People with dementia whose brains have been damaged by disease – may have problems with remembering, thinking, and speaking. Their moods or behaviours may also be negatively affected. Current drug treatments for these symptoms have limited positive effects and may even cause considerable negative side effects.
Therefore, in this article, we answer this question: Are therapies available for dementia which can help alongside or as alternatives to medication?
Several studies have explored the role of various therapies in Alzheimer’s disease (AD) and dementia, as reviewed in 2018.
The information in this article describes the main non-medical therapies that are currently used to reduce the effects of dementia:
- Exercise and motor rehabilitation
- Cognitive rehabilitation
- Therapies for behavioural and psychological symptoms
- Occupational therapy
- Complementary, alternative, and the sensory-based therapies
- Reminiscence therapy
- Validation therapy
Exercise and motor rehabilitation
Exercise has been shown to help improve important outcomes such as understanding and reasoning in people with dementia. It might also help in reducing psychological problems such as depression and behavioural issues, although study findings have not been consistent.
A 2016 review in BMJ Open concluded that health professionals should ensure that people with dementia are encouraged to exercise, as this was one of the more effective ways of limiting decline in Acti vities of Daily Living (ADL) functions, which include feeding oneself, bathing, dressing, grooming, work, and homemaking.
Physical activity, combined with other interventions, can also help to reduce paratonia, a motor abnormality that affects movement in late-stage dementia.
Cognitive rehabilitation
Cognitive functions refer to multiple mental abilities, including learning, thinking, reasoning, remembering, problem solving, decision making, and attention.
There are three main types of interventions to help cognitive function in people with dementia.
|
Cognitive stimulation therapy (CST) |
CST is the most effective approach for cognitive rehabilitation. |
|
Cognitive training |
Also known as ‘brain training’, this involves the repeated practice of a task that targets a specific cognitive function. |
|
Cognitive rehabilitation |
The emphasis here is on improving or maintaining functioning in everyday life, building on the person's strengths and finding ways to compensate for impairments and to support independence. |
Cognitive Stimulation Therapy (CST) is a form of ‘mental exercise’ that may help to delay the decline in memory for people with dementia. It involves a range of activities spread out over a number of sessions. These activities could include word and number games, puzzles, singing, cooking, or discussions of past events. All of them aim to stimulate the mind and the memory. Family caregivers can be trained to use cognitive stimulation, adapting it according to the personality and interests of the person with dementia.
|
Cognitive Stimulation Therapy (CST) is the only non-drug treatment recommended by the National Institute for Health and Care Excellence (NICE) to improve cognition, independence and wellbeing. |
A 2015 pooled analysis of 33 studies found that CST – but not cognitive training – significantly improved cognitive outcomes in people with dementia. However, the review found only limited evidence that the improved outcomes translated into clinically meaningful cognitive benefits in dementia.
Where to go for help
After a formal diagnosis of dementia, memory clinics, hospitals, day centres or residential homes may offer CST treatment. Contact your local Older Adult NHS service to find out how to enrol.
Age UK also offers maintenance CST in the community for mild and moderate dementia to fill the gap after NHS treatment finishes.
Therapies for behavioural and psychological symptoms
There are various behavioural and psychological symptoms of dementia (BPSD), but the most clinically important are depression, apathy and anxiety. These and other symptoms have not been successfully treated with drugs. The most effective means of dealing with these symptoms appears to be by training formal caregivers,
although other non-pharmacological interventions that address the physical and social environment as well as on-going education and training are also beneficial.
People with moderate dementia who received occupational therapy delivered at home have been shown to be better able to carry out ADL, to have fewer behavioural and psychological symptoms, and have a better quality of life compared to those receiving usual care. Carers also benefitted. Your GP may be able to refer you for occupational therapy.
Complementary, alternative, and the sensory-based therapies
Complementary and alternative therapies are now used more commonly to alleviate symptoms associated with dementia. Together, these therapies are called ‘sensory-based interventions’.
Massage by itself, or with the use of aromatic oils (aromatherapy), has been shown to have beneficial calming and relaxing effects in a variety of conditions. A 2020 review of 13 studies of the use of aromatherapy in dementia, however, failed to find convincing evidence for its use, but the results were either poorly reported or inconsistent.
The findings of a 2019 review of eight studies of people with mild cognitive impairment and dementia suggested that yoga may have beneficial effects on attention and verbal memory. In addition, yoga may also affect cognitive functioning through improved sleep and mood.
The arts-based therapies: art, dance, drama, music
The creative part of the brain is often the last part to be seriously damaged during dementia. This can allow a person with dementia to continue to engage in the arts as a form of leisure and communication. Examples include art, dance and drama therapy, all of which provide cognitive stimulation, communication, self-expression, and (very importantly) fun. These therapies are increasingly being seen as helping people living with dementia – as well as their carers – by improving wellbeing, quality of life, and mood, and by decreasing their sense of isolation.
There is a growing recognition that the arts can help to improve the quality of life of people living with dementia. Memory loss does not prevent them from enjoying or from participating in the arts, and their carers also benefit. Art also encourages social interaction and a sense of belonging.
Art therapy is defined by the British Association of Art Therapists as ‘a form of psychotherapy that uses art media as its primary mode of communication’.
