The prevalence of dementia has increased gradually. Dementia not only increased mortality and costs of health care for the elderly, but also caused burden on family caregivers. Non-pharmacological interventions have been regarded as first-line therapy to slow brain degradation of dementia. Reality orientation therapy belongs to psychosocial interventions. In the recent years, some researchers explored the effectiveness of reality orientation therapy (ROT) on cognitive function and behavioral problems in patients with dementia. This literature review explored the effectiveness of ROT for dementia care and relevant considerations regarding ROT. Nurses and care staff are often ROT performers. Interventional approach used reality orientation board, combining with orientation training, a large clock, calendar, and environment modification. The ROT has been shown to be effective in subjects with mild to moderate dementia. Implementation of three times a week, 30-60 minutes each time, and last at least 4 weeks can significantly improve patients’ cognitive function. Although some literatures reported the effectiveness of ROT on behavior, depression, and activities of daily living, the findings were inconsistent. There is no substantial evidence supporting the positive effects of ROT on caregivers’ depression, anxiety, care burden, and quality of life. ROT combining with donepezil have been shown to have additive effects on cognitive improvement. Cost-effectiveness analysis has shown that ROT is cost-saving if patient’s cognitive function can be improved. The results provided fundamental knowledge for dementia care with application of a simple and non-pharmacological interventions in clinical care to improve cognitive function and quality of care for dementia.