Summary: Nondrug treatments such as aromatherapy, bright light therapy and caregiver support can complement drug treatments and benefit people with dementia and their caregivers.
Almost all the presentations at ICAD were about molecular biology. They dealt with proteins like amyloid and tau, with genes like APOE and SORL1, and with the inner workings of brain cells. Sitting in dark conference rooms watching these presentations, it was easy for me to lose sight of the real-life problems of people with dementia and their caregivers.
The last session I went to brought my focus back to these real-life problems. It's too bad these presentations were given when many conference attendees were already on their way home - "Psychosocial Issues and Neuropsychology" was one of the most interesting sessions at ICAD! Four of the six presentations were specifically about nondrug treatment of dementia, and it's those presentations I'll focus on in the next few posts.
First up was Dr. Alistair Burns, a Professor and Deputy Dean of Clinical Affairs at The University of Manchester in the UK. He is involved in trials of both drug and nondrug treatments for people with dementia and their caregivers. Some of the nondrug treatments he has studied include:
- aromatherapy - an ongoing trial of melissa oil (lemon balm oil) compared with Aricept or placebo for behavioral symptoms of dementia. Results are due out late in 2008.
- bright light therapy - a trial of bright light therapy for sleep disturbance and agitation in people with dementia. Bright light therapy was found to be a powerful and cost-effective alternative to drug treatment.
- psychotherapy - a trial of brief psychotherapy for improvement of cognitive function, emotional symptoms or overall well-being. In this study, six sessions of psychotherapy did not improve any of these measures.
- caregiver intervention - a three country trial of the effect of advice, support and education for caregivers in addition to Alzheimer's medicines for the people with dementia they were caring for. The trial found that this support significantly improved quality of life for the caregivers, over and above any effect of the Alzheimer's medicines given to the people they cared for.
Other studies have shown the positive role caregiver interventions and nondrug treatments can have in the management of dementia, said Dr. Burns. Dr. Linda Teri and colleagues conducted a trial comparing an antipsychotic medication, an antidepressant, behavioral management therapy and a placebo for agitation in people with Alzheimer's. [Dr. Teri presented in this session, and I'll write about her talk next.] All of these treatments, including placebo, were mildly effective. "Pretty much whatever they did," Dr. Burns said, "a third got better."
In another trial he was involved in, Aricept was tested as a treatment for agitation in people with dementia who did not respond to psychosocial interventions (standardized social interaction, music therapy or elimination of the factors triggering agitation). The drug was not found to be more effective than placebo at treating agitation. But the important thing to note about this study was that nondrug approaches were tried first, and worked for many patients.
Cochrane Reviews on these nondrug treatments found little or no evidence that they work, because of an insufficient number of large, well-designed trials. But that should not be confused with a lack of clinical effectiveness, Dr. Burns said. In his opinion, there is some evidence that they all work, good evidence that some work, and some conflicting evidence.
"We need to overcome the negative perceptions about nondrug treatments, and combine nondrug and drug approaches," said Dr. Burns. "It's important to emphasize that the two can work together for the benefit of patients and their carers."