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A randomised controlled trial of Lavender (Lavandula Angustifolia) and Lemon Balm (Melissa Officinalis) essential oils for the treatment of agitated behaviour in older people with and without dementia
Abstract
Objective: Lavender and Lemon Balm essential oils are popular in the management of older person agitation due to their ease of application, minimal side effects and low interaction with concurrent medications. This study addressed limitations in the literature to evaluate and compare effectiveness of Lavender and Lemon Balm essential oils on the agitated behaviour of older people with and without dementia living in residential aged care facilities [RACFs]. Methods: Forty-nine nursing home residents with dementia (n=39) and without dementia (n=10) exhibiting agitation participated in this study. Participants were randomised to a counterbalanced, repeated measures design experiment that tests the treatments Lavender, Lemon Balm, and Placebo (Sunflower oil). Treatments were administered once daily for two-weeks followed by a two-week washout period before commencing the subsequent treatment. All participants trialed all three treatments over a 10-week period. Data were collected on the Neuropsychiatric Inventory (NPI) and Cohen-Mansfield Agitation Inventory (CMAI). Results: A significant difference was shown when essential oils effect were compared between the cognitive groups. Post hoc analysis reports Lemon Balm more effective in reducing NPI agitation (p =.04) and CMAI physical non-aggressive behaviour (PNAB) (p =.02) in residents without dementia. Lemon Balm less effective in reducing NPI irritability (p = 0.01) and Lavender more effective in reducing CMAI PNAB (p = 0.04) in dementia. Conclusion: The findings support an opposing effect of Lemon Balm and Lavender in reducing agitated behaviour between the participant cognitive groups. There was no reduction in agitation with treatments when compared to placebo independent of cognitive groups.
... Firstly, when 20 older adults inhaled 60 drops of lemon balm daily, significant improvements in cognitive performance relative to baseline were seen in both the ADAS-Cog and the Clinical Dementia Rating scores [64]. In a similar study [65] using the Neuropsychiatric Inventory (NPI) and the Cohen-Mansfield Agitation Inventory (CMAI) to assess agitated and irritable behaviour in nursing home residents with and without dementia, inhalation of two drops of lemon balm oil (phytochemical screening revealed beta caryophyllene, germacrene D, citral, and geraniol components) daily for two weeks had no effect on agitation levels relative to a sunflower oil placebo in residents with dementia. However, residents without dementia showed significant reductions in physical non-aggressive behaviour and irritability frequency and severity following lemon balm treatment relative to the sunflower oil placebo). ...
... Unfortunately, there are no studies to date performing a direct comparison between populations for cognitive, sleep, or mood outcomes, making it challenging to ascertain whether lemon balm may be more efficacious for particular age groups. However, on reviewing the available evidence, there do appear to be consistent benefits to low mood and anxiety across the lifespan, with improvements in mood symptoms reported in children [39,40], young [29,45,46,49,51], middle-aged [52,58,60], and older [61,62,65,66] adults. It should, however, be highlighted that mood outcomes in infants are difficult by nature to measure, particularly in the insistence of colicky infants where neurogenic, gastrointestinal, microbial, and psychosocial factors contribute to symptoms [71]. ...
... Given that this appears to be a promising avenue of research, more studies focused on sleep outcomes in older adults are warranted. Furthermore, lemon balm may be beneficial for reducing sleep disturbance in older adults with dementia, given that studies showed reduced agitation in dementia populations [65,66]. Moreover, lemon balm may be a therapeutic option for those with sundowning syndrome, which is a condition that affects some individuals with dementia, disrupting circadian rhythms and presenting anxiety and insomnia symptoms [72]. ...
Background: There is renewed interest in the use of ancient herbal remedies for their potential health benefits, particularly in the psychological domain. One herb that is receiving growing attention is lemon balm (Melissa officinalis L.) which has received considerable interest for its influence on the brain. Lemon balm boasts an array of phytochemicals, including rosmarinic acid, citral, oleanolic acid, and ursolic acid, which are believed to underpin these effects on psychological well-being. Pharmacological evidence from animal and cellular work reveals that lemon balm and its components may modulate several brain signalling pathways, including GABAergic, cholinergic, and serotonergic systems. Results/Conclusions: Although further robust randomised controlled trials using lemon balm are required, existing research indicates that lemon balm holds promise as a calming agent exhibiting both anxiolytic and anti-depressant properties and can elicit cognitive and sleep-quality enhancement.
... There is growing positive evidence for the use of essential oils in aromatherapy for dementia (Ballard et al., 2002;O'Connor et al., 2013;Takahashi et al., 2020;Watson et al., 2019;Yang et al., 2015), and the concentration, dosage, duration and frequency of the use of essential oils are progressively becoming standardized in practice. Essential oils are usually used indoors, and many studies of multisensory environmental interventions have used indoor multisensory intervention rooms (e.g. ...
