The 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 have been developed that allow delaying the process and improving the autonomy and functionality of the person on a day-to-day basis. Some of them are pharmacological, while others are part of non-pharmacological therapies or treatments of dementia . Do these treatments work? Throughout this article we will make a brief reflection on it.
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What are non-pharmacological therapies?
Non-pharmacological therapies are referred to any set of techniques, strategies and treatments dedicated to the improvement or overcoming of a disorder or illness 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, being precise that they are validated and replicable and that they are capable of generating a significant benefit or benefit in the subject in 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 (whether this is the main one or used as a support system for non-pharmacological treatment), contributing to the success of the other. These types of treatments do not apply to anyone, given that a diagnosis is required for its implementation .
In addition to the theory, these interventions must take into account the values, beliefs and experiences of the patient and environment, being these fundamental elements at the time of whether or not there is a therapeutic success in most cases in which they apply.
All the 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 clinic and health 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 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 brain injuries.
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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 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 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 lost functions. 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 more well-known and useful.
In general, non-pharmacological therapies in the treatment of dementia focus on improving the quality of life of the patient and their capacity for autonomy, a preservation of mental functions for as long as possible, an experience less traumatic and more positive possible of the disorder, the management of fears, doubts and feelings of the patient and their environment or the learning of strategies that allow to optimize the abilities of the subject and compensate for their deficits in such a way that they imply the lowest level of disability possible.
The application of this type of therapies 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.
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, with stimulation being one of the main objectives. 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 that the subject activates his mental faculties at a general level , through different activities, and their orientation is facilitated. Memory and memory, association and information processing elements are often used for this purpose.
2. Cognitive training
Strengthening and learning of operations, elements and concrete strategies to achieve the improvement of a particular cognitive skill or scope .
3. Cognitive rehabilitation
Rehabilitation focuses on processes and skills that are deteriorated or deteriorating , seeking recovery, replacement, compensation and optimization.
4. Training in daily living skills
According to the dementia advances, the subjects who suffer them will be manifesting an increasing difficulty in carrying out basic activities for their day to day, such as maintaining hygiene habits, using the telephone or even feeding or going to the bathroom. That is why training in these skills allows to strengthen the patient's autonomy .
5. Reminiscence Therapy
A type of therapy used in patients with dementia in order to help them remember and re-elaborate their experiences, strengthening them in their memory and facilitating the maintenance of a coherent vital narrative. Photos, very relevant events or songs among other elements can be used.
6. Assisted Therapy with Animals
Both in dementia and other mental disorders it has been shown that bonding with animals and especially with pets has a beneficial effect in the mental and social functioning of the patient, while improving their 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 that are used, among other areas, in dementia. Music, whether listened to passively or generated by the patients themselves, can improve cognitive functions and often serves as a reinforcement. Track rhythms, spontaneous elaborations or recognition of songs and melodies and their characteristics are some of the activities that are proposed.
Psychotherapy, generally of cognitive-behavioral type but it can also come from other currents and schools such as the systemic one, it can be useful not only in cognitive training but also in the treatment of emotional problems, stress management and mourning due to the loss of skills or training in skills like social ones.
- Perhaps you are interested: "Behavioral Cognitive Therapy: what is it and on what principles is it based?"
Light therapy It is usually 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.
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 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 abilities and affective expression . Dance therapy, theater, painting or sculpture can be included.
13. Physical exercise and physiotherapy
The realization of exercise and the realization of 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 altered in a large number of dementias. The training and strengthening in this skill is very useful, helping patients to be able to express themselves correctly and improving your speech skills .
15. Occupational therapy
Discipline in which different types of occupations or activities are used (including some of the above) in order to strengthen autonomy and quality of life. Both cognitive and physical aspects are worked , ensuring that the activities carried out are linked to those carried out in the day to day of the subject.
Oriented to different focuses
When we think of non-pharmacological treatment of dementia, we usually think of the set of strategies that are used without necessarily having pharmacological agents on the patient to cause their improvement, optimization or preservation of faculties for as long as possible.
However, it must be borne in mind 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 .
As mentioned, the patient is the main focus of attention on which treatments, both non-pharmacological and pharmacological, are applied. 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 . Their emotional needs must also be addressed and their motivation must be maintained.
Family / Environment
Although the patient is the one who suffers from dementia, also the environment and the loved ones of the subject they will experience a high level of suffering and doubts . Generally, some of them will act as caregivers of the subject, depending on how they are losing autonomy and abilities, and they will have to face difficult and painful situations.
Among the most common interventions are psychoeducation, training in general and specific care, support and counseling, psychotherapy (the presence of high levels of stress and in some cases emotional problems is common), assistance to support groups and the use of services such as day centers or home help. Usually, multicomponent programs that take into account elements of different branches and techniques are used, and in fact are the most effective.
In some cases, subjects with dementia are left to the care of professionals or services to whom non-pharmacological treatment can also be applied. This is what happens with people who offer their services as caregivers, internal or external They coexist with patients and help them in their day to day or nursing homes . We could also include professionals in medicine and psychology with frequent contact with this type of patient.
The training in caring for the subject and the search for decent alternatives in those serious cases that do not involve the restriction of the person's movements 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 face the process of diagnosis and treatment (at the end of the day they are facing a situation in which they see how a person gradually loses faculties).
Do they work?
There have been many studies 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 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 of the basic activities of daily life and the maintenance of a more positive affective tone in comparison with the absence of this type of treatments.
In fact, it is considered first choice treatment given that it generates an improvement in behavioral and cognitive aspects similar to that of personal pharmacology without its side effects. The most recommended is the cognitive stimulation and the preparation of advice from caregivers (whether family or professional)
- 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.