OBJECTIVE: To assess the impact of massage versus ear acupuncture on behavior and participation in occupational therapy of dementia patients. METHODS: We performed a controlled, randomized longitudinal trial approved by the Bioethics Commission of the University of Extremadura. One hundred twenty elderly subjects with dementia institutionalized in residential homes in Extremadura (Spain) received treatment based on massage and ear acupuncture over three months. Behavior alterations, sleep disturbance, and participation in rehabilitation and eating were assessed every month during the three months of intervention, and at one and two months of follow-up after the end of treatment. The assessment was performed through a structured questionnaire with closed format ques-tions done by an occupational therapist not involved in the study. RESULTS: There was a statistically significant positive effect of massage and ear acupuncture (P< 0.001) on measured variables in the third month of intervention, which were maintained at two months after completing the treatment (P