... In contrast to the methods and goals of using aromatherapy in- This idea is also confirmed by previous research that has shown that sensory interventions reduce negative behaviour more than other measures (Kong et al., 2009). For instance, lavender essential oil, which is extracted from living plants as the most common type of odour in clinical or care settings, can improve agitation behaviour in people with dementia (Fujii et al., 2008;O'Connor et al., 2013;Takahashi et al., 2020;Watson et al., 2019). This behavioural manifestation of dementia can be explained by the unmet needs model, also known as the needs-driven dementia-compromised behaviour model, which posits that behavioural symptoms are the result of attempts to address physical or psychological distress related to unmet needs (Algase et al., 1996) as well as the reduced ability to effectively engage with or use the environment to address these needs (Cohen-Mansfield, 2000). ...
... Activities in outdoor environments that require attention to be facilitated by the smellscape are usually considered active (Bourdon & Belmin, 2021;Collins et al., 2020;Cox et al., 2004;Gueib et al., 2020;Prolo & Sassi, 2017;Smith-Carrier et al., 2021). In contrast, aromatherapy uses essential oils for passive interventions (Fujii et al., 2008;O'Connor et al., 2013;Takahashi et al., 2020;Watson et al., 2019). ...
Background
There is mounting evidence for the health benefits of aromatic scents for the older people with dementia. However, existing research has focused on indoor aromatherapy using essential oils. It is necessary to explore the health benefits of smellscapes in the outdoor environment for older people with dementia.
Aims and Objectives
This scoping review aims to examine existing evidence for smellscape as a healing factor in institutional garden for older people with dementia, try to bridge the knowledge gaps between outdoor sensory garden scents and aromatherapy to develop green care techniques that incorporate outdoor activities.
Methods
Seven databases (Scopus, PubMed, PsycINFO, CINAHL, MEDLINE, Embase and Web of Science) were searched with English language articles published between 1990 and 2022. The PRISMA‐ScR Checklist was used.
Results
Out of 1013 articles, 11 meet the inclusion criteria. The comprehensive health outcomes include five aspects: mental health; physical health; reduced agitation behaviour; improved cognitive function; and well‐being. These aspects are part of the rehabilitation model comprising the person (older people with dementia), environment (garden smellscapes) and outdoor activities (active or passive interventions or a combination).
Conclusions
The smellscape, as a healing factor in the garden, not only benefits from evidence on indoor aromatherapy but also creates a sensory environment for older people with dementia by compensating for functional impairment, activity support and environmental creation, thereby promoting enhanced health and well‐being.
Relevance to Clinical Practice
The research on the healing effects of smellscapes presented in this review offers a novel environmental intervention technique for transferring evidence on essential oils to outdoor sensory gardens. This green care technique is suggested to assist in the creation of healing environments and interventions for people with dementia who cannot be cured.
No Patient or Public Contribution
This scoping review did not directly involve patient or public contributions to the manuscript.
... Aromatherapy is the use of essential oils distilled from plants to stimulate olfactory (smell) receptors and activate regions in the brain's limbic region (centre of emotion and memory). Several studies specifically address the use of aromatherapy with dementia, longterm care residents, and/or elders, with results showing some support and recommendations for further study (Her & Cho, 2021;Lakhan, Sheafer & Tepper, 2016;Leach et al., 2021;Viet, 2018;Watson, Hatcher & Good, 2019). Not all studies find a decrease in agitated behaviour or 'dementia symptoms' when using aromatherapy (O'Connor et al., 2013), but Yoshiyama, Arita, and Suzuki (2015) suggest aromatherapy is clinically safe. ...
... Her and Cho (2021) note that aromatherapy improves sleep quality and reduces stress, pain, anxiety, depression, and fatigue in working-age adults and elderly people; all those characteristics may underlie distressing behaviours. Watson, Hatcher, and Good (2019) suggest lavender essential oil is more effective in reducing agitation in people with dementia, while lemon balm essential oil is more effective in reducing agitation without dementia. ...
... Our findings were also consistent with Watson, Hatcher, and Good (2019), who suggest one oil (lavender) is more effective in reducing agitation in people with dementia, while another oil (lemon balm) is more effective in reducing agitation without dementia. Similarly, we found a 'mentally sharp' blend (basil, lemon, rosemary, peppermint, clove bud, cardamom, and cedarwood) worked well on the 'dementia unit' but appeared too stimulating for residents on the 'advanced dementia' unit, who responded well to a mixture of lavender and mandarin oils. ...
Context: Residents experiencing pain, anxiety, and distressing behaviours, often in conjunction with mental health diagnoses and dementia, can be challenging for staff in long-term care facilities and may result in jeopardising resident and staff safety, quality of life, staff delivery of care, and overuse of psychotropic medications.
