Assess of Combinations of Non-Pharmacological Interventions for the Reduction of Irritability in Patients with Dementia and their Caregivers: A Cross-Over RCT

Abstract

Introduction: Dementia is a very common disorder that affects people over 65 years old all over the world. Apart from the cognitive decline, Behavioral and Psychological Symptoms of Dementia (BPSD) are a crucial matter in dementia, because they affect up to 90% of the patients during the course of their illness. Irritability has been found to be a common BPSD and one of the most distressing behaviors for the caregivers. The aim of the current study was to explore the efficacy of a combination of non-pharmacological interventions to treat irritability. Methods: Sixty patients with different types and stages of dementia with irritability were participated in a cross-over RCT. Three non-pharmacological interventions were used; (a) Validation Therapy (VT)/Psycho-educational program, (b) Aromatherapy/massage and (c) Music Therapy (MT). The study assessed the three non-pharmacological interventions in order to find the most effective combination of the interventions. This study did not compare pharmacological and non-pharmacological treatments. The interventions lasted for five days. There was no drop-out rate. All patients were assessed at baseline using Mini Mental State of Examination (MMSE), Addenbrooke’s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for symptoms in dementia (FRSSD), and Neuropsychiatric Inventory (NPI) (sub questions for irritability). Only NPI used for the assessment after each intervention. The analyses used categorical variables, Wilcoxon signed-rank test, Chi-square test and z value score. Results: The most effective combination of non-pharmacological interventions was Aromatherapy/massage (p = 0.003)-VT plus Psycho-educational program (p = 0.014) plus MT (p = 0.018). The same combination was the most effective for the caregivers’ burden, too (p = 0.026). Conclusions: The above combination of non-pharmacological interventions can reduce irritability in patients with dementia and caregivers’ burden.

O uso da aromaterapia na saúde mental

“…Outros estudos afirmam que o uso do óleo de lavanda demonstrou efeitos promissores na redução dos sintomas de ansiedade e na melhoria da qualidade do sono em adultos e na redução da ansiedade em neonatos (Montibeler et al, 2018, Razaghi et al, 2019. Alguns autores encontraram evidências de que a utilização da lavanda, da água de rosas, alecrim e ylang ylang, separada ou em conjunto, está associada a efeitos benéficos em pacientes com depressão (Dimitriou et al, 2022, Kianpour et al, 2018, Amadéo et al, 2020, Wang et al, 2023, Razaghi et al, 2019. Esse efeito pode ser atribuído à estimulação do sistema olfativo e alterações neurobiológicas decorrentes.…”

“…Nesse sentido, o potencial da Aromaterapia reside na capacidade de induzir ao relaxamento e atenuar o estresseum pilar essencial do gerenciamento de condições psiquiátricas. Acredita-se que os óleos essenciais derivados de frutas cítricas Research, Society and Development, v. 12, n. 13, e04121344165, 2023 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v12i13.44165 6 misturadas possuam propriedades que melhoram o humor pela interação com o sistema límbico (Jung & Kim, 2020); isto é, os intrincados constituintes bioativos desses óleoscomo o linalol e o acetato de linalil no óleo de lavanda -, interagem potencialmente com os sistemas de neurotransmissores, moldando a reatividade emocional (Dimitriou et al, 2022). No entanto, é importante salientar que os neurotransmissores desempenham um papel fundamental em quase todas as funções do corpo humano e o equilíbrio entre eles é necessário para prevenir certas condições de saúde, como a depressão e a ansiedade (Wang et al, 2023).…”

“…3. Resultados e DiscussãoNo Quadro 1 a seguir foram selecionados nove artigos para a presente revisão(Kianpour et al, 2018, Montibeler et al, 2018, Arpornchayanon et al, 2019, Heydarirad et al, 2019, Razaghi et al, 2019, Jung & Kim, 2020, Amadéo et al, 2022, Dimitriou et al, 2022, Kollikowski et al, 2023.Quadro 1 -Artigos selecionados para revisão.…”