REVIEW OF: Hui EK et al, Int J Geriatr Psychiatry 2021;36(9):1313–1329

STUDY TYPE: Systematic review of randomized controlled trials

There are several psychosocial treatments that may improve quality of life in patients with advanced dementia. A recent review analyzed research on psychosocial treatments specifically for patients with moderate to severe dementia.

The authors reviewed randomized controlled trials published from 2000 to 2020 studying psychosocial interventions, including physical, cognitive, or social activities, that aimed to improve functioning and well-being in people diagnosed with moderate to severe dementia (a Mini Mental State Examination score of ≤20; most common diagnoses were Alzheimer’s disease, vascular dementia, or mixed dementia). A total of 14 studies including 1,161 adult participants were analyzed in this review. The intervention techniques included six multisensory stimulation programs, five multicomponent programs (interventions with more than one type of program, such as exercise and music), two exercise programs, and one program with reminiscence therapy. Median duration of the interventions was 12 weeks.

Of all the types of programs, only aromatherapy (a multisensory stimulation intervention involving essential oils, such as lemon balm, provided by diffusion or massage) and reminiscence therapy showed significant improvements in quality of life ratings (p=0.01 and p<0.01). One study of robotic pets also showed significant improvements in quality of life on subgroup analysis of people with moderate to severe dementia (p=0.01), although the subgroup was too small to be convincing. Both the aerobic exercise programs and one of the multicomponent programs (involving aerobic exercise, memory games, and music therapy) had significant improvements in cognition scores (p=0.01, <0.001, and <0.05), but all were either insufficiently powered or had low-quality design. The aerobic exercise was low intensity, like cycling 15 minutes daily or walking 30 minutes daily.

Carlat Take

This review reports evidence that aromatherapy and reminiscence therapy may improve quality of life in moderate to severe dementia. The effect of aerobic exercise in this population is still unanswered and will require larger clinical trials. To learn more about aromatherapy and reminiscence therapy, please visit the following websites: www.tinyurl.com/4xftahn2 and www.tinyurl.com/29ujp992.