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Aromatherapy for agitation in severe dementia

 

Clinical bottom line

A single trial with Melissa in 72 patients was well done and indicated that there was a 35% improvement in agitation, and using of people with a clinically significant benefit in agitation and severe dementia yielded an NNT of 4 (60% with Melissa, 14% with placebo.


Background

About half of people with dementia experience behavioural or psychiatric symptoms. Drug treatment can be problematic, and many drugs come with cautions about their use, or are not recommended.

References

CG Ballard et al. Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa. Journal of Clinical Psychiatry 2002 63: 553-558.
L Thorgrimsen et al. Aroma therapy for dementia. The Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003150. DOI: 10.1002/14651858.CD003150.


Systematic review

The Cochrane review sought relevant randomized controlled trials (RCTs). A minimum length of trial and requirements for a follow-up were not included, and participants in included studies had a diagnosis of dementia of any type and severity. The review considered all trials using fragrance from plants defined as aromatherapy as an intervention with people with dementia. Several outcomes were considered in this review, including cognitive function, quality of life, and relaxation.

Only one trial (that by Ballard) was considered of adequate quality. It used 10% Melissa and base lotion applied topically to arms and face twice daily for 1-2 minutes for 4 weeks. The control condition was sunflower oil applied in the same way. Participants were 72 people with severe dementia, diagnosed with the Clinical Dementia Rating scale and clinically significant agitation, from eight NHS specialist nursing homes. Outcome measures were: Cohen-Mansfield Agitation Inventory, The Neuropsychiatric Inventory and Dementia Care Mapping.

Results

The showed a significant reduction in the scales, with less time spent socially withdrawn (6% reduction) and more time engaged in constructive activities (6% increase). With Melissa there was a 35% improvement in agitation, compared with 11% with placebo. A clinically significant improvement occurred (by 30%) was used to generate a NNT of 4, occurring in 60% of patients with Melissa and 14% with placebo.

Comment

One trial does not constitute overwhelming evidence, but this trial was particularly well done. It does not provide evidence for aromatherapy as a whole (especially as many patients with dementia lose their sense of smell), but some evidence for Melissa used in this particular way. In the absence of better or safer alternatives, it would probably be worth trying.