Non-drug treatments for dementia agitation include music therapy, physical exercise, aromatherapy, multisensory stimulation, touch therapy, reminiscence therapy, and environmental modifications. These approaches are now considered the standard first line of care before any medication is considered. A 2025 US expert panel recommends beginning with a structured clinical framework called DICE — Describe, Investigate, Create, Evaluate — to identify the cause of agitation and build an individualized, non-pharmacologic plan before turning to drugs. For example, a person with Alzheimer’s who becomes agitated every afternoon may be responding to unmanaged pain, boredom, or a disrupted routine — all of which can be addressed without medication.
This matters because agitation is extraordinarily common in dementia. Research shows that 76% of people with Alzheimer’s dementia experience agitation, and nearly all people with dementia — 98% — will develop some form of neuropsychiatric symptom during the disease course. With approximately 6.9 million Americans age 65 and older currently living with Alzheimer’s, and that number projected to nearly double to 13.8 million by 2060, the practical and ethical case for safe, effective non-drug approaches has never been stronger. This article covers the major non-drug interventions, the evidence behind each, how they compare, their limitations, and the clinical framework that organizes them.
Table of Contents
- Why Are Non-Drug Treatments the First Choice for Dementia Agitation?
- What Does the Evidence Say About Music Therapy for Dementia Agitation?
- How Do Physical Exercise and Aromatherapy Help with Dementia Agitation?
- What Is the DICE Framework and How Does It Guide Non-Drug Treatment?
- What Are Multisensory Stimulation and Touch Therapy, and When Do They Help?
- How Do Environmental Modifications and Routine Adjustments Reduce Agitation?
- What Does the Future of Non-Drug Dementia Agitation Treatment Look Like?
- Conclusion
- Frequently Asked Questions
Why Are Non-Drug Treatments the First Choice for Dementia Agitation?
The primary reason non-drug treatments come first is safety. The FDA issued black box warnings in 2005 and 2008 on the use of antipsychotic medications in elderly patients with dementia, citing increased risks of mortality, pneumonia, cerebrovascular events, and Parkinsonian symptoms. These are not theoretical risks — they represent documented harm in vulnerable patients who are already medically fragile. When the side effect profile of a treatment includes early death, the bar for using it must be very high. Beyond safety, the efficacy argument for antipsychotics in dementia agitation is weak. Clinical trials across placebo-controlled, head-to-head, and discontinuation study designs consistently show that the benefits of antipsychotics are, at best, small.
By contrast, a systematic analysis found that non-pharmacologic interventions appeared more effective than drug treatments for reducing aggression and agitation, and came with minimal risk. The comparison is stark: interventions like music therapy carry no mortality risk, no drug interactions, and no organ toxicity. There is also an investigative reason to start with non-drug approaches. Agitation in dementia often has an identifiable, treatable cause — an infection, uncontrolled pain, depression, constipation, or a medication side effect. Addressing the root cause can eliminate the agitation entirely, without any ongoing intervention. Prescribing a sedating drug before ruling out a urinary tract infection, for instance, risks masking a serious medical problem while adding new harms.
What Does the Evidence Say About Music Therapy for Dementia Agitation?
Music therapy has the strongest and most consistent evidence of any non-drug intervention for dementia agitation. A 2025 systematic review found that both active formats — singing, playing instruments — and receptive formats, where the person simply listens, can reduce agitation, aggression, depression, and anxiety, while also supporting cognitive and social function. Sessions typically run between 20 and 90 minutes. The evidence is especially compelling because music memory is stored in a region of the brain that dementia often damages more slowly than other areas, meaning even people with advanced disease frequently retain emotional and musical responsiveness. Critically, the research shows that personalization matters. Music therapy works best when it draws on the individual’s own history — culturally familiar music, songs from young adulthood, hymns for those with a religious background, or genres the person actively enjoyed before their diagnosis.
Playing classical music to someone who spent their life listening to country or gospel does not produce the same results. This distinction has practical implications: a one-size-fits-all music station in a memory care common room is not the same as a tailored music session designed around a specific resident’s preferences. However, music therapy has limitations. It requires time, staff capacity, and some degree of individualization to work well. Passive background music has a much weaker evidence base than structured therapeutic sessions. In facilities with workforce shortages — a documented barrier identified in a 2025 systematic review of non-pharmacologic interventions in care homes — consistent delivery of quality music therapy can be difficult to maintain. Families providing home care may find it more feasible, since they already know their loved one’s musical history.
How Do Physical Exercise and Aromatherapy Help with Dementia Agitation?
