The consensus statement recently released British Association for Psychopharmacology, 1 use of aromatherapy in addition to pharmacological treatment of dementia is communicated with one of the highest level of scientific evidence -. Data from randomized controlled trials
A number of recent, studies have shown that aromatherapy (therapeutic pure plant oils) can be useful in the treatment of patients with dementia: Lavender (Lavandula angustifolia or Lavandula officinalis) and lemon balm (Melissa officinalis) are two essential oils of particular interest in this field. Objectives Article Holmes & Ballard, 2 together here, was to examine the published reports on the efficacy of aromatherapy to treat behavioral problems of people with dementia.
Results of these studies are interesting as their results have not been dismissed solely caused by the placebo effect pleasant fragrance, as the authors note, most with severe dementia will have lost any meaningful sense of smell due to early loss of olfactory neurons.3 Indeed, the pharmacological mechanism of action of aromatherapy produces its effect is not expected to involve any perception of smell. Instead, the active ingredients including the body (absorption through the lungs or olfactory mucosa) and delivered to the brain through the bloodstream where they elicit direct actions.
Aromatherapy studies in patients with dementia A number of small, uncontrolled case studies have demonstrated the efficacy of inhaled and / or local lavender oil in this mode. In summary, these studies have shown lavender oil to improve sleep patterns, 4-7 and to improve behaviour.8,9
Although only a few controlled studies have investigated the potential use of aromatherapy for the management of behavioral problems in people dementia, the results have been positive. A single-blind, case-controlled studies investigating the effects of lavender essential oil of abnormal behavior in patients with severe dementia.10,11 patients (n = 21) were randomized to receive massage only, Lavender essential oils that give a massage or lavender oil inhalation as well conversation. Of the three groups of patients who receive oil to massage showed a significantly greater decrease in the frequency of large motor behavior.
In a small (n = 15) double-blind, placebo-controlled, crossover study in patients with severe dementia of NHS care unit was 11.12 2% lavender oil administered fragrance diffuser of the department for 2 hours, alternating placebo (water) every other day, for a total of ten treatments. According to the group median Pittsburgh Agitation Scale scores, treatment with lavender aromatherapy reduced agitated behavior significantly (p = 0.016) in patients with severe dementia compared with placebo, with 60% of patients benefit. No adverse effects were reported, and pass treatment was 100%.
In a crossover study, 13 56 elderly patients with moderate to severe dementia were rubbing a cream containing a combination of four essential oils (lavender, sweet marjoram, patchouli and vetiver) or cream alone five times a day for 8 weeks. Behavioural problems and resistance to care was significantly lower in patients treated with a cream containing essential oils compared to those treated with the cream alone.
In the largest double-blind, placebo-controlled study published at the time this review was written, 11.14 72 patients with severe dementia in NHS continuing care were randomized to receive either lemon balm essential oil (n = 36) or sunflower oil (n = 36) applied topically as a cream twice daily, in addition to the patients existing antipsychotics. Clinically significant agitation (measured with the Cohen-Mansfield agitation File [CMAI]) and quality of life indices were compared between the two groups at 4 weeks of treatment. A 30% reduction in CMAI score was observed in 60% of the active treatment group and 14% of the control group. The overall improvement in agitation (mean reduction in CMAI score) was 35% in patients treated with lemon balm, compared with 11% in the placebo group (pMethodological issues
In his article, Holmes & Ballard2 draw attention to the number of methodological issues that need to be considered in the design of future studies, the potential role of aromatherapy in the clinical treatment of behavioral and psychiatric symptoms in people with dementia.
Although most people with severe dementia have little sense of smell, researchers assessed the study may be able to identify the essential oils being tested, which could compromise the double-blind study. This problem can be overcome in various ways, such as using observational measures as the main results of the study, supplying scientists with masks infused with the aroma or nose clips to be the evaluation of the participants, pumping environment control fragrance and masking fragrance of essential oils with air fresheners.
In addition, as a large placebo response seen in many studies investigating the therapeutic behavior or psychiatric symptoms in people with dementia, it is important, in research on the effects of essential oils, aromatherapy and control interventions involve similar amounts of time and relationship with each participant.
Holmes & Ballard2 conclude that it is a huge issue-based evidence suggests activity aromatherapy to improve sleep, agitated behavior and resistance to care in dementia, there is a marked shortage of sufficiently large, placebo-controlled, randomized studies in this area. However, a placebo-controlled trial has shown signs of aromatherapy may be effective as an adjunct to current therapy in patients with dementia, this study was the number of methodological flaws.
The authors identify a number of important issues that need to be addressed in investigating the efficacy of aromatherapy in patients with dementia, including
- Patients with different forms of dementia respond differently to therapeutic agents; whether the same applies to their response to aromatherapy has yet to be confirmed.
- Essential oils are administered in various massage ‘airlines (such as skin creams, massage oils), and therefore involve’ adjuvant ‘of physical contact with caregivers. It is clear that further treatment is required to minimize or control the bone before conclusions can be made about the effects of aromatherapy one.
- If it is accepted that there are active neurochemical differences in essential oils, the research should investigate not only oil from different tribes but should also compare them from related species (eg Lavandula angustifolia and Lavandula officinalis).
- properly conducted, well-designed, randomized controlled trials, needed before conclusions about the efficacy and safety of essential oils can be drawn.
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- Brooker DJR, snale M, Johnson E et al. One case assessment of the effects of aromatherapy and massage disturbing behavior in severe dementia. British Journal of Clinical Psychology, 1997; 36 :. 287-96
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- Holmes C, Hopkins V, Hens Ford C et al. Lavender oil treatment agitated behavior in severe dementia. International Journal Psychogeriatric Psychiatry 2001; 17 :. 305-8
- Bowles EJ, Griffiths DM, Quirk L et al. The effect of essential oils and touch on resistance to nursing procedures and other dementia behavior in a residential care facility. International Journal of Aromatherapy 2002; 12 :. 22-9
- Ballard CG, O’Brien JT, Reichelt K et al. Aromatherapy as a safe and effective therapeutic management of agitation in severe dementia: results of a double-blind, placebo-controlled study with Melissa. Journal of Clinical Psychiatry 2002; 63: 553-8
- Thorgrimsen L, Spector A, Wiles A, Orrell M. Aroma therapy for dementia. Cochrane Database of Systematic Reviews 2003, (3): CD003150