positive effects of massage and touch for persons with dementia. One physiological model is based on the observation that the sensation of touch or proximity has an immediate calming, reassuring influence, mediated, for example, by the production of oxytocin, and hence modifies the symptoms of discomfort, agitation and mood disorders (Lund 2002; Uvnäs-Moberg 1998). Neurological models of action have also been proposed (Scherder 1995a). Another more psychological kind of model sees touch and massage as a way to ’stay in touch’ and retain a sense of meaningful, reassuring communication even when words begin to fail (Bush 2001; Vanderbilt 2000). The sensory stimulation involved may also help to activate non-verbalized patterns of memories and meanings (Opie 1999). Under such assumptions it would be conceivable that massage and touch modalities could also help to Massage and touch for dementia (Review) 2 Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. counteract the progressive decline of cognitive abilities if this decline is at least partly due to lack of use and meaningful stimulation. In any case there seems to be a broad consensus that the potential short-term effects lie primarily in behaviour, mood and well-being, while the longer-term effects may include a limited degree of modification of cognitive decline. A wide range of massage and touch modalities are described in the recent literature. One study reports, without further specification, the use of a ’massage’ component of a combined intervention (Smallwood 2001); another reports only that a professional massage therapist was in charge of such a component (Brooker 1997). Most studies describe the parts of the patients’ bodies which were massaged or touched: in many cases these are large areas of the body, particularly back, shoulders, and back of the neck (Rowe 1999; Sansone 2000). In other cases the hands, arms and shoulders (Kim 1999), only the hands (Snyder 1995; Snyder 1995a) or only the lower legs and feet (Malaquin-Pavan 1997) were massaged or touched. Many studies report types of stroking and styles of touching in general or technical terms: tender touch with large strokes (Sansone 2000), slow strokes (Rowe 1999), expressive touch (Kim 1999), rubbing, kneading (Scherder 1995), and effleurage (Bowles 2002). In some cases the massage/touch is described as part of a general communicative situation including encouragement and friendly words (Kim 1999). In other cases a caregiver’s calm state of mind is an important element of the intervention, even to the extent that the caregivers prepare themselves through a suggestive or meditative exercise (Malaquin-Pavan 1997; Rowe 1999). This is also the case in the more or less standardized therapy form ’therapeutic touch’ (TT) in which the therapist’s hands are held near the patient’s body but not in physical contact. In four of the studies, the intervention used was TT alone or in combination (Giasson 1999; Snyder 1995; Snyder 1995a; Woods 2002). Several other more or less established therapeutic systems enter as elements in the interventions reported: reflexology (Malaquin-Pavan 1997), acupressure (Kilstoff 1998) and aromatherapy (Kilstoff 1998). The number of treatments given per patient in a study varies: in most studies it is between 10 and 50. The frequency of treatments is fixed at once or twice per day in most cases, but in a few cases it is variable according to need. The duration of each treatment varies from 1 to 30 minutes, but in a few cases this was not reported. Most studies give some information on the provider of the massage or touch intervention: nursing staff (Malaquin-Pavan 1997), nursing staff working to a specified protocol (Snyder 1995; Snyder 1995a), nursing staff trained by a therapist (Brooker 1997; Sansone 2000), therapist (Bowles 2002; Scherder 1995), investigator (Woods 2002), research assistants trained by investigator (Kim 1999), family members trained by nursing staff (Kilstoff 1998; Rowe 1999). In at least two cases it can be argued that the intervention tested was not really massage or touch per se, but training with follow up given to a caregiver at home or at an institution, so that the receiver of the intervention was not the patient but the patient-caregiver dyad (Kilstoff 1998; Rowe 1999; Sansone 2000). There is considerable heterogeneity in the style, the categories and the degree of precision with which the studies specify the interventions involved. Studies address questions of the effect of massage and touch interventions on one or several outcome variables in the general class of agitated behaviour, mood, discomfort and pain, while some also address the impact of massage/touch on cognitive/practical ability (Kilstoff 1998). A few studies combine the measurement of concrete clinical outcomes with physiological correlates which either belong to a hypothesized mechanism of action or are taken to express an outcome of anxiety, stress, relaxation, etc (Fraser 1993; Kim 1999; Snyder 1995). Study designs include non-randomized controlled trials (Snyder 1995), cross-over studies (Snyder 1995a), time-series without a control group (Kilstoff 1998; Kim 1999; Malaquin-Pavan 1997; Rowe 1999; Woods 2002), single case studies (Brooker 1997), ’action research’ - a method