Yang et al.BMC Complementary and Alternative Medicine (2015)15:93 Page 5 of 8 Table 1 Demographic data Aroma-acupressure Aroma group Control group F/X2 P value group (n=56) (n=73) (n=57) Age,mean±SD or n(%) 85.3±5.76 83.67±4.96 81.56±679 5.91°20.83 <0.01￥<0.01* 65-74 years 4(7.1%) 3(4.16) 11(1939%) 75-84year5 14(25%) 39(53.49%) 25(43.99%) ≥85 years 38(67.99%) 31(42.59%) 21(3689%) Sex,n (% 5.69 0.06 Male 46(82.19%) 48(65.89%) 43(75.49%) Female 10(17.99%) 25(34296) 14(24.69%) Diagnosis of Dementia,n(%) 20.40- <0.01* AD 45(8039%) 70(95.9%) 55(96.5%) Vascular 10(17.9%) 0(0%) 2(3.5%) Other 1(18%) 3(4.196) 0(0%6) Restraint,n (% 5.67 023 None 29(5189%) 35(4799%) 31(54.49%) One (chemical/physical) 22(3929%) 35(47.9%) 25(43.99%) Both 5(99%) 3(4296) 1(1.79%) Note."One-way ANOVA;PChi-square test;"p<0.05. finding is also consistent with the agitation results previ- acupressure and acupuncture have the same mechanism ously described.Regarding the group interaction with time, Acupuncture can adjust dopamine that has to do with sym- the sympathetic nervous system(LF%and LF/HF)in the pathetic nervous system.Mainly,the GABA nerves of aroma-acupressure group did not demonstrate a significant ventral tegmental area(VTA)can be activated then cause decline until the fourth week following the interventions. the release of dopamine from nucleus accumbens (NAc)to This result indicates that the relaxing effect of aroma- be inhibited [20].As a result,in the study of Yoon et al, acupressure was only present following an accumulation acupuncture on Shenmen point in order to activate the of time.However,only LF%in the aromatherapy group GABAg receptor of the GABA nerves of VTA,thus reduce was significantly lower in the second week following the the release of dopamine from NAc distinctly,and inhibit interventions,but LF/HF did not have any significant sympathetic nervous system eventually [21]. change during the period of study;this finding suggests The effect of aromatherapy is to absorb the essential oil that aroma-acupressure is better at inhibiting the sympa- into the circulatory system through skin.The effect mainly thetic nervous system compared with aromatherapy.Both takes place from nerve conduction.First,the peripheral Table 2 Changes in the CMAl scores over time for the three groups Pre-test Mean+SD Post-test Mean+SD Post-3 weeks test Mean+SD B(95%Cl) p value Group A-a group(n=56) 54.58±11.01 43.24±10.00 51.21±11.95 16.74(13.71-19.77 0.00 A group (n=73) 41.81±7.89 41.08±824 39.80±727 4.01(1.19—6.83) 0.01￥ Control group (n=57) 37.68±4.12 41.72±5.08 42.13±553 reference Time Post-test 3.96(2.22-5.71) <0.01* Post-3-week 439(2.64-6.13) <0.01* Group x Time A-a group x post-test -15.31(-1783to-12.79) <0.01* A-a group x post-3 weeks -7.65-1020to-5.11) <0.01* A group x post-test -4.82(-7.19to-2.45) <0.01* A group x post-3 weeks -5.93(-8.31to-3.56) <0.01* Note;Aroma-acupressure group:A-a group;Aroma group:A group;Cl:confidence interval;*p<0.05.finding is also consistent with the agitation results previ￾ously described. Regarding the group interaction with time, the sympathetic nervous system (LF% and LF/HF) in the aroma-acupressure group did not demonstrate a significant decline until the fourth week following the interventions. This result indicates that the relaxing effect of aroma￾acupressure was only present following an accumulation of time. However, only LF% in the aromatherapy group was significantly lower in the second week following the interventions, but LF/HF did not have any significant change during the period of study; this finding suggests that aroma-acupressure is better at inhibiting the sympa￾thetic nervous system compared with aromatherapy. Both acupressure and acupuncture have the same mechanism. Acupuncture can adjust dopamine that has to do with sym￾pathetic nervous system. Mainly, the GABA nerves of ventral tegmental area (VTA) can be activated then cause the release of dopamine from nucleus accumbens (NAc) to be inhibited [20]. As a result, in the study of Yoon et al., acupuncture on Shenmen point in order to activate the GABAB receptor of the GABA nerves of VTA, thus reduce the release of dopamine from NAc distinctly, and inhibit sympathetic nervous system eventually [21]. The effect of aromatherapy is to absorb the essential oil into the circulatory system through skin. The effect mainly takes place from nerve conduction. First, the peripheral Table 1 Demographic data Aroma-acupressure group (n = 56) Aroma group (n = 73) Control group (n = 57) Fa /χ2b P value Age, mean ± SD or n (%) 85.3 ± 5.76 83.67 ± 4.96 81.56 ± 6.79 5.91a 20.83b <0.01* <0.01* 65-74 years 4 (7.1%) 3 (4.1%) 11 (19.3%) 75-84 years 14 (25%) 39 (53.4%) 25 (43.9%) ≧85 years 38 (67.9%) 31 (42.5%) 21 (36.8%) Sex, n (%) 5.69b 0.06 Male 46 (82.1%) 48 (65.8%) 43 (75.4%) Female 10 (17.9%) 25 (34.2%) 14 (24.6%) Diagnosis of Dementia, n (%) 20.40b <0.01* AD 45 (80.3%) 70 (95.9%) 55 (96.5%) Vascular 10 (17.9%) 0 (0%) 2 (3.5%) Other 1 (1.8%) 3 (4.1%) 0 (0%) Restraint, n (%) 5.67b 0.23 None 29 (51.8%) 35 (47.9%) 31 (54.4%) One (chemical/physical) 22 (39.2%) 35 (47.9%) 25 (43.9%) Both 5 (9%) 3 (4.2%) 1 (1.7%) Note. a One-way ANOVA; b Chi-square test; *p < 0.05. Table 2 Changes in the CMAI scores over time for the three groups Pre-test Mean ± SD Post-test Mean ± SD Post −3 weeks test Mean ± SD β (95%CI) p value Group A-a group (n = 56) 54.58 ± 11.01 43.24 ± 10.00 51.21 ± 11.95 16.74(13.71—19.77) 0.00* A group (n = 73) 41.81 ± 7.89 41.08 ± 8.24 39.80 ± 7.27 4.01(1.19—6.83) 0.01* Control group (n = 57) 37.68 ± 4.12 41.72 ± 5.08 42.13 ± 5.53 reference Time Post-test 3.96(2.22-5.71) <0.01* Post- 3-week 4.39(2.64-6.13) <0.01* Group x Time A-a group x post-test −15.31(−17.83 to −12.79) <0.01* A-a group x post-3 weeks −7.65(−10.20 to −5.11) <0.01* A group x post-test −4.82(−7.19 to −2.45) <0.01* A group x post-3 weeks −5.93(−8.31 to −3.56) <0.01* Note.; Aroma-acupressure group: A-a group; Aroma group: A group; CI: confidence interval; * p < 0.05. Yang et al. BMC Complementary and Alternative Medicine (2015) 15:93 Page 5 of 8