Non-pharmacological treatment of dementia: does it work?

Beyond medications, there are other ways to improve the quality of life of these patients.

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

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

What are non-pharmacological therapies?

Non-pharmacological therapies are any set of techniques, strategies and treatments aimed at 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 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 drawn from scientific knowledge, requiring that they be validated and replicable and that they prove capable of generating a significant advantage or benefit in the subject to which they are applied. It is important to keep in mind that although these therapies are non-pharmacological in themselves, they are often accompanied by a pharmacological treatment (whether this is the main treatment or used as a support system for the non-pharmacological treatment), each contributing to the success of the other. This type of treatment is not applicable to everyone, since a diagnosis is required for its implementation. a diagnosis is required for their implementation..

In addition to the 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 a therapeutic success in most cases in which they are applied.

Non-pharmacological therapies include all those contributions of medicine that do not require chemical agents in the form of drugs (e.g. ablation of parts of the body, dialysis, laser treatments), those of psychology (both clinical and health and in other areas) and other health-related disciplines such as occupational therapy, speech therapy or physiotherapy. other health-related disciplines such as occupational therapy, speech therapy and physiotherapy..

It is possible to apply them to a large number of fields, 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.

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 dementia. Dementias are the set of alterations generated by neurodegenerative diseases, usually incurable, progressive, progressive, and usually incurable, progressive and chronic, in which the subject in which the subject loses one or more mental faculties over time.

These are disorders in which there is no curative medical treatment, focusing interventions on palliating 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. (e.g., tacrine and/or donepezil are used in Alzheimer's disease), but non-pharmacological therapies are generally much better known and more useful.

In general, non-pharmacological therapies in the treatment of dementia focus on improving the patient's quality of life and capacity for autonomy, preservation of mental functions for as long as possible, a less traumatic and more positive experience of the disorder, management of fears, doubts and feelings of the patient and his environment, or learning strategies to optimize the subject's skills and compensate for his deficits in such a way as to compensate for his deficits. compensate their deficits in such a way that they entail the lowest possible 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.

Therapies or treatments most commonly 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 the following.

1. Cognitive stimulation

One of the main and best known, cognitive stimulation is aimed at the subject to activate his or her mental faculties at a general level, through different activities, andthrough 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 specific operations, elements, and strategies to achieve improvement in a specific cognitive skill or domain..

3. Cognitive rehabilitation

Cognitive rehabilitation focuses on impaired or deteriorating processes and skills, seeking their recovery, substitution, compensation and optimization.and skills, aiming at their recovery, substitution, compensation and optimization.

4. Training in daily living skills

As dementia progresses, sufferers will manifest increasing difficulty in performing basic daily activities, such as maintaining hygiene habits, using the telephone or even feeding themselves or going to the bathroom. That is why training in these skills allows the patient's autonomy to be strengthened..

5. Reminiscence Therapy

A type of therapy used with dementia patients to help them remember and reelaborate their experiences, strengthening their memory and facilitating the maintenance of a coherent life narrative. Photos, very 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 it has been shown that bonding with animals, especially pets, has a beneficial effect on the patient's mental and social functioning. on the mental and social functioning of the patient, while improving their motivation and affectivity. A great variety of animals can be used, being very common the use of dogs.

7. Music therapy

Music therapy is one of the non-pharmacological treatments used, among other areas, in dementia. Music, either 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 proposed.

8. Psychotherapy

Psychotherapy, generally of 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 mourning for the loss of abilities or training in skills such as social skills.

9. Phototherapy

Light therapy 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 anxietythrough 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 capabilities 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 skills and to strengthen the patient's abilities and affective expression.. It can include dance therapy, theater, painting or sculpture.

13. Physical exercise and physiotherapy

Exercise and massage are important elements in keeping the patient stimulated, maintain 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 this skill is very useful, helping patients to be able to express themselves correctly and improving their oral-phonatory skills. improving their bucco-phonatory skills..

15. Occupational therapy

Discipline in which different types of occupations or activities (including some of the above) are used to strengthen autonomy and quality of life. Both cognitive and physical aspects are worked onThe activities that are carried out are linked to those performed in the daily life 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 mediating pharmacological agents on the patient to cause improvement, optimization or preservation of faculties for as long as possible.

However, it should be noted that although the identified patient is the main focus of attention, different techniques and non-pharmacological treatments are also applied on the other elements linked to him: his family and environment and the team of professionals who care for him.

Patient

As we have mentioned, the patient is the main focus of attention on which treatments, both non-pharmacological and pharmacological, are applied. The above examples of therapies and treatments are applied to the patient. It is important to keep in mind that it is not only about preserving skills, but also about improving their quality of life as much as possible.. Their emotional needs must also be attended to and their motivation must be maintained.

Family/Environment

Although it is the patient who suffers from dementia, the patient's family and loved ones will also experience a high level of distress and doubts. will experience a high level of distress and doubt.. Generally, some of them will act as caregivers for the subject as he/she loses autonomy and abilities, and will have to deal with difficult and painful situations.

Among the most common interventions are psychoeducation, training in general and specific care, support and counseling, 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 centers or home help. Multi-component programs that take into account elements of different branches and techniques are often used and are in fact the most effective.

Professionals

In some cases, subjects with dementia are left in 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, who live with the patients and help them. patients and help them in their day-to-day life or nursing homes.. We could also include medical and psychology professionals with frequent contact with this type of patient.

Training in the care of the subject and the search for dignified alternatives in those severe 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 to them. Psychotherapy and counseling may also be required.For those who are in contact with a patient as well as for those who are dealing with the diagnosis and treatment process (after all, they are dealing with a situation in which they see how a person is gradually losing his or her 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 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 has been shown to be highly recommended, since it greatly improves the quality of life of the patient and his or her caregivers, the maintenance and improvement in basic activities of daily living and the maintenance of a more positive affective tone compared to the absence of this type of treatment.

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

Bibliographic references

• Olazarán, J. and Muñiz, R. (2009). Map of Non-Pharmacological Therapies for Alzheimer's Dementias. Technical initiation guide for professionals. Maria Wolff Foundation and International Non Pharmacological Therapies Project.