Agitation In Dementia Research Articles

Effect of Massage and Touch on Agitation in Dementia: A Meta-Analysis.

To systematically assess the effects of massage and touch on agitation in patients with dementia and to determine the optimal intervention design. Agitated behaviour is the most common behavioural symptom in patients with dementia and can seriously affect the health status and quality of life of individuals with dementia and their caregivers. Massage and touch have been widely used as a non-pharmacological intervention to address the behavioural issues of dementia. However, current research findings on the effects of massage and touch on agitation in people with dementia are inconsistent. A meta-analysis of randomised controlled trials. This meta-analysis complied with PRISMA guidelines, and relevant literature up to January 2024 was systematically retrieved from PubMed, Embase, Web of Science, the Clinical Trials Registry, Cochrane Library and four Chinese databases. Statistical evaluations were performed utilising Review Manager 5.4, and the included studies' bias risks were assessed with the Cochrane Collaboration tool. Seventeen randomised controlled trials involving 980 patients with dementia were included. The results of the meta-analysis showed that massage and touch could ameliorate agitation and behaviour problems in dementia. Subgroup analyses based on massage type showed that hand, head and foot massage significantly improved agitation. Massage and touch for ≤ 4 weeks were more effective in reducing agitated behaviour than those for > 4 weeks. Furthermore, subgroup analysis revealed that massages and touch were more effective for individuals with less severe dementia. Massage and touch in the short term can effectively improve agitation in dementia patients, while hand, head and foot massage can effectively reduce agitation. Thus, clinical nursing staff and caregivers of individuals should be actively helped to apply massage and touch to their patients. However, more studies are needed to validate our results before we can give a more definitive recommendation. This study suggests that massage and touch can be used as complementary treatments for agitation in people with dementia and encourages nursing staff and caregivers to apply massage and touch to better cope with the agitated behaviour of older adults with dementia. No patient or public contribution. PROSPERO registration number: CRD42024507133.

A Review of Dextromethorphan-Quinidine for the Treatment of Agitation in Dementia.

A Review of Dextromethorphan-Quinidine for the Treatment of Agitation in Dementia.

Indoor environmental conditions and likelihood of reported violence and aggression in a purpose-built residential dementia hospital

This study, conducted on purpose-built NHS dementia wards, investigates correlations between patient aggression and indoor temperature and humidity. Temperature and humidity, measured at 3-min intervals, on male and female wards, over 12–15 months, were compared against staff-recorded incidents (n = 299; females n = 100; males n = 199). Linear regression was used to assess potential correlations. Binomial analysis measured relative risk of incidents outside comfortable thermal (22–24 °C) and humidity (30%–60%) ranges. Temperatures ranged from 17 to 27oC and humidity ranged from 16 to 70%. On the male ward, both extremes of temperature were correlated with increased incident likelihood (R2 = 0.473) and relative risk of incidents was 1.89 (p = 0.0015) at temperatures <22oC and 1.73 (p < 0.001) at temperatures >24oC. On the female ward, increasing temperature was correlated with increased incident likelihood (R2 = 0.568) and relative risk of incidents was 1.99 (p < 0.001) at temperatures >24oC. Strong associations between relative humidity levels and incidents were not identified. Extreme temperatures were associated with significantly increased risk of incidents of agitation, suggesting relevance of environmental conditions in the formulation of agitation in dementia.

Controversies in Aging: Anticonvulsants for Management of Agitation in Dementia

Controversies in Aging: Anticonvulsants for Management of Agitation in Dementia

Brexpiprazole for the treatment of agitation associated with dementia due to Alzheimer's disease: A 12-week, active-treatment, extension trial.

