Aromatherapy and dementia

Many research studies have been carried out worldwide. By the likes of Holmes et al., 2002, Lin et al., 2007, Snow et al., 2004 and Ballard et al.,2002 and many more. Which have explored how alternative medicines are effective in counteracting the effects of dementia. The main focuses throughout are to be based on aromatherapy, which can be used in many forms such as;

In the form of touch or in some cases aroma essential oils as diffusers (indirect) against a placebo, or even as a skin cream. The trait amongst the research studies has highlighted how the skills of a therapist can influence the results of such research alongside the tools, which are being used to measure the effectiveness. It also details how specific essential oils such as lavender and Melissa (lemon Balm) blends have proven proactive within helping the subject who has the disease to cope as the disease progresses. You will gain anatomical and physiological aspects as to what effects dementia has on the body.

Research will highlight what age groups it has been reoccurring in and what possible life situations may of led to this or whether or not it is hereditary. We will also discuss what other complementary therapies are available in the preventative and treating of such disease.

Aromatherapy is said to be by (Wildwood, 1996) the use of essential oils of aromatic plants and trees to promote peace of mind and health of the body with massage to help combat against everyday ailments to more severe diseases in this case dementia.

Dementia is characterised by the dramatic decline of intellectual function. (Williams & Wilkins, 2005) Dementia's most common form is Alzheimer’s disease (AD), which a slowly progressive disorder that destroys the neurons and communication pathways of the brain.

A clinical trial which was carried out using Lavendula (Lavender) and Melissa Officinalis (Lemon Balm) for residential care residents with advanced dementia has shown that the treatments can increase functional abilities and communication it also decreased difficult behaviour within the residents.

Lemon balm and lavender aroma were introduced to six patients and compared to a control group using sunflower oil for one week. The treatment increased functional abilities and communication, and decreased difficult behaviour. (Mitchell, 1993)

In a clinical trial carried out by (Smallwood, Brown, & Coulter, 2001), they found that aromatherapy with massage alone after a period of a week significantly reduced the frequency of excessive motor behaviour.

Lavender aroma and massage with 21 patients were compared to aroma or massage alone for one week. Aromatherapy with massage significantly reduced frequency of excessive motor behaviour. (Smallwood, Brown, & Coulter, 2001)

In this study carried out by (Holmes, Hopkins, & Hensford, 2002) Lavender essential oil was given to 15 patients and placebo for alternative days for ten days. The lavender oil significantly reduced agitated behaviour in comparison to the placebo.

Lavender aroma oil was given to 15 patients and placebo (water) on alternate days for ten days. The aromatherapy significantly reduced agitated behaviour (as assessed using the Pittsburgh Agitation scale) versus placebo.

(Holmes, Hopkins, & Hensford, 2002)

Previous studies have been carried using Lemon Balm (Mitchell, 1993) which provided evidence that Lemon Balm increases functional abilities, communication and decreases difficult behaviour. However this study 9 years later on (Ballard, O'Brien, & Reichelt, 2002) provides evidence that Lemon Balm was highly significant in the reduction of social withdrawal together with an increase in constructive activities. Observations here demonstrate that technology may of improved in regards to measuring how effective these tests are in comparison to the methods used years ago to test essential oils with such conditions. The only concern here is why it did not highlight the fact that Lemon Balm was effective back then with increasing functional abilities now when the same oil was being trialled.

Lemon balm (Melissa) lotion was applied to the face and arms of 36 patients, whilst another 36 patients had sunflower oil applied. Melissa was associated with highly significant reductions measured on the Cohen-Mansfield Agitation Inventory (CMAI) and social withdrawal, together with an increase in constructive activities (dementia care mapping).

(Ballard, O'Brien, & Reichelt, 2002)

In this study carried out by (Bowles-Dilys, Griffiths, & Quirk, 2002) it appears that they came to a better understanding of the uses of essential oils. As not only did they change the variable within the trial but they added more in this case three different essential oils Marjoram, Patchouli and Vetivert.

The results show that the combination significantly enhanced positive results as this increase the Mini Mental State Examination but also increase resistance to care (due to increased alertness).

This was most likely due to the combination of the essential oils. Each essential oil holds its own chemical constituents that have varied adverse reactions to the human body physically, intellectually, socially and mentally. Patchouli otherwise known as Pogostemon Cablin main constituents are Patchoulol, pogostol, bulnesol, nor patchoulenol, bulnese and patchoulene these hold a range of properties such as antidepressant, stimulant and is uses therapeutically within a complementary therapist practice to help combat ailments such as depression, nervous exhaustion and stress-related disorders. (Wildwood, 1996)

Marjoram is an essential oil that tends to be fairly calming within its nature its main constituents are carvacrol, thymol, camphor, borneol, origanol, pinene, sabinene and terpineol. The properties that this essential oil holds are a wide range from being analgesic, antispasmodic, digestive, sedative, and vasodilator. (Wildwood, 1996)

