aggression in patients with dementia (N = 55).28 Although a downward trend occurred in the intensity of agitation and aggression in patients receiving the foot massage in comparison with the control patients, the differences were not statistically significant. A randomized, crossover pilot study involving patients with dementia (N = 14) in Japan reported that application of aroma therapy together with massage 3 times per week for 4 weeks did not improve mood, agitation, or verbal or nonverbal communication.29 Discussion Except for few studies showing no significant results for massage therapy,26,29 most of studies have documented that massage therapy, either alone7-9 or in combination with aromatherapy4,17-20 was effective in normalizing behavioral cognitive stimulation therapy (n = 29), and reminiscence therapy (n = 43) in patients with dementia.18 The patients received different interventions once per week for 8 to 10 weeks. Among these interventions, aroma massage therapy was reported to be more efficacious than the other therapies in decreasing agitation and depressive symptoms in patients with dementia. Another randomized controlled trial conducted by the same group of scientists with 59 patients reported a significant decline in agitation and depressive symptoms upon receiving aromatherapy with massage once per week for 8 weeks.19Another study conducted with patients with dementia (N = 14) at 2 hospitals in Turkey also revealed the efficacy of 4 weeks of aromatherapy with massage in attenuating agitation, neuropsychiatric symptoms, distress, and caregiver burden.20 A recent randomized clinical trial in 60 older patients with dementia also revealed the efficacy of attenuating behavioral and psychological symptoms using aromatherapy and massage therapy.21 These studies suggest that the combination of aromatherapy and massage therapy may be an effective as well as a safe intervention to overcome agitated behaviors and depressive mood in patients with dementia. Massage With Calming Music. Like aromatherapy, exposure to calming music has been found to attenuate anxiety, stress, and agitation. A recent, randomized, controlled crossover trial has found a superiority of music therapy over aromatherapy and massage therapy.22 Accordingly, scientists have attempted to combine massage and calming music as a nonpharmacological intervention in controlling behavioral disturbances in patients with dementia. However, data are limited about using a combination of massage and calming music with patients with dementia. In residential nursing home, exposure of hand massage or calming music or their combination in patients with dementia (N = 68) for 10 minutes significantly reduced agitated behaviors.23 Nevertheless, no significant effect was observed for the combination of calming music and massage in comparison to the individual treatments regarding improvements in behavioral abnormalities in patients with dementia. Reflexology. Reflexology is defined as gentle pressing on certain zones of the hands or/and feet to produce a desirable therapeutic effect in the body. Like aromatherapy, calming music and reflexology also belong to the category of nonpharmacological interventions, and they may produce a number of desirable effects in the body, including decreasing anxiety and agitation. A crossover study in a nursing home was conducted to explore the efficacy of reflexology in reducing physiologic distress and pain in patients (N = 21) with mild-to-moderate dementia in the United States.24 These patients were randomly divided into 2 groups, and one group received 4 weeks of reflexology treatment followed by 4 weeks of friendly visits from nurses. The second group first received 4 weeks of friendly visits from nurses and then 4 weeks of reflexology treatment. The study found that the reflexology treatment resulted in a decrease in physiological distress, assessed in terms of a decrease in the levels of This article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com Zhao—Massage Rherapy and Agitation in Patients With Dementia ALTERNATIVE THERAPIES, NOV/DEC 2020 VOL. 26 NO. 6 33 5. Kilstoff K, Chenoweth L. New approaches to health and well-being for dementia day-care clients, family carers and day-care staff. Int J Nurs Pract. 1998;4(2):70-83. 6. Sansone P, Schmitt L. Providing tender touch massage to elderly nursing home residents: A demonstration project. Geriatr Nurs. 2000;21(6):303-308. 7. Moyle W, Johnston AN, O’Dwyer ST. Exploring the effect of foot massage on agitated behaviors in older people with dementia: A pilot study. Australas J Ageing. 2011;30(3):159-161. 8. Snyder M, Egan EC, Burns KR. Efficacy of hand massage in decreasing agitation behaviors associated with care activities in persons with dementia. Geriatr Nurs. 1995;16(2):60-63. 9. Snyder M, Egan EC, Burns KR. Interventions for decreasing agitation behaviors in persons with dementia. J Gerontol Nurs. 199;21(7):34-40. 10. Malaquin-Pavan E. Therapeutic benefit of touch-massage in the overall management of demented elderly. Rech Soins Infirm. 1997;(49):11-66. 11. Rowe M, Alfred D. The effectiveness of slow-stroke massage in diffusing agitated behaviors in individuals with Alzheimer’s disease. J Gerontol