A 12-week randomized controlled trial demonstrated that brexpiprazole is efficacious for treating agitation in patients with dementia due to Alzheimer's disease. To assess the long-term safety and tolerability of brexpiprazole for the treatment of agitation associated with dementia due to Alzheimer's disease. This 12-week, active-treatment (oral brexpiprazole 2 or 3 mg/day) extension trial ran from October 2018-September 2022 at 66 sites in Europe/US. Patients with agitation in dementia due to Alzheimer's disease in a care facility/community-based setting who completed the randomized trial were eligible (N = 259 enrolled/analyzed for safety; 88.4% completed). Stable Alzheimer's disease medications were permitted. The primary safety endpoint was the frequency and severity of treatment-emergent adverse events (TEAEs). Change in Cohen-Mansfield Agitation Inventory (CMAI) total score was an exploratory efficacy endpoint. Mean (SD) age was 74.3 (7.6) years, 145 patients (56.0%) were female, and 248 (95.8%) were White. TEAEs were reported by 67 patients (25.9%), most commonly headache (3.5%) and fall (2.3%). Most TEAEs were mild or moderate in severity; 5 patients (1.9%) reported a severe TEAE, including 3 severe falls attributed to tripping, misjudging sitting, or dehydration. Twelve patients (4.6%) discontinued due to TEAEs. No patients died. Mean CMAI total score improved by 9.1 points over 12 weeks. Considering the randomized and extension trials together, brexpiprazole 2 or 3 mg was generally well tolerated for up to 24 weeks in elderly patients with agitation associated with dementia due to Alzheimer's disease. Patients showed continued improvement in agitation. NCT03594123 (registration date: July 11, 2018).

COVID-19 and Its Influence on Prevalence of Dementia and Agitation in Australian Residential Aged Care: A Comparative Study

Agitation is one of the most common and persistent behavioral and psychological symptoms among persons with dementia (PWD) in residential aged care facilities (RACFs). While most studies have explored the general impact of COVID-19 on the mental health and well-being of aged care residents, there has been limited research on the pandemic’s impact on agitation in dementia within RACFs. This knowledge is crucial to ensuring that RACFs are better equipped to handle future public health emergencies. Therefore, this retrospective cohort study investigates the impact of the pandemic on agitation incidents within 40 Australian RACFs. Using Python, we extracted agitation symptoms from nursing notes and compared the frequency and percentage of symptom occurrence pre-pandemic versus during-pandemic. Chi-square tests examined any significant change in the prevalence of dementia and agitation in dementia between the comparative groups and periods. Dementia prevalence dropped significantly during the second year of the pandemic, with a concurrent increase in early-onset dementia cases. Overall, agitation symptoms decreased by 20.1%, but six symptoms significantly increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%). Conversely, pacing decreased by 15.88% and speaking loudly decreased by 10.9%. Over half of the care recipients with dementia experienced agitation symptoms 2–5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021. Despite the co-occurrence of symptoms such as falls, confusion, and weakness, there was no evidence to suggest that these comorbidities were specific to COVID-19; rather, they appeared to be prevalent even before the pandemic. Persons with agitation in dementia had a significantly higher death rate during the COVID-19 pandemic than otherwise.

Dexmedetomidine for agitation in dementia: Current data and future direction.

The incidence and prevalence of dementia, and thus dementia-related behavioral and psychological symptoms, are increasing significantly. Currently, there are limited safe and efficacious options for treating these symptoms. Dexmedetomidine has been used for agitation related to delirium and showed significant benefit in prior studies. This raises the question whether dexmedetomidine could also provide a safe and effective treatment for BPSD, including agitation related to dementia. Our team searched PubMed, Cochrane Database, and Ovid with the terms dexmedetomidine and dementia. Only studies published in English language journals, or with official English language translations, and human studies were included. All reports of dexmedetomidine for dementia were included regardless of study type. No completed studies on dexmedetomidine for agitation in dementia were identified. The TRANQUILITY study is in progress, although results are yet to be published. Dexmedetomidine has shown benefit for hospital delirium and for agitation in schizophrenia and bipolar disorder. However, there are no completed studies published on dexmedetomidine for agitation in dementia. Controlled studies with larger sample sizes are needed to assess the efficacy, safety, and the best route of administration for this drug in managing BPSD including agitation.

Electroconvulsive therapy for the acute management of severe agitation in dementia (ECT-AD): A modified study protocol

Objective This study began as a single-blind randomized controlled trial (RCT) to investigate the efficacy and safety of electroconvulsive therapy (ECT) for severe treatment-refractory agitation in advanced dementia. The aims are to assess agitation reduction using the Cohen-Mansfield Agitation Inventory (CMAI), evaluate tolerability and safety outcomes, and explore the long-term stability of agitation reduction and global functioning. Due to challenges encountered during implementation, including recruitment obstacles and operational difficulties, the study design was modified to an open-label format and other protocol amendments were implemented. Methods Initially, the RCT randomized participants 1:1 to either ECT plus usual care or simulated ECT plus usual care (S-ECT) groups. As patients were enrolled, data were collected from both ECT and simulated ECT (S-ECT) patients. The study now continues in an open-label study design where all patients receive actual ECT, reducing the targeted sample size from 200 to 50 participants. Results Study is ongoing and open to enrollment. Conclusion The transition of the ECT-AD study design from an RCT to open-label design exemplifies adaptive research methodologies in response to real-world challenges. Data from both the RCT and open-label phases of the study will provide a unique perspective on the role of ECT in managing severe treatment-refractory agitation in dementia, potentially influencing future clinical practices and research approaches.