Physical exercise is recommended for the broader category of behavioral and psychological symptoms of dementia (BPSD), which includes agitation. The evidence supports exercise as a general regulator of mood, sleep, and behavioral symptoms, likely through its effects on neurochemistry, sleep quality, and physical comfort. A person who is sedentary and uncomfortable is more likely to express distress through agitation. Structured walks, gentle chair exercises, or guided movement programs can reduce that baseline discomfort and restlessness, particularly in the afternoon hours when sundowning is common. Aromatherapy occupies a more specific niche in the evidence. An umbrella review published in a peer-reviewed nursing journal found that aromatherapy was particularly recommended for agitation specifically — as distinct from depression or anxiety — while other interventions like reminiscence therapy were better suited to depression. Lavender oil applied to the skin or diffused in the environment is the most commonly studied agent.
The mechanism is not fully understood but may involve the olfactory system’s direct connections to the limbic brain, which regulates emotion. Importantly, aromatherapy is low-cost, easy to administer, and carries minimal risk for most people. One practical example: a care facility in a pilot program introduced lavender diffusers in resident rooms during the late afternoon, when agitation peaks for many people with dementia. Staff reported a measurable decrease in distress calls and physical altercations during that window. That is consistent with the literature. However, aromatherapy is not appropriate for everyone — some individuals have respiratory sensitivities or allergies, and topical application must be done carefully to avoid skin irritation in elderly skin. It is also worth noting that aromatherapy should supplement, not replace, efforts to identify underlying causes of agitation.
What Is the DICE Framework and How Does It Guide Non-Drug Treatment?
The DICE framework — Describe, Investigate, Create, Evaluate — is the clinical structure recommended by a 2025 US multispecialty expert panel as the standard starting point for managing agitation in Alzheimer’s disease. It is not a single intervention but a decision-making process that organizes non-pharmacologic care. The first step, Describe, means documenting the specific behavior: what is happening, when, how often, and in what context. “She gets agitated” is not a clinical description; “she becomes physically aggressive during morning personal care, particularly when staff attempt to remove her nightgown” is one. The second step, Investigate, means looking for causes — medical, environmental, interpersonal, and contextual. Is there pain? An infection? A change in routine? A staff member whose voice or manner triggers anxiety? The third step, Create, means building an individualized non-pharmacologic plan based on what was found.
If the agitation during personal care stems from modesty discomfort, the plan might involve a different care approach, a same-gender aide, or a distraction strategy using music. The fourth step, Evaluate, means monitoring whether the plan is working and adjusting it. The tradeoff in using DICE is that it requires training, documentation, and care coordination — resources that are not always available in under-resourced settings. The 2025 systematic review of implementation barriers in care homes specifically identified time constraints, workforce shortages, and gaps in staff collaboration as the primary obstacles to using non-drug interventions consistently. DICE works well when teams are trained and have capacity; it is harder to execute when a facility is short-staffed and overextended. That does not diminish its value — it identifies a structural problem that needs addressing at the systems level.
What Are Multisensory Stimulation and Touch Therapy, and When Do They Help?
Multisensory stimulation — often called Snoezelen, after the specialized rooms originally designed for it — combines light effects, calming sounds, gentle smells, and tactile materials to create an environment that reduces anxiety and agitation without requiring cognitive engagement. This is significant because people with moderate to severe dementia may no longer be able to participate in structured activities, hold a conversation, or follow instructions. Snoezelen works precisely because it does not demand those capabilities. Sessions average about 30 minutes and can range from a few sessions to daily use over many months, depending on the individual and the care setting. Touch therapy — including hand massage, foot massage, and gentle therapeutic touch — addresses a dimension of dementia care that is often underappreciated: social isolation and the loss of physical connection. Research suggests that touch may stimulate oxytocin production, providing a neurobiological basis for the sense of reassurance and calm it can produce.
For someone who can no longer reliably communicate through language, a gentle hand held or a slow shoulder massage may convey safety more effectively than words. The limitation of both approaches is access. Snoezelen rooms require dedicated space and equipment that most private homes and many smaller care facilities do not have. And touch therapy, while simple in concept, carries a warning: it must be approached carefully with individuals who have a history of trauma, abuse, or who simply do not tolerate physical contact. Some people with dementia become more agitated, not less, when touched unexpectedly. Observing the person’s response carefully and using only approaches they find comfortable is essential.
How Do Environmental Modifications and Routine Adjustments Reduce Agitation?
Environmental and behavioral modifications are among the least glamorous but most consistently effective tools for reducing dementia agitation. These include simplifying the physical environment to reduce overstimulation, establishing predictable daily routines, minimizing unexpected changes, reducing noise and clutter, ensuring adequate lighting, and adjusting the timing of care tasks to align with periods when the person is most calm and cooperative. A person who becomes distressed during a busy communal lunch may do better eating earlier, in a quieter setting, with fewer distractions.