Lavender true, also known as Lavandula angustofolia, is an essential oil that tends to be quite uplifting, calming and refreshing within its nature from the essence. However its main constituents are linalool, linalyl  acetate, lavandulol, lavandulyl acetate, terpineol, limonene and caryophyllene. Lavender has again a lot of therapeutic properties however it appears to cover all aspects in alleviating the effects of the Dementia on a whole temporarily. As its properties range from being anticonvulsive, antidepressant, antirheumatic, antispasmodic, antitoxic, cytophylactic, sedative, vulnerary and vermifugal. (Wildwood, 1996)

Vertivert also known as Vitiveria zizanoides is an essential oil that tends to be calming and warming and also an aphrodisiac within the essence. The main constituents are vetiverol, vitivone and vetivenes. There are not as many therapeutic uses in comparison to lavender but vertiver is great for improving muscular aches and pains, poor circulation, insomnia, light headedness, nervous exhaustion and other stress-related ailments. (Wildwood, 1996)

From the blend which was used by (Bowles-Dilys, Griffiths, & Quirk, 2002) trial I can see that the combination holds a wide range of therapeutic properties and chemical constituents. This is clear evidence of the effects of essential oils as a significant improvement was clearly established in comparison to the inert oil.

Lavender, marjoram, patchouli and vetivert were applied as a cream to the body and limbs of 36 patients and compared with inert oil. The essential oil combination significantly increased the Mini Mental State Examination (MMSE) but also increased resistance to care (considered to be due to increase in alertness), compared to inert oil.

 (Bowles-Dilys, Griffiths, & Quirk, 2002)

Dementia, more commonly known as Alzheimer’s, does not get better with time. As the time passes the individual only continues to lose what was ever known of themselves. This has a very emotional knock on effect for close family and loved ones as there is no cure. Nor is there any accurate evidence as to the onset of such disease. Some may settle with the factor that it’s due to old age or too much stress but still further research is needed.

Many clinical trials have been carried out to help a person deal with dementia more positively in the aspects of how they respond in certain situations and how they respond to their caregivers. The alternative therapies that have been tested are Bright light therapy, movement therapy, music, multi-sensory stimulation therapy, occupational therapy touch, massage (Craniosacral therapy) and balancing arousals. These have all shown varying responses as they have been trialled for different time periods. (Please refer to appendices 1.)

In particular with Occupational therapy the assessment of motor and process skills, process scale, interview of deterioration in daily activities in dementia and performance scale is all positively effective within the first 6weeks

When treating patients 8 weeks on (Dooley and Hinojosa, 2004) the physical self-maintenance scale; affect and activity limitation and Alzheimer's disease assessment show positive effects of the intervention on 2 of 3 endpoints. Already within a short period of two weeks the individual is unable to score 3 out of 3 within the intervention. However this may be due to the fact that the individuals were being tested have mild to moderate dementia.

When patients were tested with more severe dementia Baker et al., 2003 and Van Weert et al., 2005 they tried to use sensory stimulation to help the patients. However the patients being tested residential conditions were different where as one was in nursing home dependent (inpatient care) the other was in a psycho-geriatric ward (day clinic). The inpatient care monitoring of sensory stimulation was administered as usual activity for a period of 18months. The day clinic care for sensory stimulation was administered as activity classes for 4 weeks. No significant improvements or progress was made over the 4 weeks in comparison to the inpatient care who had the sensory stimulation over 18months with severe dementia. It appears that for people suffering with dementia need to be under alternative interventions consistently as part of their daily regime in order for any progress to be made throughout.

Dementia is a progressive brain disease that involves loss of memory confusion and problems with speech and understanding. Sliwinski et al. (2003) found that there was no direct statistical relationship with chronological age. Even though most people assume that it is due to old age. The progression of pre-clinical Dementia is the main predictor of memory loss. However even though Alzheimer’s disease (AD) is the most common form of dementia it has been found that AD is actually due to genetics.

It has been discovered that people with learning difficulties are more prone to the risks of dementia at an earlier age in life. There are many forms of dementia the one that is affected by the way an individual lives there life is vascular dementia (VD) this is typically caused and affected by lifestyle factors due to the fact they may be a heavy smoker or a heavy drinker and under a lot of stress within their daily lives due to family or demands of their job.

The main problem that has become visible in all the research is that Dementia’s onset of symptoms develops after quite a long period of time. This therefore leads it to be discovered in its later stages. Due to societies view of the disease many times people are just pushed aside when consistently believing something is wrong with them. Doctors and family tend to think that the individual is either crying out for some attention or in most cases believes they are just a hypochondriac. Those are just a few of the stigmas associated with many mental health diseases. Dementia is diagnosed through semantic knowledge, verbal recall and simple reasoning abilities (Earnst et al 2000).