Physiological Profiling of Agitation in Dementia: Insights From Wearable Sensor Data.

The number of people with dementia is expected to triple to 152 million in 2050, with 90% having accompanying behavioral and psychological symptoms (BPSD). Agitation is among the most critical BPSD and can lead to decreased quality of life for people with dementia and their caregivers. This study aims to explore objective quantification of agitation in people with dementia by analyzing the relationships between physiological and movement data from wearables and observational measures of agitation. The data presented here is from 30 people with dementia, each included for 1 week, collected following our previously published multimodal data collection protocol. This observational protocol has a cross-sectional repeated measures design, encompassing data from both wearable and fixed sensors. Generalized linear mixed models were used to quantify the relationship between data from different wearable sensor modalities and agitation, as well as motor and verbal agitation specifically. Several features from wearable data are significantly associated with agitation, at least the p < .05 level (absolute β: 0.224-0.753). Additionally, different features are informative depending on the agitation type or the patient the data were collected from. Adding context with key confounding variables (time of day, movement, and temperature) allows for a clearer interpretation of feature differences when a person with dementia is agitated. The features shown to be significantly different, across the study population, suggest possible autonomic nervous system activation when agitated. Differences when splitting the data by agitation type point toward a need for future detection models to tailor to the primary type of agitation expressed. Finally, patient-specific differences in features indicate a need for patient- or group-level model personalization. The findings reported in this study both reinforce and add to the fundamental understanding of and can be used to drive the objective quantification of agitation.

“From Stigma to Solution” – Using THC Edibles for the Palliative Treatment of Aggression and Agitation in Dementia

“From Stigma to Solution” – Using THC Edibles for the Palliative Treatment of Aggression and Agitation in Dementia

Neuromodulation in Behavioral and Psychological Symptoms of Dementia (BPSD)

Neuromodulation in Behavioral and Psychological Symptoms of Dementia (BPSD)

Wrist-worn actigraphy in agitated late-stage dementia patients: A feasibility study on digital inclusion.

Wrist-worn actigraphy can be an objective tool to assess sleep and other behavioral and psychological symptoms in dementia (BPSD). We investigated the feasibility of using wearable actigraphy in agitated late-stage dementia patients. Agitated, late-stage Alzheimer's dementia care home residents in Greater London area (n=29; 14 females, mean age±SD: 80.8±8.2; 93.1% White) were recruited to wear an actigraphy watch for 4weeks. Wearing time was extracted to evaluate compliance, and factors influencing compliance were explored. A high watch-acceptance (96.6%) and compliance rate (88.0%) was noted. Non-compliance was not associated with age or BPSD symptomatology. However, participants with "better" cognitive function (R=0.42, p=0.022) and during nightshift (F1.240, 33.475=8.075, p=0.005) were less compliant. Female participants were also marginally less compliant (F1, 26=3.790, p=0.062). Wrist-worn actigraphy appears acceptable and feasible in late-stage agitated dementia patients. Accommodating the needs of both the patients and their carers may further improve compliance.

Extracting Symptoms of Agitation in Dementia from Free-Text Nursing Notes Using Advanced Natural Language Processing.

Extracting Symptoms of Agitation in Dementia from Free-Text Nursing Notes Using Advanced Natural Language Processing.