Objective: Describe the effects of three holistic interventions (hand portion of the ‘M’ Technique®, aromatherapy, and energy healing) to reduce pain, anxiety, and distressing behaviours in long-term care residents.
Method: Pragmatic secondary analysis of pre- and post-intervention quantitative and qualitative data.
Findings: Staff administered a total of 363 individual sessions using the ‘M’ Technique® for hands, aromatherapy, and/or energy healing to 75 residents who were able to indicate their pain and/or anxiety levels before and after a session. Results indicate significant differences in decreased pain by session, decreased anxiety by session, decreased pain by person, and decreased anxiety by person. Qualitative results, primarily gathered from an additional 1,024 sessions in which residents were unable to use pain and anxiety scales, indicate a decrease in distressing behaviours and overall improvement of milieu.
Limitations: We collected data as part of a quality improvement programme without the intent of being published as a research study. It is difficult to assess the reliability and validity of self-reported quantitative pain and anxiety scales for people with dementia.
Implications: Holistic interventions, including the ‘M’ Technique for hands, aromatherapy, and/or energy healing, show promise in reducing pain, anxiety, and distressing behaviours in residents of long-term care facilities, along with improvements in the facilities’ environment.
... Trois ECR [23][24][25] ont été analysées. Elles sont toutes spécifiques de la personne âgée et deux d'entre elles ont été réalisées auprès de personnes atteintes de MNC [24,25]. ...
... Trois ECR [23][24][25] ont été analysées. Elles sont toutes spécifiques de la personne âgée et deux d'entre elles ont été réalisées auprès de personnes atteintes de MNC [24,25]. Les données extraites sont présentées dans le Tableau 2. ...
... Dans l'anxiété, les HE sont des compléments thérapeutiques qui visent à réduire les posologies des médicaments ainsi que leurs risques d'effets secondaires lors d'escalade thérapeutique. En effet, leur potentiel anxiolytique est confirmé par des méta-analyses [9,10,12,14,[18][19][20]22] (sauf en soins palliatifs [19,42] ainsi qu'en cancérologie [10]) et des études randomisées en double aveugle [23][24][25], en particulier pour la lavande vraie et la camomille [23,43,44]. Ces études portent essentiellement sur les TA secondaires et les TA de la personne âgée atteinte de MNC. ...
Contexte : Les troubles anxieux sont fréquents chez les personnes âgées. Leur prise en charge fait appel aux thérapeutiques pharmacologiques et non pharmacologiques. L’aromathérapie compte parmi ces stratégies. L’objectif de cette revue de littérature est de caractériser l’efficacité et la tolérance de l’aromathérapie.
Méthodes : Une revue non systématique de la littérature a été conduite sur PubMed de 2012 à 2022. Les méta-analyses et études contrôlées randomisées (ECR) ont été répertoriées.
Résultats : Quatorze méta-analyses ont été incluses ainsi que 3 ECR. L’analyse a montré une efficacité significative de l’aromathérapie dans les troubles anxieux chez l’adulte et la personne âgée.
Discussion : Après un bref rappel sur les troubles anxieux de la personne âgée, les principes de l’aromathérapie sont présentés : voies d’administration, choix des huiles essentielles, effica- cité, tolérance, approche multimodale et limites de la prescription. Un support pour élaborer un protocole médical d’aromathérapie est proposé.
Conclusion : L’aromathérapie est efficace et bien tolérée dans le trouble anxieux de la per- sonne âgée en ambulatoire comme en établissement gériatrique.
... According to Snow et al. (Snow et al., 2004;Watson et al., 2019), the mere inhalation of oils through the olfactory system may have no effect on people with Alzheimer's disease because, in advanced stages, affected people may lose their sense of smell, while the application of oils on the skin appears to be effective. Applying massage allows the essential oils to also be absorbed into circulation through the skin. ...
... If the results obtained from this study are compared to scientific evidence already available in the current literature, the use of Melissa Officinalis essential oil applied through a massage has a positive effect both on the agitation levels (Wilkinson et al., 2007;Li et al., 2022) and above all on the levels of the quality of life, as shown in various studies in patients affected by moderate to severe Alzheimer's. The results obtained from this experiment are, therefore, in line with the study by Ballard et al., carried out in 2002(Ballard et al., 2002Watson et al., 2019) and with the study by Burns et al., carried out in 2011(Burns et al., 2011. The positive results reported by patients arise from the use of Melissa Officinalis essential oil, which is inhaled and absorbed through the skin (Snow et al., 2004;Watson et al., 2019) and by its association with the massage which promotes a state of relaxation and a consequent improvement in patients' quality of life. ...
