Non-pharmacological treatment of dementia: does it work?

Dementias are neurodegenerative disorders of generally organic origin that are characterized by the progressive loss of mental faculties generated by the degeneration of neuronal tissue.

Although these are chronic, progressive and generally irreversible disorders, different treatments and therapies that slow down the process and improve the autonomy and functionality of the person in the day to day. Some of them are pharmacological, while others are part of non-pharmacological therapies or treatments for dementia. Do these treatments work? Throughout this article we are going to make a brief reflection on it.

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What are non-pharmacological therapies?

Non-pharmacological therapies are called any set of techniques, strategies and treatments dedicated to the improvement or overcoming of a disorder or disease without resorting to the use of pharmacological elements during its application. The element of these therapies that contribute to the improvement of the patient is the interaction between professional and patient and the different techniques and strategies used by the former.

These types of therapies are based on and extracted from scientific knowledge, specifying that they are validated and are replicable and that are shown to be capable of generating a significant advantage or benefit in the subject in which they are applied. apply. It is important to note that although these therapies are themselves non-pharmacological, they are often accompanied by treatment pharmacological (whether this is the main one or is used as a support system for non-pharmacological treatment), one contributing to the success of the other. This type of treatment does not apply to everyone, since diagnostics required for commissioning.

In addition to theory, these interventions must take into account the values, beliefs and experiences of the patient and environment, these being fundamental elements when it comes to whether or not there is therapeutic success in the majority of cases in which apply.

Non-pharmacological therapies can be considered as all those contributions of medicine that do not require chemical agents in the form of drugs (for example the ablation of parts of the organism, dialysis, laser treatments), those of psychology (both clinical and health as well as in other areas) and other disciplines related to the field of health such as occupational therapy, speech therapy or physiotherapy.

It is possible to apply them to a large number of areas, disorders and alterations, ranging from the application of coadjuvant treatments with pharmacology in the case of diseases chronic diseases such as diabetes to the application of psychological therapy in different mental disorders or the recovery of functions of a subject after suffering injuries cerebral.

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Non-pharmacological treatment of dementia

One of the fields of application where non-pharmacological treatments are used, and in fact one of the most common, is in the treatment of dementia. Dementias are the set of alterations generated by neurodegenerative diseases. usually incurable, progressive and chronic in which the subject is losing one or more mental faculties over time.

We are dealing with disorders in which there is no curative medical treatment, interventions focusing on alleviating symptoms and delaying the loss of functions at the couple that tries to improve the functioning and autonomy of the subject by providing different strategies and trying to recover, optimize or compensate the functions losses. In this ambit there are some drugs that slow the progression of the disorder (for example, in the case of Alzheimer's, tacrine and/or donepezil are used), but non-pharmacological therapies are generally much better known and useful.

In general, non-pharmacological therapies in the treatment of dementia focus on seeking an improvement in the quality of life of the patient and in their capacity for autonomy, preservation of mental functions for as long as possible, a less traumatic and more positive experience of the disorder, the management of fears, doubts and feelings of the patient and her environment or the learning of strategies that allow optimizing the abilities of the subject and compensate their deficits in such a way that they represent the lowest level of disability possible.

The application of this type of therapy usually requires the collaboration of a multidisciplinary team, with the presence of fields such as psychology, medicine, occupational therapy, speech therapy and physiotherapy as well as that of the field social.

Therapies or treatments most used in patients with dementia

There are a large number of possible non-pharmacological interventions that can be carried out in patients with dementia, one of the main objectives being their stimulation. Some of the therapies that have been classified as non-pharmacological treatment in these patients are as follows.

1. cognitive stimulation

One of the main and best known, cognitive stimulation aims to that the subject activates his mental faculties at a general level, through different activities, and their orientation is facilitated. Elements of memory and recall, association and information processing are often used for this.

2. cognitive training

Strengthening and learning of operations, elements and concrete strategies to achieve the improvement of a specific skill or cognitive domain.

3. cognitive rehabilitation

Rehabilitation focuses on deteriorating or deteriorating processes and skills, seeking its recovery, replacement, compensation and optimization.

4. Training in daily living skills

As the dementia progresses, the subjects who suffer from it will show increasing difficulty in performing basic activities for your day to day, such as maintaining hygiene habits, using the telephone or even eating or going to the bathroom. That is why training in these skills allows to strengthen the autonomy of the patient.

5. Reminiscence Therapy

A type of therapy that is used in patients with dementia in order to help them remember and rework their experiences, strengthening them in their memory and making it easier to maintain a vital narrative consistent. Photos, very relevant events or songs among other elements can be used.

6. Animal Assisted Therapy

Both in dementia and in other mental disorders bonding with animals and especially pets has been shown to have a beneficial effect in the mental and social functioning of the patient, while improving his motivation and affectivity. A wide variety of animals can be used, the use of dogs being very common.

