Therapeutic Aids for Dementia
If you have dementia and if, for example, this means you have problems remembering recent events, this can be challenging and disorienting. It is therefore not surprising that this can affect both mood and behaviour. Possible effects can include feeling agitated or depressed, apathy, sleep problems and wandering. Are there therapies available which can help here - alongside or as an alternative to medication?
A review of studies, published in 2015, suggests a number of therapies which can help here, with fewer side effects than some medication. Examples include music therapy, aromatherapy, art therapy, behavioural therapy and exercise.
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 the feeling of having control over what they are recalling. Their individuality is retained by talking about things which have happened in their lives. So encouraging them to discuss past memories can be helpful. Memory aids such as photos, letters, life story books and any other memorabilia may help bring back memories. Developments in information technology, including access to online material and touch screen technology, mean there are now a variety of resources available and of ways of providing stimulus material to encourage reminiscence. Reminiscence therapy should obviously be used sensitively, as some images (such as war time photographs or pictures of relatives who have died) may prove distressing.
Research on the effectiveness of Reminiscence therapy has been mixed, possibly because many of the studies have been small-scale. An analysis of published studies in 2015 found a small, short term improvement in cognitive function and a moderate, short term effect on depressive symptoms among elderly people with dementia.
Suggestions when using reminiscence therapy:
Cognitive Stimulation Therapy
This is a form of ‘mental exercise.’ It 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 could be word and number games, puzzles, singing, cooking, or a discussion of past events. All aim to stimulate the mind and the memory. Family caregivers can be trained to use cognitive stimulation, adapting according to the personality and interests of the individual with dementia.
A 2012 review analysed 15 trials and 718 participants. It found that cognitive stimulation benefited memory and cognition scores for people with dementia. There was also evidence that communication, interaction and quality of life improved. However mood and independent functioning did not improve. A 2015 review of 33 studies, published in BMJ Open, found that cognitive stimulation produced improvements in some areas but not others and noted that the way the research was conducted made comparison with the effectiveness of dementia drugs difficult.
Where can I access this?
CST treatment can take place in memory clinics, hospitals, day centres or residential homes. Contact your local Older Adult NHS service to find out how to enrol.
Exercise is one of the simplest options for people to pursue. It is probably also one of the more effective. 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 Activities of Daily Living (ADL) functioning.
This is when the carer supports and validates what is being said by the person with dementia rather than contradicting them. It is about accepting the opinion of the person with dementia as their personal truth. For example, if the person with dementia believes that they are correct in their statement, confronting them about being incorrect (as in Reality Orientation where the truth of a situation is constantly reinforced) could be seen as insensitive.
There is not enough evidence from randomised trials to draw conclusions about the effectiveness of validation therapy for dementia. However it is known to be a preferred form of therapy to Reality Orientation Therapy (which was most popular before the 1990’s).
Arts based therapies
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 are increasingly being seen as helping people living with dementia, without some of the negative side-effects associated with the use on antipsychotic medication.
Art Therapy- 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 a person 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. In the UK Dementia and Imagination, a Research Council project, has been exploring the potential of observing art and making art to help people with dementia.
Dance/Movement Therapy- involves emotional exploration through movement, storytelling, creativity and personal expression. Dance/movement therapy is also a good form of exercise, which The Alzheimer's Society recommend for people with dementia.
Drama Therapy- involves improvisation, storytelling, acting and role-play as forms of communication and self-expression.
Music Therapy- involves singing, creating music, musical dialogue and improvisation. 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, enables people with dementia to join together to sing. Initial research suggests that people with Alzheimer’s were able to participate and tended to grow in confidence and alertness. In 2014 a review of published studies concluded that, although more research was needed, initial findings suggested that music therapy showed promising results.
Reawakening the Mind evaluated 17 art-based projects for people with dementia and their carers, and found that 94% of participants retained their positive and energised mood overnight, and 60% retained this for at least a week after. Music and dance produced an energising effect that lasted for a significantly longer period of time than that produced by other art forms.
How can I access these arts therapies?
Arts 4 Dementia is a London-based charity - but it signposts opportunities around the country for people with dementia to engage in the arts. It also provides details of a number of professional organisations who can direct you to your local arts specialists:
Another option would be to contact your local NHS Older People’s Mental Health Services for information on what your locality provides. An NHS Dementia Advisor can help with research and resources local to you.
Serena Sharma February 2014, Reviewed and updated by Charlotte Christopherson January 2017, Next review date January 2020