... The results obtained from this experiment are, therefore, in line with the study by Ballard et al., carried out in 2002(Ballard et al., 2002Watson et al., 2019) and with the study by Burns et al., carried out in 2011(Burns et al., 2011. The positive results reported by patients arise from the use of Melissa Officinalis essential oil, which is inhaled and absorbed through the skin (Snow et al., 2004;Watson et al., 2019) and by its association with the massage which promotes a state of relaxation and a consequent improvement in patients' quality of life. This was recorded at the end of each session when patients expressed their state of wellbeing through the answers given in the questionnaire and verbally by praising the masseur and the lovely smell of Melissa that was diffused in the environment. ...
Background: Alzheimer's Disease (AD) is the most widespread form of dementia. The present study analyses the effects of aromatherapy using Melissa Officinalis essential oil, applied by massage to the hands and forearms of patients suffering from Alzheimer's disease. and to evaluate the effect on their perceived overall quality of life.Methods:Aprospective observational study was conducted in two nursing homes in Italy in 2018. Data were collected through individual qualitative structured interviews based on the Quality of Life in Alzheimer's Disease (QoL-AD) questionnaire and the Mini Mental State Examination (MMSE). The authors referred to STROBE guidelines for quality reporting of observational studies.Results:Treatment with Melissa thOfficinalis showed positive effects on all patients after the 12week of treatment. The results were most evident in patients in class 3 MMSE. However, class 4 MMSE patients also benefited from the treatment. Conclusion:The aromatherapy treatment delivered in this observational study, using Melissa Officinalis essential oil applied to hands and forearms, showed an improvement in the quality of life of the patients living in two different nursing homes. Due to the small sample size in this study, it is suggested that more research be done on the effects and effectiveness of aromatherapy with Melissa Officinalis essential oil for Alzheimer's disease patients.
... Watson et al. [129] from Sydney reported the effects of M. officinalis essential oil in the treatment of agitated behaviour in older people with and without dementia. A total of 39 nursing home residents with dementia and 10 without dementia participated in this study. ...
... Participants were treated with essential oil for two weeks followed by a two-week washout period before commencing the subsequent treatment. Essential oil of M. officinalis exhibited more effective in reducing agitation in people without dementia (Trial registration no: ACTRN12614000130662) [129]. ...
Melissa officinalis has long been used in folk medicine as an integrated pharmacy, used in the treatment of many diseases since ancient times, as a remedy for headaches, indigestion, abdominal cramps, and heart failure. Lemon balm is characterized by antibacterial, antiviral and antidiabetic properties. The therapeutic benefit of this species is that it contains a wide variety of secondary metabolites such as essential oils, flavonoids, phenolic acid, and terpenes. Lemon balm contains many secondary metabolites such as eugenol, octinol, octyin, octinone, citral, hexenol and haramin, in addition to high levels of rosmarinic acid, which is used to treat many diseases in the field of alternative medicine. Lemon balm essential oils are concentrated hydrophobic oils that contain volatile chemicals that are used in food processing, where they are added to food, and in the cosmetics and perfumery industry. Despite the enormous benefits of M. officinalis aromatic oils, they do have side effects if not used properly. They can cause skin irritations, especially in children. The essential oils of this plant are effective against many types of bacteria, such as Salmonella, Escherichia coli, Staphylococcus, Pseudomonas, Bacillus and have an effective antifungal activity, especially against Candida and yeasts.
... Watson et al. [129] from Sydney reported the effects of M. officinalis essential oil in the treatment of agitated behaviour in older people with and without dementia. A total of 39 nursing home residents with dementia and 10 without dementia participated in this study. ...
... Participants were treated with essential oil for two weeks followed by a two-week washout period before commencing the subsequent treatment. Essential oil of M. officinalis exhibited more effective in reducing agitation in people without dementia (Trial registration no: ACTRN12614000130662) [129]. ...
Medicinal plants are being used worldwide for centuries for their beneficial properties. Some of the most popular medicinal plants belong to the Melissa genus, and different health beneficial effects have already been identified for this genus. Among these species, in particular, the Melissa officinalis L. has been reported as having many biological activities, such as antioxidant, antimicrobial, antitumour, antiviral, antiallergic, anti-inflammatory, and also flatulence inhibiting effects. The beneficial properties of the Melissa officinalis, also known as “lemon balm herb”, can be related to the bioactive compounds such as terpenoids, alcohols, rosmarinic acid, and phenolic antioxidants which are present in the plant. In this updated review, the botanical, geographical, nutritional, phytochemical, and traditional medical aspects of M. officinalis have been considered as well as in vitro and in vivo and clinically proven therapeutic properties have been reviewed with a special focus on health-promoting effects and possible perspective nutraceutical applications. To evidence the relevance of this plant in the research and completely assess the context, a literature quantitative research analysis has been performed indicating the great interest towards this plant for its beneficial properties.