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7. music therapy

Music therapy is one of the non-pharmacological treatments used, among other areas, in dementia. Music, whether passively listened to or generated by the patients themselves, can improve cognitive functions and often serves as reinforcement. Following rhythms, spontaneous elaborations or recognition of songs and melodies and their characteristics are some of the activities that are proposed.

8. Psychotherapy

psychotherapy, usually cognitive-behavioral but that can also come from other currents and schools such as systemic, it can be useful not only in cognitive training but also in the treatment of emotional problems, stress management and mourning for the loss of abilities or training in skills such as social ones.

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9. Phototherapy

light therapy It is generally used in people with depressive-type problems, especially in seasonal affective disorder. It is based on exposure to different types and intensities of light in order to regulate the Cardiac rhtyms.

10. Relaxation

Application of relaxation techniques to relieve stress and anxiety, through breathing and muscle tension.

11. recreational therapy

Therapy based on the use of ludic activities and guided games to generate improvements in the capacities and emotional states of the patient.

12. Art therapy and expressive therapies

It is based on the elaboration of artistic elements as a mechanism for strengthen the patient's skills and affective expression. Dance therapy, theater, painting or sculpture can be included within.

13. Physical exercise and physiotherapy

Exercising and performing massages are important elements in order to keep the patient stimulated, preserve psychomotor skills and generate pleasant bodily sensations.

14. speech therapy

The ability to communicate is impaired in a large number of dementias. Training and strengthening in this ability is very useful, helping patients to be able to express themselves correctly and improving their oral skills.

15. occupational therapy

Discipline in which different types of occupations or activities (including some of the above) are used in order to strengthen autonomy and quality of life. Both cognitive and physical aspects are worked on, ensuring that the activities carried out are linked to those carried out in the subject's day-to-day.

Oriented to different foci

When we think of non-pharmacological treatment of dementia, we usually think of the set of strategies that are used without the mediation of necessarily pharmacological agents on the patient to cause their improvement, optimization or preservation of faculties for the longest time possible.

However, it must be taken into account that although the identified patient is the main focus of attention, different techniques and non-pharmacological treatments on the rest of the elements linked to him: his family and environment and the team of professionals who attends.

Patient

As we have mentioned, the patient is the main focus of attention on which treatments are applied, both non-pharmacological and pharmacological. The previous examples of therapies and treatments are applied in this one. It's important to put attention on It is not only about preserving skills, but about improving their quality of life as much as possible. They must also attend to their emotional needs and try to maintain their motivation.

Family/Environment

Although the patient is the one who suffers from dementia, also the environment and loved ones of the subject they will experience a high level of suffering and doubts. Generally, some of them will act as caregivers for the subject as he or she loses autonomy and abilities, and they will have to face harsh and painful situations.

Among the most common interventions is psychoeducation, training in general and specific care, support and advice, psychotherapy (it is common presence of high levels of stress and in some cases affective problems), attendance at support groups and the use of services such as day centers or help in home. Often used, and in fact are the most effective, multicomponent programs that take into account elements of different branches and techniques.

Professionals

In some cases, subjects with dementia are left in the care of professionals or services that can also be applied to non-pharmacological treatment. This is what happens with people who offer their services as caregivers, internal or external, who live with patients and help them in their day-to-day lives or nursing homes. We could also include medical and psychological professionals with frequent contact with this type of patient.

Training in the care of the subject and the search for dignified alternatives in those serious cases that do not involve the restriction of movement of the person are some of the elements that are part of the elements that are taught. Psychotherapy and counseling may also be required., both for those who are in contact with a patient and for those who deal with the process of diagnosis and treatment (after all, they are facing a situation in which they see how a person is gradually losing faculties).

Do they work?

Many different studies have been carried out on the operation and effectiveness of different therapies and treatments applied in the case of dementia. Although there is the complication that studies of this type of treatment are more complicated to carry out given the high number of variables involved and the differences in the possibility of maintaining certain types of intervention, the results are favorable to its application.

Non-pharmacological treatment has been highly recommended, since it greatly improves the quality of life of the patient and their caregivers, the maintenance and improvement in basic activities of daily living and maintenance of a more positive affective tone compared to the absence of this type of treatments.

In fact, considered first choice treatment since it generates an improvement in behavioral and cognitive aspects similar to that of pharmacology perso without its side effects. The most recommended is cognitive stimulation and the preparation of advice from caregivers (whether family members or professionals).

Bibliographic references

• Olazaran, J. and Muniz, R. (2009). Map of Non-Pharmacological Therapies for Dementias of the Alzheimer Type. Technical initiation guide for professionals. Maria Wolff Foundation and International Non Pharmacological Therapies Project.