE was done at baseline before the 6-week intervention and again after intervention. An occupational therapist who had experience with psychological evaluation of elderly people with severe dementia conducted the MMSE interviews. The Gottfries-Brane-Steen Scale The Gottfries-Brane-Steen scale (GBS) focuses on qualitative differences in dementia. The GBS uses a 0- to 6-point scale to evaluate items including (A) motor function, 6 items (0-36); (B) intellectual function, 11 items (0-66); (C) emotional function, 3 items (0-18); and (D) different symptoms common in dementia, 6 items (0-36).18 Higher GBS scores represent worse functioning. The GBS was done at baseline before the 6-week intervention and again after intervention. Nurses who took charge of participants in the intervention and control groups performed the GBS evaluations before and after the intervention. Behavior Pathology in Alzheimer’s Disease Rating Scale The Behavior Pathology in Alzheimer’s Disease Rating scale (BEHAVE-AD) evaluates the medicinal effects of drug therapy for Alzheimer’s disease based on the following 8 items: (a) paranoid and delusional ideation, 7 items (0-21); (b) hallucinations, 5 items (0-15); (c) activity disturbances, 3