... Watson et al. [129] from Sydney reported the effects of M. officinalis essential oil in the treatment of agitated behaviour in older people with and without dementia. A total of 39 nursing home residents with dementia and 10 without dementia participated in this study. ...
... Participants were treated with essential oil for two weeks followed by a two-week washout period before commencing the subsequent treatment. Essential oil of M. officinalis exhibited more effective in reducing agitation in people without dementia (Trial registration no: ACTRN12614000130662) [129]. ...
... Although agitation in the lavender group reduced compared with that in the placebo group, no significant difference was found between the three groups. Watson et al. [32] examined the effect of lavender on agitated behaviors in older people and showed that lavender did not reduce agitation of the older people [32]. However, Mashouf et al. [8] in Iran showed that lavender [8]. ...
... Although agitation in the lavender group reduced compared with that in the placebo group, no significant difference was found between the three groups. Watson et al. [32] examined the effect of lavender on agitated behaviors in older people and showed that lavender did not reduce agitation of the older people [32]. However, Mashouf et al. [8] in Iran showed that lavender [8]. ...
Background:
Conscious patients admitted to intensive care units (ICU) suffer from anxiety and agitation for various reasons, which can affect their recovery processes.
Aims:
To compare the effects of lavender and Citrus aurantium essential oils on anxiety and agitation of conscious patients admitted to ICUs.
Design:
A randomized parallel placebo-controlled trial.
Methods:
One hundred and fifty conscious patients admitted to ICUs were selected by convenience sampling and were randomly divided into three groups, groups of lavender aromatherapy and Citrus aurantium aromatherapy, in addition to the routine care and inhalation of five drops of lavender or Citrus aurantium essential oils for 30 minutes. The placebo group, in addition to routine care, was provided with 5 drops of normal saline for 30 minutes. Anxiety was assessed with the state subscale of State-Trait Anxiety Inventory, and agitation was examined with Richmond Agitation-Sedation Scale before, immediately, one hour, and three hours after the intervention.
Results:
All three groups suffered from relatively severe state anxiety before the intervention. The level of anxiety in the lavender and Citrus aurantium groups was significantly lower than that of the placebo group immediately and three hours after the intervention (P < 0.05). No significant difference was observed between the two groups of lavender and Citrus aurantium. The majority of the samples in all three groups were agitated before the intervention, but agitation of all three groups decreased after the intervention. Restless/agitation reduced significantly in all three groups. Although restless/agitation of the lavender and Citrus aurantium groups reduced more than that of the placebo, no significant difference was found between the three groups.
Conclusion:
The results of the present study showed the positive effects of lavender aromatherapy and Citrus aurantium aromatherapy on reducing the anxiety of patients admitted to ICUs. Relevance to Clinical Practice. Aromatherapy can be used as an effective and safe intervention to reduce anxiety in ICUs.
... În schimb, alte surse nu recomandă folosirea balsamului în timpul sarcinii şi alăptării [28]. Un studiu realizat pe 49 de pacienți vârstnici, dintre care 39 sufereau de demență, a constatat reducerea agitației la cei fără demență după administrarea uleiului de roiniță timp de două săptămani [31]. 5. Guarana (Paullinia cupana, guarana) este o PM indicată pentru probleme gastro-intestinale şi tulburări psihice, inclusiv pentru slăbire, având efecte astringente, de prevenire a malariei şi dizenteriei, îmbunătățire a performanței atletice, reducere a oboselii psihice şi fizice, tratare a sindromului de oboseală cronică şi acționând ca stimulent [33]. ...
Introduction. Drug treatment during pregnancy and breastfeeding period presents certain risks, especially in patients with concomitant mental disorders and somatic pathologies. The purpose of the research was to study the potential effects of medicinal plants and biological supplements during pregnancy and lactation in psychiatric patients with gastro-intestinal pathology. Materials and methods. We analyzed 504 herbs and active biological nutritional supplements including their alternative names: 299 in gastroenterology and 205 in psychiatry. From these, 40 alternative names of plants could be used in gastroenterology and psychiatry and 33 alternative names of plants and active biological nutritional supplements that could be used in psychiatry were selected. Results. Only one herb, damiana (Turnera diffusa), is described as having “no known side effects” during pregnancy and breastfeeding. According to other sources, this herb should not be used during pregnancy and breastfeeding due to the serious risks involved. Another plant Moringa oleifera is found to have multiple protective functions in mental health and gastro-intestinal diseases, being described as potentially safe during pregnancy and breastfeeding, but with specific indications. Conclusions. Prescribing herbs and active biological nutritional supplements during pregnancy and breastfeeding carries certain risks. The information is contradictory, requiring further research and informing patients about the risk-benefit ratio.