Staff training is inseparable from environmental modification. The way a caregiver approaches someone with dementia — tone of voice, speed of movement, use of touch, whether they explain what they are doing — can itself be either a trigger for agitation or a calming influence. Facilities that invest in dementia-specific communication training and person-centered care models tend to report fewer behavioral incidents. For family caregivers, learning de-escalation strategies and understanding the behavioral triggers specific to their loved one is often the highest-leverage intervention available.
What Does the Future of Non-Drug Dementia Agitation Treatment Look Like?
The evidence base for non-pharmacologic interventions in dementia is growing, but it still has gaps. Most studies involve small samples, short durations, and heterogeneous populations, making it difficult to draw definitive conclusions about which interventions work best for which individuals and at which stage of disease. The 2025 systematic review landscape reflects a field that is maturing but not yet fully systematized. Larger, longer, better-controlled trials are needed — particularly for interventions like aromatherapy and touch therapy, where the mechanistic and clinical evidence remains thinner than for music therapy or exercise.
What is clear is the direction of travel. Clinical guidelines, expert panels, and systematic reviews consistently point toward individualized, non-pharmacologic-first care as the standard of practice. The DICE framework and similar structured approaches are beginning to standardize how clinicians and care teams think about agitation — not as a symptom to be suppressed, but as a communication to be understood. As the population of people living with dementia grows substantially over the coming decades, building the workforce capacity and care infrastructure to deliver these interventions consistently will be one of the defining challenges of dementia care.
Conclusion
Non-drug treatments for dementia agitation — music therapy, exercise, aromatherapy, multisensory stimulation, touch therapy, reminiscence therapy, and environmental modification — are not alternatives to real medicine. They are the evidence-supported, guideline-recommended first line of care. The FDA’s black box warnings on antipsychotics in dementia, combined with data showing those drugs offer minimal benefit even when risks are accepted, make a compelling case for starting elsewhere.
The 2025 DICE expert panel framework provides a practical clinical structure for doing exactly that: describe the behavior, investigate causes, create an individualized plan, and evaluate outcomes. For families and care teams, the practical starting point is observation and individualization. What triggers agitation in this specific person? What has calmed them before? What are their lifelong interests and routines? Music from their era, a familiar scent, a consistent daily structure, a calm and patient caregiver approach — these are not soft add-ons. They are interventions with evidence behind them, and for the tens of millions of people who will be living with dementia in the coming decades, they represent a more humane and often more effective path than reaching for a prescription pad first.
Frequently Asked Questions
Are non-drug treatments for dementia agitation better than medications?
Research suggests they can be. A systematic analysis found non-pharmacologic interventions appeared more effective than drug treatments for reducing agitation and aggression, with far fewer risks. Antipsychotics carry FDA black box warnings in dementia patients due to increased mortality and serious adverse events, and their clinical benefits have been characterized as “at best small” across multiple types of clinical trials.
What is the single most evidence-supported non-drug treatment for dementia agitation?
Music therapy has the strongest and most consistent evidence base. A 2025 systematic review found it reduces agitation, aggression, depression, and anxiety in people with dementia. Both active participation and simply listening to personalized, culturally relevant music have demonstrated benefits.
Can agitation in dementia be caused by something treatable?
Yes, frequently. Agitation can be caused or worsened by infections, uncontrolled pain, depression, constipation, or medication side effects. Identifying and treating the underlying cause can resolve the agitation entirely, without any ongoing behavioral intervention.
What is the DICE approach to dementia agitation?
DICE stands for Describe, Investigate, Create, and Evaluate. It is a clinical framework recommended by a 2025 US expert panel as the standard starting point for managing agitation in Alzheimer’s disease. It guides clinicians and care teams through identifying the specific behavior, investigating its causes, building an individualized non-drug care plan, and monitoring outcomes.
Do non-drug treatments work for people with severe dementia?
Some do. Multisensory stimulation (Snoezelen) and touch therapy are specifically designed for people who can no longer engage in structured activities or verbal interaction. Music therapy also tends to reach people even at advanced stages, since musical memory is often preserved longer than other cognitive functions. The 2025 expert panel notes that non-pharmacologic interventions are most effective for those with mild or moderate symptoms, but options exist across the disease spectrum.
Why aren’t non-drug treatments used more consistently in care facilities?
A 2025 systematic review identified the main barriers as time constraints, workforce shortages, severity of residents’ cognitive and physical impairment, and gaps in staff collaboration and care coordination. These are structural problems in how care is resourced and organized, not problems with the interventions themselves.
