OBJECTIVES: To explore the effectiveness of acupressure and Montessori-based activities in decreasing the agitated behaviors of residents with dementia. DESIGN: A double-blinded, randomized (two treatments and one control; three time periods) cross-over design was used. SETTING: Six special care units for residents with dementia in long-term care facilities in Taiwan were the sites for the study. PARTICIPANTS: One hundred thirty-three institutionalized residents with dementia. INTERVENTION: Subjects were randomized into three treatment sequences: acupressure-presence-Montessori methods, Montessori methods-acupressure-presence and presence-Montessori methods-acupressure. All treatments were done once a day, 6 days per week, for a 4-week period. MEASUREMENT: The Cohen-Mansfield Agitation Inventory, Ease-of-Care, and the Apparent Affect Rating Scale. RESULTS: After receiving the intervention, the acupressure and Montessori-based-activities groups saw a significant decrease in agitated behaviors, aggressive behaviors, and physically nonaggressive behaviors than the presence group. Additionally, the ease-of-care ratings for the acupressure and Montessori-based-activities groups were significantly better than for the presence group. In terms of apparent affect, positive affect in the Montessori-based-activities group was significantly better than in the presence group. CONCLUSION: This study confirms that a blending of traditional Chinese medicine and a Western activities program would be useful in elderly care and that in-service training for formal caregivers in the use of these interventions would be beneficial for patients