... The fact that this plant is used in Iran for women's health problems requires more research. Studies have investigated the use of herbal medicinal drugs in East Asia, such as China (Khalid et al., 2009;Watson et al., 2019). ...
... After treatment, all patients showed significant enhancement in self-reported cognitive presentation on the Japanese versions of both the Gott fries, Brane, Steen Scale, and the Type Dementia Assessment Scale. 10 Lavender essential oil, popular due to its ease of application and minimal side effects, significantly reduces non-aggressive physical behaviors in residential patients with dementia. 11 A randomized clinical trial of 3 months of Highlights • Alzheimer's disease (AD) is a complex multifactorial neurodegenerative disease for which only a few drugs are currently available as symptomatic treatment. ...
Aims
The aim of this review is to outline recent advancements in the application and mechanistic studies of aromatic plant extracts in Alzhermer`s disease (AD) to demonstrate their value in the management of this disease.
Background
AD is a neurodegenerative disease with a complex pathogenesis characterized by severe cognitive impairment. Currently, there are very few drugs available for the treatment of AD, and treatments are primarily focused on symptom relief. Aromatherapy is a traditional complementary alternative therapy that focuses on the prevention and treatment of the disease through the inhalation or transdermal administration of aromatic plant extracts. Over the past few years, studies on the use of aromatic plant extracts for the treatment of AD have been increasing and have demonstrated a definitive therapeutic effect.
Methods
We systematically summarized in vitro, in vivo, and clinical studies focusing on the potential use of aromatic plant extracts in the treatment of AD in PubMed, ScienceDirect, Google Scholar, and the Chinese National Knowledge Infrastructure from 2000 to 2022.
Results
Our literature survey indicates that aromatic plant extracts exert anti‐AD effects by modulating pathological changes through anti‐amyloid, anti‐tau phosphorylation, anti‐cholinesterase, anti‐inflammation, and anti‐oxidative stress mechanisms (Figure 1).
Conclusion
This review provides a future strategy for the research of novel anti‐AD drugs from aromatic plant extracts.
... Some research suggest positive effects of aromatherapy using balm oil with an 360 Almansour overall improvement in agitation and quality of life parameters (Ballard et al., 2002;Li et al., 2021). Other research show a cognitive group-specific effect of Lemon Balm's ability to calm anxious behavior (Watson et al., 2019). ...
Mental disorders are patterns of behavioral or psychological symptoms that affect multiple areas of life; these disorders create distress for the person experiencing these symptoms. The search for the most effective and safe treatments is essential. Aromatherapy as a specialized segment of Phyto-therapy has attracted the attention of many researchers as a complementary method for treating patients with neurological and psychiatric complaints due to their low cost and ease of use. While, it could be practiced via inhalation or topical application and massage utilizing specific essential oils for several, minor, clinical uses as a natural way of healing a person's mind, body, and soul.
... Anesthetic, neuroprotective, anti-inflammatory potential and antioxidant properties [18] ( continued on next page ) local analgesia [24] ( continued on next page ) Anti-allergic effect on skin [28] ( continued on next page ) treat depression [33] Many EOs present anti-dementia effects by reducing A toxicity and neurological dysfunction. Watson et al. found that lemon EO and lavender EO could reduce physical non-aggressive behaviors in patients with Alzheimer's disease [48] . Other researchers indicated that Pinus halepensis EO has neuroprotective effects as it could recover the memory misbehavior in y-maze tests caused by amyloid [49] . ...
Background
Essential oils (EOs) are a plant-derived volatile mixture. Due to their extensive biological activity, EOs have been utilized as ancient remedies to treat a variety of illnesses.
Objectives
Our review aims to expand our understanding of EOs’ biological activity on the central nervous system (CNS) and to highlight the importance of utilizing EOs in CNS disorders.
Method
A systematic literature search was conducted using PubMed, ScienceDirect, China National Knowledge Infrastructure (CNKI), Springer Link, Wan-fang database, and Chinese Biomedicine Database (CBM). The search was conducted to collect relevant journals and contents using the following terms: "essential oils", "aromatherapy", "essential oils" and "CNS". Language of publications was unlimited.
Results
EOs are concentrated volatile aromatic liquids extracted from natural plants with different chemical compositions, obtained by physical and chemical methods such as distillation and pressing. This paper explores the effects of EOs products on CNS including promoting intelligence, improving sleep, promoting cognition and memory, anti-anxiety and depression, sedation and anti-epilepsy. EOs exert their neuropharmacological effects through blood circulation or the olfactory system. This paper summarizes clinical studies showing that aromatherapy could improve sleep, relieve preoperative anxiety and postoperative PONV, relieve gynecological disease pain, and play a role in hospice care.
Conclusion
The present findings suggest that EOs have neuropharmacological effects such as nootropic, sleep improvement, anti-dementia, anti-anxiety and depression, analgesic effect, and antiepileptic, emphasizing the importance of EOs in CNS disorders and indicating the potential clinical application.
