Alzheimer's, Aromatherapy, and Bright Lights

Summarized by Robert W. Griffith, MD
December 20, 2002 (Reviewed: December 16, 2004)

Introduction

People suffering from Alzheimer's disease and other forms of dementia often go through difficult stages as the disease progresses: depression, aggression, agitation, delusions, hallucinations, sleep disturbance, and wandering. These conditions are often treated with drugs to sedate or 'tranquilize' the patient, but the side effects they produce are quite often worse then their benefits. Excessive sedation leads to falls, and sometimes they may accelerate mental decline. Behavioral therapy is a better option, but it requires extensive involvement by health professionals, and may not always be readily available.

It's not surprising that 'alternative medicine' approaches have been tried for such patients, but it is surprising that two such treatments have proved quite successful in controlled clinical studies - aromatherapy and bright-light boxes. Two professors and two senior lecturers of old age psychiatry have recently reviewed the evidence in favor of these therapies in the British Medical Journal.

Aromatherapy

Three studies reported in the last two years show significant benefits of aromatherapy on agitation in advanced Alzheimer's; and there were no side effects. In the first study, 2% lavender oil was given by daily inhalation, while the second used the same therapy twice weekly. In the third, lemon (or Melissa) oil was used in a hand cream, twice daily. Almost all the severely demented patients completed the studies, which is itself remarkable; in drug studies with a similar purpose there is usually a 30% drop-out rate. All three studies showed significant improvements in agitation scores.

One must remember that severely demented people have usually lost their sense of smell completely (see the first link below). This means the "aroma" effect doesn't work through the smell sensors in the nose. It's likely that substances called terpines, which are present in essential oils, are absorbed through the lungs and find their way to the brain. Some terpines are reported to have 'cholinergic' effects, like those of the cholinergic drugs effective in Alzheimer's (donepezil, galantamine, and rivastigmine).

Bright-light treatment

Bright light boxes, which the patient must look at for a short period - 1/2 to 1 hour - each day, provide up to 30 times the amount of an average office light. This is an accepted treatment for the depression called the 'winter blues', otherwise known as seasonal affective disorder. Three controlled studies have been reported concerning its effect in seriously demented patients. There were many more drop-outs than with aromatherapy; 40% to 50% of the patients didn't complete their course of treatment.

Results, however, were positive. In one study, restlessness and unnecessary movement were reduced, sleep was improved in another, and mental ability test scores (mini-mental state examination) were increased in the third. Again, there were no side effects.

Comment

This review article is quite brief, and doesn't contain enough details to let us conclude that these treatments should become standard therapy. However, the results are encouraging, and the lack of side effects should support further studies. The idea of sensory stimulation for demented patients is worth exploring. And it's interesting to speculate what aromatherapy may have to offer in other behavioral or psychiatric conditions.

Here's a feedback on this article that we've received from a reader in Thailand :

My wife, a Thai, age 75, began with dementia 7 years ago and developed into a zombie state, fighting taking a bath. Last year I was advised about holistic treatments. I have used PCA/rx from Hood River, Oregon; lavender aroma therapy; healing music (bought a CD player and play the music continually,albeit softly); and use a Chinese type balm for massage of arms, hands, legs, feet every night before sleeping.

Within 6 months her eyes have brightened, she no longer fights baths or being cleaned (she is incontinent in bed), allows herself to be walked from bed across a patio to a sala where we spoon feed her (we must lift her out of the bed before she begins walking), and she now speaks 10-12 words whereas for a few years she spoke nothing. She does not understand the spoken word, although her hearing is all right: she hears a sound and turns to look. For several years she has not been able to read or write. Now she watches television with seeming interest, and is amused by an 18 month old boy when he is in her presence.

We were told that a brain scan two years ago showed complete atrophy of the brain. However, due to her improvement, the doctor has reduced the prescription medicine. Her cholesterol, triglycerides, blood pressure, blood sugar which previously were very high are now down to the maximum of normal levels.

As I see it now, there are two problems: one is insufficient dissemination of holistic treatment information and the availability of holistic medications; the second is finding a doctor who will permit usage of holistic treatment.

We are always pleased to post positive, constructive feedback from our readers, like this one. Robert Griffith, Editor.

Source

Sensory stimulation in dementia. An effective option for managing behavioural problems. A. Burns, J. Byrne, C. Ballard, BMJ, 2002, vol. 325, pp. 1312--1313