Dementia, Aromatherapy, and Bright-Light Treatment

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

Introduction

People suffering from progressive dementia often go through stages where there are signs of behavioral and psychiatric disturbances: depression, aggression, agitation, delusions, hallucinations, sleep disturbance, and wandering. Prescription of drugs such as neuroleptics or sedatives are usually written, but their side effects are quite often worse then their benefits: extrapyramidal signs, sedation leading to falls, and even accelerated cognitive decline. Behavioral management is a better option, but is not always readily available.

It's not surprising that 'alternative medicine' approaches have been tried for such patients, but what is surprising is that two such measures have achieved considerable success in well-conducted studies. Two professors and two senior lecturers of old age psychiatry have recently reviewed the evidence in favor of these therapies.

Aromatherapy

Three placebo-controlled studies have been reported in the last two years, all showing significant benefits on agitation in the absence of side effects¹. The agents used were lemon (or Melissa) balm and lavender oil, given by inhalation or skin application twice daily, daily, or twice weekly. Almost all the severely demented patients completed the studies, which is itself remarkable; with pharmaceutical interventions there is usually a 30% drop-out rate. All three studies showed statistically significant improvements in agitation measures.

It should be remembered that severely demented subjects have almost invariably lost their sense of smell, so the "aroma" mechanism is clearly an indirect one. However, essential oils contain many terpines, which are readily absorbed through the lungs, and cross the blood-brain barrier. Some are reported to possess cholinergic or gamma aminobutyric acid (GABA) receptor activity.

Bright-light treatment

Bright light, using up to 10,000 lux from a light box, is an accepted treatment for seasonal affective disorder. Now three controlled trials have been reported examining its effect on behavioral disorders and sleep disturbance in dementia². Compliance in these studies was not as good as with aromatherapy - only 50% to 60% completed their treatments. However, different parameters were improved in each study - reduced motor restlessness in one, increased total sleep time in another, and increased mini-mental state examination (MMSE) scores in the third. Again, there were no side effects. The reviewers describe these findings as 'promising'.

Comment

This review article is brief and does not contain sufficient details to allow a full independent assessment of the quality of the 6 studies cited. Moreover, the authors do not speculate further on the mechanisms of the beneficial effects encountered. Nevertheless, the results are encouraging, and the safety of the procedures will certainly support further studies in the direction of sensory stimulation for these patients. Moreover, it's interesting to speculate what aromatherapy may have to offer in other behavioral or psychiatric disorders.

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

Footnotes
1. Lavender oil as a treatment for agitated behaviour in severe dementia. C. Holmes, V. Hopkins, C. Hensford, Int J Geriatr Psychiatry, 2002, vol. 17, pp. 305--308
1. Aromatherapy and behavioural disturbances dementia. J. Smallwood, R. Brown, F. Coulter, Int J Geriatr Psychiatry, 2001, vol. 16, pp. 1010--1013
1. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia. CG. Ballard, J. O'Brien, K. Reichelt, E. Perry, J Clin Psychiatry, 2002, vol. 63, pp. 553--558
2. Bright light therapy and melatonin in motor restless behaviour in dementia. PM. Haffmanns, RC. Sival, SA. Lucius, Int J Geriatr Psychiatry, 2001, vol. 16, pp. 106--110
2. A randomized control trial of bright light therapy for agitated behaviours in dementia patients residing in long-term care. C. Lyketsos, LL. Veiel, A. Baker, C. Steele, Int J Geriatr Psychiatry, 1999, vol. 14, pp. 520--525
2. The effects of light therapy on mini-mental state examination scores in demented patients. A. Graf, C. Wallner, V. Schubert, Biol Psychiatry, 2001, vol. 50, pp. 725--727

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