Very little research has been carried out to investigate whether art therapy is beneficial in dementia, but there is a lot of evidence from work done in the community that it can increase brain stimulation, improve memory, and boost mood and wellbeing.
A 2013 Canadian study medical news story found that a sculptor with severe vascular dementia who could not recall items listed to her minutes before, was nonetheless able to produce detailed drawings from memory. This was despite her extensive memory loss and cognitive impairment. This supports the idea that while people with dementia may struggle with verbal and written communication during the advanced stages of dementia, they can communicate their thoughts and express themselves through art forms.
This kind of therapy involves emotional exploration through movement, storytelling, creativity and personal expression.
A randomised, controlled study of 204 older adults with mild dementia showed that dance movement therapy, compared with moderate exercise, resulted in significant decreases in depression, loneliness and negative moods. In addition, daily functioning (ADL) improved and remained so for up to one year. The lack of beneficial effects in the exercise group differs from previous studies but may be explained by the shorter period and lesser intensity of the exercise programme.
Drama therapy involves improvisation, storytelling, acting and role-play as forms of communication and self-expression.
A 2018 study of 178 people with dementia in the US who took part in a semi-improvised drama programme showed decreased depression. The study also showed that the programme increased positive forms of engagement while negative forms of engagement decreased. These results suggest that the drama therapy intervention increased their quality of life.
Music therapy
Singing, making music, musical dialogues and musical improvisation can all be included in music therapy.
Age UK encourages singing and music to encourage communication and to help surface memories from the past. Singing for the Brain, a service run by the Alzheimer’s Society in the UK, enables people with dementia to join together to sing. Although many people are currently unable to meet in person because of the COVID pandemic, singing sessions are available over the internet using the video platform Zoom, or over the phone (‘Ring and Sing’).
A study involving interviews with people with dementia and their carers who attended Singing for the Brain sessions showed that social belonging and improvements in relationships, memory and mood were found to be particularly important. Participants enjoyed the sessions and found that they helped in accepting and coping with dementia.
In 2018 a pooled analysis of 21 studies of people with dementia in institutional care concluded that at least five music therapy sessions ‘probably’ reduced depression and improved behavioural problems at the end of the treatment. The sessions may also improve emotional wellbeing and quality of life, and reduce anxiety, although the long-term effects are uncertain.
How can I access these arts-based therapies?
- Arts 4 Dementia is a London-based charity that signposts opportunities around the country for people with dementia to engage in the arts. It also provides details of a number of professional organisations that can direct you to your local arts specialists.
- Another option is to contact your local NHS Older People’s Mental Health Services for information on what is available locally.
- An NHS Dementia Advisor can help with research and resources local to you.
Reminiscence therapy
People with dementia may recall events that occurred earlier in life far more easily than more recent occurrences. They may enjoy talking about the past and enjoy the feeling of having control over what they are recalling. Their individuality is retained by talking about things which have happened in their lives. Encouraging them to talk about past memories can therefore be helpful. Memory aids such as photos, letters, music, life-story books and any other memorabilia may help bring back memories.
Developments in information technology, including access to online material and easy-to-use touch screen technology, mean that there are now many resources available and many ways of providing stimulus material to encourage reminiscence in Dementia.
Clearly, reminiscence therapy should be used sensitively, as some images (such as war-time photographs, or pictures of relatives who have died) may prove distressing.
Research results on the effectiveness of reminiscence therapy have been mixed, possibly because many of the studies have only been on a small scale. A pooled analysis of 16 studies in 2018 found some positive effects on people with dementia as to their quality of life, cognitive function, communication and mood. There is a definite need for more rigorous research in this area.
Suggestions when using reminiscence therapy
|
When the carer supports and validates what is being said by the person with dementia – rather than contradicting or correcting them – then we call this ‘validation therapy’. This kind of therapy places more emphasis on the emotional aspect of a conversation and less on the factual content.
For example, if the person with dementia believes that what they say is correct, suggesting that they are incorrect could be seen as insensitive.
Small studies have shown positive effects of validation therapy on agitation, apathy, irritability and night-time disturbance, but findings were mixed. High quality randomised trials are needed to confirm the effectiveness of this approach for people with dementia.
|
Validation therapy is about accepting and respecting the opinion of the person with dementia as their personal truth. Reality orientation is a technique for constantly reinforcing the truth of a situation. |
Conclusions
- Exercise helps to improve cognition, and it limits a decline in daily living activities (ADL). It may also help paratonia – a motor abnormality – in late-stage dementia
- Cognitive Stimulation Therapy (CST) with a range of different activities may help to delay a decline in memory. CST is recommended by NICE to improve cognition, independence and wellbeing.
- Training of formal caregivers appears to be the most effective way to alleviate depression, apathy and anxiety.
- Occupational therapy at home can improve daily living activities and decrease behavioural and psychological symptoms. Carers benefit too.
- Sensory-based therapies such as aromatherapy/massage, yoga and the arts-based therapies have been shown to improve quality of life.
- The effectiveness of reminiscence and validation therapies remains unclear, as the results from small studies have been mixed.
Reviewed and updated by Barbara Baker, March 2022. Next review date February 2026.
_________________________________________
Other relevant articles on the Age Watch website: