Functional analysis may be a promising alternative treatment for challenging behaviour in dementia


Mood, memory and behaviour are all affected by dementia and it is not unusual for behaviour to become ‘challenging’. People with dementia may become agitated or aggressive and this can be extremely difficult and stressful for family members and carers.

Challenging behaviour has traditionally been managed with antipsychotic drugs, despite the fact that they do not work that well in this patient group and have considerable side effects. There is therefore a significant amount of interest in any alternative treatment for challenging behaviour in people with dementia.

This new Cochrane review set out to assess the effects of functional analysis-based interventions for people with dementia (and their caregivers) living in their own home or in other settings.

Functional analysis is a behavioural intervention that involves a therapist considering why a person with dementia is behaving in a particular way. The purpose and meaning of individual behaviour is investigated and family and carers are given strategies to help them reduce the distress, agitation or aggression.

The Cochrane reviewers carried out a comprehensive search for randomised controlled trials that reported behavioural outcomes that could be associated with functional analysis for the management of challenging behaviour in dementia. They found 18 trials suitable for inclusion, most of which were in a family care setting.

In most of the studies, functional analysis was just one aspect of a broad programme of care. This made it impossible to study the specific effects of functional analysis accurately.

However, the review did find that the multi-component interventions that include functional analysis are potentially beneficial for patients. The frequency of reported behavioural problems was reduced, as was the reaction of the caregiver. No significant effects were found for incidence or severity of mood and other problem behaviours. Similarly, no significant effects were found for caregiver mood or burden.

The reviewers concluded:

Whilst it is too early to reach a firm conclusion on the evidence for functional analysis in the management of challenging behaviour in dementia, we note emerging beneficial effects on challenging behaviour where multi-component psychosocial interventions have used functional analysis as part of the programme of care.

Moniz Cook ED, Swift K, James I, Malouf R, De Vugt M, Verhey F. Functional analysis-based interventions for challenging behaviour in dementia. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD006929. DOI: 10.1002/14651858.CD006929.pub2.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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