... Forty-nine % of the patients reduced their anxiety levels at seven days and 54% improved their sleep quality [85]. Other authors showed that M. officinalis essential oil was effective in reducing agitated behavior in the elderly affected or not by dementia [86]. The study was conducted in a nursing home recruiting 39 patients affected by dementia and 10 control patients (no dementia). ...
The authors would like to make a correction to the article [1]. The authors clarify that the reference [2] in the Fig. 5 caption is not cited in this review article in error. We apologise to readers for any inconvenience caused and state that the scientific conclusions are unaffected. This correction was approved by the Academic Editor. The references in the article have also been updated.
... 4,5 It has been stated in the literature that therapies such as acupuncture, herbal therapies, yoga, music therapy, and aromatherapy have positive effects on the health of individuals. [42][43][44][45] The theories of nurse theorists are also compatible with the fifth principle of IHT. Watson's theory includes knowing and applying all remedial practices in the care process. ...
Nursing theories aim to increase the quality of care while improving nursing practices. Integrative nursing, which constitutes the application area of holistic philosophy, is a complex health care system that evaluates the individual with his environment, supports his innate healing capacity, emphasizes the healing power of nature, advocates personcentered and relationship-based care, includes the most appropriate evidence-based healing therapies, and provides interdisciplinary cooperation. This nursing approach is described as “a way of being-knowing-doing” that improves the health and well-being of the individual, family, and society through care and therapeutic relationships. Integrative nursing, whose main framework is formed by 6 principles, can be considered as an application theory based on previous theories. Applying integrative nursing principles into practice and planning nursing care according to these principles can present quality care and provide a theorybased care. In this review, it is aimed to explain how to use integrative nursing principles in the clinic/field, their compatibility with other theories and models, the interventions that can be applied, and what can be done in the measurement of results.
... Forty-nine % of the patients reduced their anxiety levels at seven days and 54% improved their sleep quality [84]. Other authors showed that M. officinalis essential oil was effective in reducing agitated behavior in the elderly affected or not by dementia [85]. The study was conducted in a nursing home recruiting 39 patients affected by dementia and 10 control patients (no dementia). ...
Melissa officinalis L. is a plant of the Lamiaceae family known in numerous countries for its medicinal activities. This plant has been used since ancient times to treat different disorders, including gastrointestinal, cardiovascular, neurological, psychological conditions. M. officinalis contains several phytochemicals such as phenolic acids, flavonoids, terpenoids, and many others at the basis of its pharmacological activities. Indeed, the plant can have antioxidant, anti-inflammatory, antispasmodic, antimicrobial, neuroprotective, nephroprotective, antinociceptive effects. Given its consolidated use, M. officinalis has also been experimented with clinical settings, demonstrating interesting properties against different human diseases, such as anxiety, sleeping difficulties, palpitation, hypertension, depression, dementia, infantile colic, bruxism, metabolic problems, Alzheimer’s disease, and sexual disorders. As for any natural compound, drug, or plant extract, also M. officinalis can have adverse effects, even though the reported events are very rare and the plant can be considered substantially safe. This review has been prepared with a specific research strategy, interrogating different databases with the keyword M. officinalis. Moreover, this work analyzes the properties of this plant updating currently available literature, with a special emphasis on human studies.
... Agonistic effect on serotonin pathway and other subtypes of GABA and cholinergic receptors are the recommended mechanisms of action for Neurogol. 12 Watson et al. 27 studied 39 subjects of dementia and agitated behaviors with essential oils of lavender and lemon balm. Their achievement showed asignificant reduction of agitated behavior with a dominant role of lemon balm (p = 0.04). ...
Background:
This study was pointed to evaluate the efficacy and safety of valerian and lemon balm additional to the quetiapine in critically ill patients with delirium and agitation.
Methods:
We conducted a randomized, double-blind, placebo-controlled study. Fifty-three adult intensive care unit (ICU) patients (according to ICU Confusion Assessment Method scores) who were treated for delirium received quetiapine and Neurogol syrup (a combination of valerian and lemon balm) or placebo 5 mL every 12 hours for five consecutive days. Improvement in agitation according to the Richmond Sedation and Restlessness Scale was considered the main outcome.
Results:
The trial was completed for 53 patients (27 in the treatment group and 26 in the placebo group). The baseline characteristics between the groups were similar. In the treatment group, the number of agitated patients was significantly reduced and the difference was statistically significant (p = 0.000). Compared with the placebo group, the length of ICU stay in the treatment group was significantly reduced (p = 0.001). The Glasgow Coma Scale improved significantly at the end of day 5 (p = 0.04). There was no statistical difference in the improvement of delirium between the study groups (p = 0.14). Neurogol syrup was well tolerated.
