can be assumed that closing the distance between the nurse and patient through tactile massage fulfilled the psychological need of attachment. It has also been reported Suzuki et al 685 that individualized music reduces fretfulness in elderly patients with severe dementia.4,5 This study had several limitations. The number of participants in this study was small, and the fact that they were elderly patients with severe dementia meant that some participants had to withdraw from the study midway because of worsening complications and other reasons, and that it was not possible to collect saliva samples from some participants. There is a need to examine the effects of tactile massage on elderly patients with severe dementia with a larger number of participants in future studies. In conclusion, tactile massage, which seems to offer the potential to reduce BPSD in elderly patients with severe dementia through the fundamental connection of warm handto-hand contact with nurses, may be a method of nonverbal communication that can be used to restore a sense of humanness in elderly patients with severe dementia and to improve the quality of dementia care as a whole. Acknowledgments The authors express their sincere thanks to the patients who collaborated in the study and their families, as well as to the nurses and care staff of the wards that collaborated in the study. Declaration of Conflicting Interests The authors declared no conflicts of interest with respect to the authorship and publication of this article. Funding The authors received no financial support for the research and authorship of this article. References 1. Japanese cabinet. 2007 Elderly White Book. Tokyo, Japan: Gyosei; 2006. 2. Alzheimer’s Disease International. Dementia in the Asia Pacific region-Japanese. http://www.alz.co.uk/research/asiapacificreport. html, London (6.10. 2010). 3. International Psychogeriatric Association. The BPSD Educational Pack; 1998. 4. Suzuki M, Kanamori M, Watanabe M, et al. Behavioral and endocrinological evaluation of music therapy for elderly patients with dementia. Nurs Health Sci. 2004;6(1):11-18. 5. Suzuki M, Kanamori M, Nagasawa S, Isowa T, Saruhara T. Music therapy-induced changes in behavioral evaluations, and saliva chromogranin a and immunoglobulin a concentrations in elderly patients with senile dementia. Gerontol Geriatr Int. 2007;7(1): 61-71. 6. Kanamori M, Suzuki M, Yamamoto K, et al. A day care program and evaluation of animal-assisted therapy (AAT) for the elderly with senile dementia. Am J Alzheimers Dis Other Demen. 2001;16(4):234-239. 7. Andersson K, To¨ rnkvist L, Wa¨ndell P. Tactile massage within the primary health care setting. Complement Ther Clin Pract. 2009;15(3):158-160. 8. Taylor A. The Principle and Practice of Physical Therapy. 3rd ed. Cheltenham, London: Stanley Thamas; 1991. 9. Andersson K, Wa¨ndell P, To¨ rnkvist L. Tactile massage improves glycaemic control in women with type 2 diabetes apilot study. Pract Diab Int. 2004;21(3):105-109. 10. Agren A, Berg M. Tactile massage and severe nausea and vomiting during pregnancy-women’s experiences. Scand J Caring Sci. 2006;20(2):169-176. 11. Henricson M, Erssonc A, Ma¨tta¨ S, Segestena K, Berglundb A. The outcome of tactile massage on stress parameters in intensive care. A randomized controlled trial. Complement Ther Clin Pract. 2008;14(4):244-254. 12. Snyder M, Egan EC, Burns KR. Interventions for decreasing agitation behaviors in persons with dementia. J Gerontol Nurs. 1995;21(7):34-40. 13. Kim EJ, Buschmann MT. The effect of expressive physical touch on patients with dementia. Int J Nurs Stud. 1999;36(3):235-243. 14. Remington R. Calming music and hand massage with agitated elderly. Nurs Res. 2002;51(5):317-323. 15. Hicks-Moore SL. Favorite music and hand massage, dementa. Dementia. 2008;7(1):95-108. 16. Hall G, Buckwalter KC. Progressively lowered stress threshould. A conceptual model for care of adults with Alzheimer’s disease. Arch Psychiatr Nurs. 1987;1(6):399-406. 17. Folstein MF, Folstein SE, McHugh PR. Mini-mental State. Practical method for grading the cognitive state for the clinician. J Psychiatr Res. 1975;12(3):189-198. 18. Gottfries CG, Brane G, Steen G. A new rating scale for dementia syndromes. Arch Gerontol Geriatr. 1982;1(4):311-330. 19. Reisberg B, Borenstein J, Salob S Massage Therapy in Nursing as Nonpharmacological Intervention to Control Agitation and Stress in Patients With Dementia Hui Zhao, MA; Weiwei Gu, MA; Min Zhang, BA REVIEW ARTICLE ABSTRACT Context • Agitation, aggression, stress, and anxiety are common in patients with dementia. Another essential feature of dementia is a significant decline in a patient’s cognitive ability, and communicating among patients through language becomes virtually ineffective. Scientists have examined techniques to maintain communication with patients with dementia at a basic level, such as through gentle touch in the form of massage. Objective • The literature review intended to examine the role of massage therapy, either alone or in conjunction with other nonpharmacological interventions such as aromatherapy or calming music, in attenuating aggression and related behavioral disorders in patients with dementia. Design • The research team performed a literature review, searched the PubMed database, using different keyword