Non-pharmacological treatment for dementia: does it work?

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

Although these are chronic, progressive and generally irreversible disorders, various treatments and therapies have been developed which make it possible to slow down the process and improve the autonomy and functionality of the person on a daily basis. 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 will do a brief reflection on this.

    What are non-pharmacological therapies?

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

    These types of therapies are based on and extracted from scientific knowledge, requiring that they be validated and reproducible and that they be shown to generate a significant advantage or benefit in the subject in which they are applied. It is important to note that while these therapies are in themselves non-pharmacological, they are often accompanied by pharmacological treatment (either this is the main one, or it serves as a support for a non-pharmacological treatment), contributing to the the success of the other. These types of treatments do not apply to anyone because a diagnosis is necessary for its implementation.

    In addition to theory, these interventions must take into account the values, beliefs and experiences of the patient and the environment, these elements being fundamental to knowing whether or not there is therapeutic success in most cases in what they apply.

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

    They can be applied to a large number of fields, disorders and alterations, ranging from the application of adjuvant treatments with pharmacology in the case of chronic diseases such as diabetes to the application of psychological therapy in various mental disorders. . or the recovery of functions of a subject after suffering brain damage.

      Non-pharmacological treatment of dementia

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

      We are dealing with disorders in which there is no curative medical treatment, focusing interventions on the relief of symptoms and the delay of the loss of function while trying to improve the functioning and the autonomy of the subject by offering different strategies and trying to recover, optimize or compensate for lost functions. In this area certain drugs slow the progression of the disorder (For example, in the case of Alzheimer’s disease, tacrine and / or donepezil are used), but in general, non-pharmacological therapies are much better known and useful.

      In general, non-pharmacological therapies in the treatment of dementia focus on the search for an improvement in the patient’s quality of life and his capacity for autonomy, the preservation of mental functions for as long as possible, the experience as less traumatic and as positive as possible. the disorder, the management of fears, doubts and feelings of the patient and his environment or the learning of strategies allowing to optimize the capacities of the subject and compensate for their deficits so that they involve the lowest level of handicap possible.

      The application of this type of therapy generally 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 the social sphere.

      Most Used Therapies or Treatments in Patients with Dementia

      There are a large number of possible non-pharmacological interventions that can be performed in patients with dementia, one of the main purposes 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 goals of cognitive stimulation that the subject activates his mental faculties at a general level, Through different activities, and facilitate their orientation. Elements of memory and recollection, association and information processing are often used for this purpose.

      2. Cognitive training

      Reinforce and learn from specific operations, elements and strategies to improve a specific skill or cognitive area.

      3. Cognitive rehabilitation

      rehabilitation focuses on altered or deteriorating processes and skills, Seeking its recovery, replacement, compensation and optimization.

      4. Life skills training

      As dementia progresses, people with it will find it increasingly difficult to perform basic activities of their daily living, such as maintaining hygiene habits, using the phone, or even eating or going. in the bathroom. This is why training in these skills helps strengthen patient autonomy.

      5. Reminiscence therapy

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

      6. Animal assisted therapy

      In both dementias and other mental disorders Bonds with animals and especially pets have 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, with the use of dogs being very common.

        7. Music therapy

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

        8. Psychotherapy

        Psychotherapy, usually cognitive-behavioral but which can also come from other currents and schools such as systemic, can be useful not only in cognitive training but also in the treatment of emotional problems, the management of stress and grief due to the loss of capacities or in the training in skills such as social.

          9. Phototherapy

          Light therapy it is generally used in people with depressive problems, especially in seasonal affective disorder. It is based on exposure to different types and intensities of light in order to regulate circadian rhythms.

          10. Relaxation

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

          11. Recreational therapy

          Therapy based on the use of recreational activities and guided games to generate improvements in the patient’s abilities and emotional states.

          12. Art therapy and expressive therapies

          It is based on the elaboration of artistic elements such as mechanism for strengthen the skills and emotional expression of the patient. It can be included in dance therapy, theater, painting or sculpture.

          13. Physical exercise and physiotherapy

          Exercising and massaging are important elements in keeping the patient stimulated, preserve psychomotor skills and generate pleasant bodily sensations.

          14. Speech therapy

          The ability to communicate is impaired in many dementias. Training and reinforcement of this skill is very helpful, helping patients to be able to express themselves properly and improve their bucofonatorias abilities.

          15. Occupational therapy

          Discipline in which different types of professions or activities are used (including some of the above) in order to enhance autonomy and quality of life. Cognitive and physical aspects are worked on, Ensure that the activities carried out are linked to those carried out on a day-to-day basis.

          Oriented to different homes

          When we think of the non-pharmacological treatment of dementia, we generally think of all the strategies which are employed without necessarily having pharmacological agents available on the patient to cause their improvement, optimization or preservation of the faculties for as long as possible.

          However, it should be kept in mind that if the identified patient is the main object of care, different non-pharmacological techniques and treatments are also applied to other elements related to him: his family and his environment and the team of professionals. that accompanies you. .

          patient

          As we have mentioned, the patient is the main center of care on which the treatments, both non-pharmacological and pharmacological, are applied. The above examples of therapies and treatments are applied herein. It is important to note that it is not only a question of preserving skills, but of improving their quality of life as much as possible. They also have to meet their emotional needs and try to stay motivated.

          Family / Environment

          Although the patient suffers from dementia, so does the subject’s environment and loved ones. they will experience a high level of suffering and doubt. Generally, some of them will act as caregivers of the subject as he loses his autonomy and capacities, and will have to face difficult and painful situations.

          Some of the most common interventions include psychoeducation, training in general and specific care, support and counseling, psychotherapy (it is common to have high levels of stress and in some cases emotional problems), help to support groups and the use of services such as the day. centers or home help. They are often used and are in fact the most efficient multicomponent programs that take into account elements from different branches and techniques.

          professionals

          In some cases, people with dementia are placed in the care of professionals or services to which non-pharmacological treatment can also be applied. This is what happens to people who offer their services as caregivers, internal or external. they live with the patients and help them in their daily life or in a retirement home. We could also include medical and psychological professionals who have frequent contact with this type of patient.

          Management training and finding valid alternatives in severe cases that do not involve restriction of movement of the person are some of the elements taught. Psychotherapy and counseling may also be needed, Both for those who are in contact with a patient and for those who are faced with the process of diagnosis and treatment (in the end they are faced with a situation in which they see how a person slowly loses his faculties).

          Are they working?

          Various studies have been carried out on the functioning and effectiveness of different therapies and treatments applied in the case of dementia. If there is a complication that studies of this type of treatment are more complicated to carry out given the large 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 was strongly recommended, as it greatly improves the quality of life of the patient and his caregivers, maintaining and improving basic activities of daily living and maintaining tone. Affective more positive compared to the absence of such treatment.

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

          bibliographical references

          • Olazarán, J. and Muñiz, R. (2009). Map of non-pharmacological therapies for Alzheimer’s dementia. Technical initiation guide for professionals. Maria Wolff Foundation and international project of non-pharmacological therapies.

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