In a recently published consensus statement by the British Association for Psychopharmacology,1 the use of aromatherapy as an adjunct to pharmacological treatment of dementia is supported by one of the highest levels of scientific evidence: evidence from randomized controlled trials.

Several recent controlled studies have shown that aromatherapy (the therapeutic use of pure essential oils from plants) can be helpful in treating patients with dementia: lavender (Lavandula angustifolia or Lavandula officinalis) and lemon balm (Melissa officinalis) are two essential . oils of special interest in this field. The purpose of the Holmes & Ballard article,2 summarized here, was to review the published reports on the efficacy of aromatherapy for the treatment of behavior problems in people with dementia.

The results of these studies are interesting, as their findings cannot be dismissed as the result of a mere placebo effect of a pleasant-smelling fragrance: as the authors point out, most people with severe dementia will have lost any sense of smell due to the early loss. of olfactory neurons.3 In fact, the pharmacological mechanism by which aromatherapy produces its effects is not believed to involve the perception of odor. Instead, the active compounds are believed to enter the body (by absorption through the lungs or olfactory mucosa) and reach the brain via the bloodstream, where they cause direct actions.

Aromatherapy studies in patients with dementia A large number of small, uncontrolled case studies have demonstrated the efficacy of inhaled and/or topical lavender oil in this setting. In summary, these studies have shown that lavender oil improves sleep patterns,4-7 and improves behavior.8,9

Although only a few controlled studies have investigated the potential use of aromatherapy for managing behavioral problems in people with dementia, the results have been positive. A single-blind, case-control study investigated the effects of lavender essential oil on behavioral disturbances in patients with severe dementia.10,11 Patients (n=21) were randomized to receive massage alone, lavender essential oil administered as massage or lavender oil. administered by inhalation plus conversation. Of the three groups of patients, those who received the essential oil in a massage showed a significantly greater reduction in the frequency of excessive motor behavior.

In a small (n=15) double-blind, placebo-controlled crossover trial in patients with severe dementia in an NHS care ward,11,12 2% lavender oil was administered in an aroma diffuser in the ward for 2 hours. period, alternated with placebo (water) every other day, for a total of ten treatment sessions. Based on group mean Pittsburgh Agitation Scale score, lavender aromatherapy treatment significantly reduced agitated behavior (p = 0.016) in patients with severe dementia compared with placebo, with 60% of patients experiencing some benefit. No adverse events were reported and compliance with therapy was 100%.

In a crossover study,13 56 elderly patients with moderate to severe dementia were massaged with a cream containing a blend of four essential oils (lavender, sweet marjoram, patchouli, and vetiver) or cream alone five times daily for 8 weeks. Behavioral problems and resistance to care were significantly lower in patients who received the cream containing the essential oils compared to those who received the cream alone.

In the largest double-blind, placebo-controlled study published at the time this review was written, 72 NHS continuing care patients with severe dementia were randomized to receive lemon balm essential oil (n = 36) or sunflower oil (n=36) applied topically as a cream twice daily, in addition to patients’ existing psychotropic medication. Clinically significant changes in agitation (assessed using the Cohen-Mansfield Agitation Inventory) [CMAI]) and quality of life indices were compared between the two groups over a 4-week treatment period. 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 those who received placebo (pMethodological issues

In their article, Holmes and Ballard2 draw attention to a number of methodological issues that need to be considered in the design of future studies investigating 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 a poor sense of smell, the researchers evaluating the study may be able to identify the essential oil being tested, which could compromise a double-blind study. This problem can be overcome in a number of ways, such as using observational measures as primary study outcomes, providing researchers with fragrance-infused masks or nose clips to wear when assessing participants, infusing the environment with control fragrances, and masking scent of essential oil with air fresheners.

Furthermore, since large placebo responses have been observed in many studies investigating the treatment of behavioral or psychiatric symptoms in people with dementia, it is important, in studies investigating the effects of essential oils, that aromatherapy and control interventions involve similar amounts of time and contact with each participant.

recommendations

Holmes and Ballard2 conclude that, although there is much case-based evidence suggesting the efficacy of aromatherapy in improving sleep, agitated behaviors, and resistance to attention in dementia, there is a marked lack of randomized, placebo-controlled, and clinical trials. adequate size in this area. Although a placebo-controlled study has shown evidence that aromatherapy can be effective as an adjunct to existing therapy in the treatment of dementia patients, this study had a number of methodological flaws.

The authors identify a number of important questions 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 pharmacological agents; Whether the same is true regarding their response to aromatherapy remains to be determined.
• Essential oils are administered by massage in various ‘carriers’ (eg skin creams, massage oils) and therefore involve the ‘additional therapy’ of physical contact with caregivers. Clearly, this additional therapy must be minimized or controlled before direct inferences about the effects of aromatherapy alone can be made.
• If it is accepted that active neurochemical differences exist between essential oils, then research should investigate not only oils from different genera, but also compare those from related species (eg, Lavandula angustifolia and Lavandula officinalis).
• Well-designed, well-conducted, randomized controlled trials are required before firm conclusions can be drawn regarding the efficacy and safety of essential oils.

References

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