Structural brain network degeneration associated with agitation in dementia

AbstractBackgroundAgitation is a behavioral syndrome involving increased motor activity, restlessness, aggressiveness and emotional distress. Its has a 30% prevalence across multiple types of dementia and is associated with negative outcomes, including reduced quality of life, caregiver distress, and mortality. Pharmacological treatment risks serious side effects, including mortality. Understanding brain network topology could provide insights into novel treatment methods.MethodParticipants comprised 600 subjects from 3 existing databases: the Alzheimer’s Disease Neuroimaging Initiative (ADNI), Frontotemporal Lobar Degeneration Neuroimaging Initiative (NIFD) and the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease at Northwestern University. Participants were clinically diagnosed with either behavioral variant frontotemporal dementia (bvFTD), mild cognitive impairment (MCI), dementia of the Alzeheimer type (DAT) or cognitively normal (CN). The Neuropsychiatric Inventory Questionnaire (NPI‐Q) caregiver rating was used to determine whether individuals were agitated or not. Morphometric similarity networks (MSNs) were generated from Freesurfer statistics calculated from T1‐weighted MRIs. 7 surface‐based cortical metrics (e.g. gray matter volume, surface area) were calculated for each of 360 parcels. Pairwise inter‐parcel Pearson correlations of feature vectors were calculated to produce a morphometric similarity matrix for each individual. We calculated sub‐matrices for salience (SN) cognitive control (CCN) and default mode networks (DMN). Brain Connectivity Toolbox calculated transitivity and global efficiency of each network. Metrics were calculated at different thresholds to ensure the results were not threshold‐dependent. We calculated 2 (Agitation present/absent) x 4 (Diagnosis) repeated measures ANCOVAS for transitivity and global efficiency for each network. Covariates were age, sex, race, database, education, ICV, CDR‐SB and days MRI‐NPI‐Q.ResultFor the SN, people with Agitation had significantly lower global efficiency than people without Agitation (Figure 1). There were no significant effects of diagnosis or interaction. For the CCN, people with agitation had significantly lower transitivity than people without Agitation (Figure 2). There were no significant effect of diagnosis or interaction.ConclusionAcross different forms of dementia, Agitation is associated with reduced integration (global efficiency) of the salience network, and reduced segregation (transitivity) of the cognitive control network. Interventions that alter these topological network features may be effective in reducing agitation in dementia, regardless of clinical diagnosis.

Structural brain network degeneration associated with agitation in dementia

AbstractBackgroundAgitation is a behavioral syndrome involving increased motor activity, restlessness, aggressiveness and emotional distress. Its has a 30% prevalence across multiple types of dementia and is associated with negative outcomes, including reduced quality of life, caregiver distress, and mortality. Pharmacological treatment risks serious side effects, including mortality. Understanding brain network topology could provide insights into novel treatment methods.MethodParticipants comprised 600 subjects from 3 existing databases: the Alzheimer’s Disease Neuroimaging Initiative (ADNI), Frontotemporal Lobar Degeneration Neuroimaging Initiative (NIFD) and the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease at Northwestern University.Participants were clinically diagnosed with either behavioral variant frontotemporal dementia (bvFTD), mild cognitive impairment (MCI), dementia of the Alzeheimer type (DAT) or cognitively normal (CN). The Neuropsychiatric Inventory Questionnaire (NPI‐Q) caregiver rating was used to determine whether individuals were agitated or not.Morphometric similarity networks (MSNs) were generated from Freesurfer statistics calculated from T1‐weighted MRIs. 7 surface‐based cortical metrics (e.g. gray matter volume, surface area) were calculated for each of 360 parcels. Pairwise inter‐parcel Pearson correlations of feature vectors were calculated to produce a morphometric similarity matrix for each individual. We calculated sub‐matrices for salience (SN) cognitive control (CCN) and default mode networks (DMN). Brain Connectivity Toolbox calculated transitivity and global efficiency of each network. Metrics were calculated at different thresholds to ensure the results were not threshold‐dependent.We calculated 2 (Agitation present/absent) x 4 (Diagnosis) repeated measures ANCOVAS for transitivity and global efficiency for each network. Covariates were age, sex, race, database, education, ICV, CDR‐SB and days MRI‐NPI‐Q.ResultFor the SN, people with Agitation had significantly lower global efficiency than people without Agitation (Figure 1). There were no significant effects of diagnosis or interaction.For the CCN, people with agitation had significantly lower transitivity than people without Agitation (Figure 2). There were no significant effect of diagnosis or interaction.ConclusionAcross different forms of dementia, Agitation is associated with reduced integration (global efficiency) of the salience network, and reduced segregation (transitivity) of the cognitive control network. Interventions that alter these topological network features may be effective in reducing agitation in dementia, regardless of clinical diagnosis.

