Dementias are neurodegenerative disorders of generally organic origin that are characterised 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 have been developed to slow down the process and improve the autonomy and functionality of the person on a daily basis. Some of these are pharmacological, while others form part of the non-pharmacological therapies or treatments for dementia . Do these treatments work? Throughout this article we will briefly reflect on this.

What are non-pharmacological therapies?

Non-pharmacological therapies are any set of techniques, strategies and treatments dedicated to the improvement or overcoming of a disorder or illness without resorting to the use of pharmacological elements during their application . The element of these therapies that contributes 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 replicable and that they be shown to be capable of generating a significant advantage or benefit in the subject to which they are applied. It is important to bear in mind that although these therapies are non-pharmacological in themselves, they are often accompanied by a pharmacological treatment (either the main one or used as a support system for non-pharmacological treatment), contributing to the success of the other. This type of treatment is not applicable to everyone, given that a diagnosis is required 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 being fundamental elements in whether or not there is therapeutic success in the majority of cases in which they are applied.

Non-pharmacological therapies can include all those contributions of medicine that 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-related and in other areas) and other disciplines linked 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 adjuvant treatments with pharmacology in the case of chronic diseases such as diabetes to the application of psychological therapy in the different mental disorders or the recovery of functions of a subject after suffering brain injuries.

Non-pharmacological treatment of dementia

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

We are facing disorders in which there is no curative medical treatment, focusing interventions on alleviating symptoms and delaying the loss of functions while trying to improve the functioning and autonomy of the subject by providing different strategies and trying to recover, optimize or compensate for lost functions. In this area there are some drugs that slow down the progression of the disorder (for example, in the case of Alzheimer’s disease, tacrine and/or donepezil are used), but generally non-pharmacological therapies are 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 his or her capacity for autonomy, preservation of mental functions for as long as possible, a less traumatic and more positive experience of the disorder as possible, management of the patient’s fears, doubts and feelings and his or her environment, or learning strategies that allow the optimization of the subject’s abilities and compensate for his or her deficits in such a way that they imply the least level of disability possible.

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

Most commonly used therapies or treatments 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 the following.

1. Cognitive stimulation

One of the main and best known, cognitive stimulation aims to activate the subject’s mental faculties on a general level , through different activities, and to facilitate their orientation. Elements of memory and recall, association and information processing are often used for this purpose.

2. Cognitive training

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

3. Cognitive rehabilitation

Rehabilitation focuses on impaired or deteriorating processes and skills , seeking their recovery, replacement, compensation and optimisation.

4. Life skills training

As the dementia progresses, the subjects who suffer from it are going to show an increasing difficulty in carrying out basic activities for their day-to-day life, such as maintaining hygiene habits, using the telephone or even feeding themselves or going to the bathroom. This is why training in these skills allows the patient to strengthen his/her autonomy .

5. Reminiscence Therapy

A type of therapy that is used in patients with dementia to help them remember and re-elaborate their experiences, strengthening their memory and facilitating the maintenance of a coherent vital narrative. Pictures, relevant events or songs can be used among other elements.

6. Animal Assisted Therapy

Both in dementias and in other mental disorders it has been shown that bonding with animals and especially with pets has a beneficial effect on the mental and social functioning of the patient, while improving their motivation and affectivity. A wide variety of animals can be used, and the use of dogs is very common.

7. Music therapy

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

8. Psychotherapy

Psychotherapy, generally of a cognitive-behavioral type 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, stress management and grief for the loss of abilities or in training in skills such as social skills.

9. Phototherapy

Light therapy 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 with the aim of regulating circadian rhythms.

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 playful 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 as a mechanism to strengthen the patient’s abilities and emotional expression . It can include dance therapy, theatre, painting or sculpture.

13. Physical exercise and physical therapy

Exercise and massage are important elements to keep the patient stimulated, preserve psychomotor skills and generate pleasant body sensations .

14. Speech therapy

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

15. Occupational therapy

Discipline in which different types of occupations or activities (including some of the above) are employed 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 life.

Oriented to different focuses

When we think of non-pharmacological treatment of dementia, we tend to think of the set of strategies that are used without necessarily mediating pharmacological agents on the patient to bring about their improvement, optimization or preservation of faculties for as long as 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 are also applied to the rest of the elements linked to him: his family and environment and the team of professionals who attend him.

Patient

As we have mentioned, the patient is the main focus of attention on which both non-pharmacological and pharmacological treatments are applied. The previous examples of therapies and treatments are applied in this one. It is important to bear in mind that it is not only a question of preserving skills, but also of improving the quality of life as much as possible . Their emotional needs should also be addressed and they should try to maintain their motivation.

Family/Environment

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

The most common interventions include psychoeducation, training in general and specific care, support and counselling, psychotherapy (high levels of stress and in some cases affective problems are common), attendance at support groups and the use of services such as day centres or home help. Multi-component programmes, which take into account elements from different branches and techniques, are often used and in fact are the most effective.

Professionals

In some cases, subjects with dementia are left in the care of professionals or services to which non-pharmacological treatment can also be applied. This is what happens with people who offer their services as carers, inpatients or outpatients who live with the patients and help them in their daily lives or in nursing homes . We may 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 worthy alternatives in those serious cases that do not involve restricting the person’s movements are some of the elements that are taught. Psychotherapy and counselling may also be required , both for those who are in contact with a patient and for those who are facing the process of diagnosis and treatment (after all, they are facing a situation in which they see a person gradually losing his or her faculties).

Do they work?

Many different studies have been carried out on the functioning 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 favourable to their application .

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

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

Bibliographic references

  • Olazarán, J. and Muñiz, R. (2009). Map of non-pharmacological therapies for Alzheimer’s type dementias. Technical initiation guide for professionals. Maria Wolff Foundation and International Non Pharmacological Therapies Project.