The paper by Graff and colleagues in this week's BMJ comes at a time of disappointment and confusion for people with dementia and for those who care for them.1 The National Institute for Health and Clinical Excellence (NICE) recently recommended that cholinesterase inhibitors should not be used in patients with mild dementia, on the grounds that the modest benefits of treatment do not justify the healthcare costs.2 The hope that atypical antipsychotic drugs might play an important role in the management of non-cognitive aspects of dementia has been thwarted by evidence of adverse cerebrovascular events and increased mortality.3 Against this background, Graff and colleagues' study provides hope for effective non-pharmacological interventions and an example of how to design research into care for dementia.

The trial participants comprised 135 people with mild to moderate dementia who were living in the community. It found that a five week occupational therapy intervention (about 18 hours for each patient and care giver) significantly increased …