S7: Updates on Electroconvulsive Therapy practice and research

S7: Updates on Electroconvulsive Therapy practice and research

Lessons from Covid‐19: A narrative and reflective practice review of non‐pharmacological treatments for agitation in Alzheimer’s dementia, in a time of social distancing

AbstractBackgroundAgitation as a behavioural and psychological symptom of dementia is common and distressing for patients and their carers. There are several non‐pharmacological approaches to managing agitation in Alzheimer’s Dementia (AD). Many of these require close interactions with the patient. However, social distancing during the coronavirus pandemic has made many of these interventions impractical. As busy clinicians working on a psychiatric unit managing AD patients with agitation, we wished to explore what we could offer in a time of social distancing. Our study sought to review the literature looking at the non‐pharmacological management of agitation in dementia and reflect on this as clinicians working amid a pandemic. While the pandemic recedes, this review and reflection still offers guidance for the management of agitation in AD whilst reducing the risk of disease transmission. The review would help to keep our most vulnerable safe during future outbreaks of infectious disease.MethodWe conducted a systematic review of the literature to identify non‐pharmacological treatments for the management of agitation in Alzheimer’s disease related dementia. Specifically, we sought evidence related to treatment in inpatient and care facilities. We appraised the evidence about these treatments. We then went on to use practitioner reflection on this evidence to consider the practicalities of implementation during the social distancing restrictions of the Covid‐19 pandemic.ResultMyriad non‐pharmacological therapies exist to help treat agitation in individuals with AD. Of these the evidence suggests music therapies and caregiver education interventions reduced agitation most significantly. We found that the most effective methods tailor treatment to the individual’s preferences and needs and use active engagement in therapies. Non‐group activities and those which do not involve shared equipment are most easily implementable during Covid‐19.ConclusionInterventions which are individually tailored to the patient and involve an active element to them are most effective, however those with an active element are less easily used during a pandemic. Given the evidence base and practicalities of implementation, our review suggests music therapy for those with agitation in AD.

Feasibility of Using Wearable Actigraphy for Behavioural Monitoring in Care Home Residents Living with Moderate to Severe Alzheimer’s Disease and Agitation

AbstractBackgroundMeasuring and monitoring behaviour is difficult in people living with later stage Alzheimer’s disease and specific behavioural symptoms such as agitation and aggression (AA). Currently, subjective information given by these patients is highly susceptible to inaccurate recall, clinicians rely on answers provided by care givers, which can be biased and lack fine‐grain temporal detail. Although actigraphy watches have been useful tools for research, little is known about the feasibility of their use in agitated dementia participants and on the factors influencing watch compliance.MethodPeople diagnosed with Alzheimer’s disease and significant AA symptoms living in care homes were asked to wear an actigraphy watch (GENEactiv Original) for 4 consecutive weeks. Demographic data, Functional Assessment Staging Tool (FAST) score, behavioural symptom pattern and severity were recorded using the Neuropsychiatric Inventory Nursing Home Version (NPI‐NH). Watch‐recorded wearing time and activity data were used to evaluate adherence. Care home staff were interviewed to explore factors influencing watch wearing by participants and to develop solutions to improve compliance.ResultWe recruited 28 participants (14 female) and found wearing the watch feasible overall. No statistical compliance difference was found between different groups based on age, FAST score, agitation pattern or severity; however, a significant gender difference was found with male participants being more adherent (Table). Participants were more compliant in weeks 3‐4, and first week adherence predicted overall adherence (Figure). Factors influencing compliance include the design and appearance of the watch, previous watch wearing habit, and the perceived purpose of the study. Using documents easily readable to participants and care givers to facilitate understanding of the study and to communicate challenging clinical scenarios appeared to enhance adherence.ConclusionWearing an actigraphy watch for behavioural monitoring was feasible for moderate to severe Alzheimer’s disease patients with AA symptoms in care home settings. Gender‐specific design and appearance should be considered when selecting the actigraphy watch. For dementia studies planning to use an actigraphy watch, compliance can be improved by incorporating a short lead‐in phase to establish a watch wearing routine and by providing reader‐friendly documents about the watch purpose to communicate with participants and care givers.

