Journal of Alzheimer’s Disease 41 (2014) 15–28 DOI 10.3233/JAD-132357 IOS Press 15 Review Expanded Review Criteria: The Case of Nonpharmacological Interventions in Dementia Jiska Cohen-Mansfield a,b,* , Kathleen Buckwalter c , Elizabeth Beattie d , Karen Rose e , Christine Neville f and Ann Kolanowski g a Tel-Aviv University, Tel-Aviv, Israel b George Washington University, Washington, DC, USA c The University of Iowa, Iowa City, IA, USA d Queensland University of Technology, Kelvin Grove QLD, Australia e University of Virginia, Charlottesville, VA, USA f The University of Queensland, Brisbane, St Lucia QLD, Australia g Penn State University, State College, PA, USA Accepted 12 January 2014 Abstract. This paper challenges the assumptions underlying many reviews and offers alternative criteria for examining evidence for nonpharmacological interventions. We evaluated 27 reviews examining interventions for persons with dementia as they relate to the issues of selection based on randomized controlled trial (RCT) design. Reviews were described by type of intervention, level of cognitive function, and criteria for inclusion. Of the 27 reviews, 46% required RCTs for inclusion and most had stringent inclusion criteria. This resulted in poor utilization of the literature and low ecological validity. Eliminating most of the available data poses a critical problem to clinical and research development. Studies meeting strict methodological criteria may not generalize to the greater population or may exclude sub-populations and interventions. Limitations of double-blind RCTs and potential design solutions are set forth based on appropriate populations, problems, interventions, and settings characteristics. Keywords: dementia, interventions, older persons, randomized controlled trials, research designs, review The trend to utilize research results to guide practice led to identifying which interventions have sufficient evidence of success and can thus be termed “Evidence- Based Practices”. This process utilizes review articles ascertaining such interventions. This paper challenges many of the assumptions underlying these system- * Correspondence to: Jiska Cohen-Mansfield, Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, and Herczeg Institute on Aging, Tel Aviv University. Address: Tel-Aviv University, P.O.B. 39040, Ramat Aviv, Tel-Aviv 69978, Israel. Tel.: +972 3 6407337; Fax: +972 3 6407339; E-mail: Jiska@post.tau.ac.il. atic reviews, specifically for those involving persons with moderate to advanced dementia or their formal caregivers, and offers additional criteria for examining evidence for the effectiveness of nonpharmacological interventions. Healthcare providers increasingly rely on the scien- tific literature and clinical practice guidelines, along with patient preferences [1], to decide how best to treat older people with dementia who exhibit behav- ioral symptoms. Unfortunately, because of a variety of factors, discussed herein, many promising and poten- tially effective nonpharmacological interventions are ISSN 1387-2877/14/$27.50 © 2014 – IOS Press and the authors. All rights reserved