Another factor, which may affect diagnostics of such disease, is the fact that depression and anxiety can also be associated with Dementia. Once again this is something, which occurs after a longer period of time. The person whom is suffering with dementia does not recognise any difference neither do they acknowledge it but their lives can be endangered when having to be left in the care of family and loved ones who are uneducated. The way for a person to be able to manage with dementia more positively is by having understanding family members who are educated on the criteria of such disease.

Possible recommendation for such disease to be treated better is for those who may have it in their family history to have regular check ups and for the judgement to be removed when a patient confides in you for concern of their own health. More research needs to be placed, and possibly interventions should be introduced into the patients home before deciding to place them in care.

REFERENCE:

http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=306&pageNumber=2

Baker R, Dowling Z, Wareing LA, Dawson J, Assey J. Snoezelen: its long-term and short-term effects on older people with dementia. Br J Occup Ther. 1997; 60:213–218.

Baker R, Bell S, Baker E, Gibson S, Holloway J, Pearce R, Dowling Z, Thomas P, Assey J, Wareing LA. A randomized controlled trial of the effects of multi-sensory stimulation (MSS) for people with dementia. Br J Clin Psychol. 2001; 40(Pt 1): 81–96. [PubMed]

Baker R, Holloway J, Holtkamp CC, Larsson A, Hartman LC, Pearce R, Scherman B, Johansson S, Thomas PW, Wareing LA, Owens M. Effects of multi-sensory stimulation for people with dementia. J Adv Nurs. 2003; 43:465–477. [PubMed]

Ballard, C., O'Brien, J., & Reichelt, K. (2002). Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a doublebline, placebo-controlled trial with Melissa. Aromatherapy as a safe and effective treatment of rthe management of agitation in severe dementia: the results of a doubleblind, placebo-controlled trial with Melissa. , 63, 553-8.

Ballard C, O'Brien J, Reichelt K, Perry E. A Randomized controlled trial of aromatherapy for dementia. Int Psychogeriatr. 2003; 15(suppl 2): 96–97.

Bowles-Dilys, E., Griffiths, M., & Quirk, L. (2002). Effects of essential oils and touch on resistance to nursing care procedures and other dementia-related behaviours in a residential care facility. Effects of essential oils and touch on resistance to nursing care procedures and other dementia-related behaviours in a residential care facility. , 12, 1-8.

Dooley NR, Hinojosa J. Improving quality of life for persons with Alzheimer's disease and their family caregivers: brief occupational therapy intervention. The Am J Occup Ther. 2004; 58:561–569.

Gitlin LN, Winter L, Corcoran M, Dennis MP, Schinfeld S, Hauck WW. Effects of the home environmental skill-building program on the caregiver-care recipient dyad: 6-month outcomes from the Philadelphia REACH Initiative. Gerontologist. 2003; 43:532–546. [PubMed]

Gitlin LN, Hauck WW, Dennis MP, Winter L. Maintenance of effects of the home environmental skill building program for family caregivers and individuals with Alzheimer's disease and related disorders. J Gerontol A Biol Sci Med Sci. 2005;60:368–374. [PubMed]

Graff MJ, Vernooij-Dassen MJ, Thijssen M, Dekker J, Hoefnagels WH, Rikkert MG. Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. BMJ. 2006; 333:1196. [PMC free article] [PubMed]

Holmes, C., Hopkins, V., & Hensford, C. (2002). Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study , 17, 305-8.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3347873/

Mitchell, S. (1993). Aromatherapy's effectiveness in disorders associated with dementia. Aromatherapy's effectiveness in disorders associated with dementia , 4, 20-23.

Remington R. Calming music and hand massage with agitated elderly. Nurs Res. 2002;51:317–323. [PubMed]

Smallwood, J., Brown, R., & Coulter, F. (2001). Aromatherapy and behaviour disturbance in dementia: a randomized controlled trial. (Geriatr., Ed.) Int.J. , 16, 1010-3.

Van Weert JC, van Dulmen AM, Spreeuwenberg PM, Ribbe MW, Bensing JM. Behavioral and mood effects of snoezelen integrated into 24-hour dementia care. J Am Geriatr Soc. 2005;53:24–33. [PubMed]

Walker, J., Payne, S., Smith, P., & Jarret, N. (2004). Memory, understanding and information giving. In J. Walker, S. Payne, P. Smith, N. Jarrett, & P. Abbott (Ed.), Psychology for Nurses and the Caring Professions (2nd ed., pp. 43-71). Maidenhead, Berkshire, UK: Open University Press.

Wildwood, C. (1996). Aromatherapy. In C. Wildwood, Aromatherapy (p. 2). London, UK: Bloomsbury.

Williams, L., & Wilkins. (2005). Diseases & Disorders. In L. &. Williams, & L. W. Ochoa (Ed.), Diseases & Disorders (2nd ed.). Skokie: Anatomical Chart Company.