34 Specific Agitation Behaviors in Dementia Differentially Contribute to Caregiver Burden

Objective:Agitation is a common neuropsychiatric symptom within the dementia spectrum, experienced by 70 percent of individuals with cognitive decline. Prior literature demonstrates a strong association between care recipient agitation and burden in caregivers of individuals with dementia, as these symptoms are often difficult to manage and predict. Understanding how agitation symptoms in the person with dementia may influence caregiver burden is imperative given these strong associations; however, both agitation and burden are complex, multidimensional constructs. Agitation in dementia involves a range of behaviors including increased motor activity, emotional distress, and aggressive behaviors. Caregiver burden is also multi-faceted and often incorporates dimensions of social/relationship, emotional, and physical health strain. The current study sought to determine whether specific presentations of agitation differentially relate to distinct patterns of caregiver burden.Participants and Methods:Medical record data from an outpatient memory clinic were extracted for 609 persons with dementia and their caregivers. Caregivers completed the Zarit Burden Interview (ZBI) to assess caregiver burden and the Cohen-Mansfield Agitation Inventory (CMAI) to assess care recipient agitation behaviors. At their initial outpatient appointment, care recipients were also administered a measure of global cognitive functioning (either the Montreal Cognitive Assessment or the Mini-Mental State Examination). Demographic information was extracted from medical records. Exploratory factor analysis was used to determine ZBI and CMAI factor structures. Hierarchical multiple regression analyses then examined whether factors of the CMAI differentially predicted ZBI factors, controlling for dementia severity and demographic variables.Results:Exploratory factor analysis yielded three domains of agitation on the CMAI ("Physically Aggressive," "Physically NonAggressive," "Verbally Agitated") and four domains of burden on the ZBI ("Impact on Life," "Guilt/Uncertainty," "Embarrassed/Frustrated," and "Overwhelm"). Regression analyses demonstrated all domains of agitation positively predicted overall burden. Regarding specific aspects of burden, Physically Aggressive behaviors predicted only Embarrassment/Frustration (B=.41, SE=.10, ß=.16, p&lt;.001). Non-Aggressive behaviors predicted Impact on Life (B=.14, SE=.05, ß=.13, p&lt;.01) and Guilt/Uncertainty (B=.05, SE=.02, ß=.10, p&lt;.05). Verbally Agitated behaviors predicted all burden dimensions: Impact on Life (B=.35, SE=.06, ß=.32, p&lt;.001), Guilt/Uncertainty (B=.12, SE=.03, ß=.22, p&lt;.001), Embarrassment/Frustration (B=.17, SE=.02, ß=.38, p&lt;.001), and Overwhelm (B=.16, SE=.02, ß=.40, p&lt;.001).Conclusions:Findings enhance understanding of the relationships between specific agitation symptoms and distinctive aspects of caregiver burden, suggesting that targeted interventions for aspects of caregiver burden based on agitation symptoms may be useful in alleviating burden. Interventions focused on caregivers' feelings of guilt, personal health decline, lack of time for themselves, and fear and uncertainty about the future may be effective when care recipients present with physically nonaggressive behaviors (e.g., pacing, restlessness, inappropriate dress or disrobing). When a care recipient presents with physically aggressive behaviors, helping the caregiver cope with embarrassment or anger may be of benefit. When a care recipient presents with verbally agitated behaviors, interventions targeting burden globally may be most useful. Future work should seek to replicate the current findings and explore such interventions.

Characteristics of Music Therapy With Beneficial Impacts on Agitation in Dementia

Several reviews in recent years have reported evidence of the effect of music on the serious problem of agitation in dementia. Some reviews draw different conclusions, however, which actualizes the need for studies that examine characteristics of music therapy with beneficial impacts on agitation. In an instrumental case study, documented through qualitative interviews, recordings of group meetings, and patient record excerpts, we examine how music was used intensively in interaction with a man in his 70s at a unit for persons with dementia. Music therapy was often able to ease his agitation and was especially valuable in a period when he needed to be isolated due to a suspected coronavirus infection. However, the interventions did not work every time, and his responses differed considerably. The case illustrates that music therapy can address agitation in dementia for some clients, but the claim must be qualified. Potential characteristics of music therapy with such an ability might be i) situated use of the most favored music, ii) careful adjustment to signs of pain and discomfort, iii) sustained effort to build trustful relationships, iv) transferable interaction patterns of health musicking, and v) sufficient access to attention and support for the client(s) during the musical interventions.