Conclusion:
The addition of Neurogol to quetiapine (a combination of valerian and lemon balm) can reduce agitation and shorten the length of stay in the ICU without adverse effects. Clearly, more research is still needed to investigate the role of herbal medicines in ICUs and their efficacy and safety.
How to cite this article:
Alikiaie B, Shahmoradi E, Yekdaneh A, Mousavi S. Addition of Valerian and Lemon Balm Extract to Quetiapine Reduces Agitation in Critically Ill Patients with Delirium: A Pilot Randomized Clinical Trial. Indian J Crit Care Med 2021;25(7):785-790.
... Furthermore, lemon essential oil helps to clear acne, cleanse oily skin and hair and remove dead skin cells (6). In addition, the fresh aroma of lemon essential oil can refresh the mind and spirit, relieve irritability and purify the air (7). ...
The aim of this study was to analyze the non-volatile composition and antioxidant differences of lemon essential oils (LEOs) obtained by cold-pressing vs. hydrodistillation. Pathological observations showed that LEO effectively inhibited liver injury caused by oxidative stress, and CPLEO was more effective than HDLEO. CPLEO increased serum T-AOC, SOD, GSH, and GSH-Px levels while decreasing NO, COX-2, IL-6, IL-1β, IFN-γ, and TNF-α levels in mice with oxidative damage. The effects of CPLEO were stronger than those of HDLEO and similar to those of vitamin C. CPLEO upregulated mRNA and protein expressions of Cu/Zn-SOD, Mn-SOD, CAT, HO-1, Nrf2, and NQO1 while downregulating nNOS, iNOS, IL-1β, COX-2, TNF-α, and NF-κB mRNA expression and nNOS, eNOS, iNOS, and COX-2 protein expression in mice with oxidative damage. The results demonstrate that LEO has good antioxidant effects and that CPLEO has a better antioxidant effect than HDLEO as it retains more active non-volatile substances.
... In our previous study, using a Morris water maze task, we showed that aqueous extract of lavender improves impaired spatial learning and memory in an animal model of AD (5). A clinical trial, reported that lavender significantly reduced physical non-aggressive behaviors in patients with the dementia disorder (83). Metabolomic analysis of serum collected from the AD model of rats, receiving aqueous extract of lavender, showed that the extract restores metabolic profile of AD treated animals to normal status (84). ...
One of the most frequent forms of dementia in neurological disorders is Alzheimer's disease (AD). It is a chronic neurodegenerative disease characterized by impaired learning and memory. Pathological symptoms as extracellular amyloid-beta (Aβ) plaques and intracellular accumulation of neurofibrillary tangles occur in AD. Due to the aging of the population and increased prevalence of AD, discovery of new therapeutic agents with the highest effectiveness and fewer side effect seems to be necessary. Numerous synthetic medicines such as tacrine, donepezil, galantamine, rivastigmine, memantine, glutathione, ascorbic acid, ubiquinone, ibuprofen, and ladostigil are routinely used for reduction of the symptoms and prevention of disease progression. Nowadays, herbal medicines have attracted popular attention for numerous beneficial effects with little side effects. Lavandula angustifolia, Ginkgo biloba, Melissa officinalis, Crocus sativus, Ginseng, Salvia miltiorrhiza, and Magnolia officinalis have been widely used for relief of symptoms of some neurological disorders. This paper reviews the therapeutic effects of phytomedicines with prominent effects against various factors implicated in the emergence and progression of AD. © 2021 Mashhad University of Medical Sciences. All rights reserved.
... Combination of Ginkgo biloba and Panax ginseng exhibited improvements in working and episodic memory [19,20]. Some of the other important herbs that have been shown to improve cognition are Panax ginseng [21e23], Melissa officinalis [20,24,25], Rhodiola rosea [26e29], Hypericum perforatum [30], and Salvia lavandulaefolia [31]. ...
The chapter reviews the overall neuronal molecular mechanisms of Bacopa monnieri with respect to cognitive performance. It starts with defining cognition, and how interruption in signal transduction can cause cognitive impairment. Then the factors influencing signal transduction and regulation of those factors are briefed to give a glimpse on cascade involved in signal transduction and their importance in governing the cognitive performance. The drugs and nutraceuticals commonly used as cognition enhancers and their mechanisms of action are covered in brief before taking up details of B. monnieri. Later, effect of B. monnieri on various factors contributing to signal transduction like neurotransmitters, receptors, second messenger system, gene expression, neuronal structural factors, neuronal connections, cerebral blood flow and neuroprotection are detailed to understand the neuronal molecular mechanisms involved in improving cognitive performance. Summary of this review points toward strong scientific substantiation available in the literature to justify the use of B. monnieri in dietary and food supplements intended for cognitive health.
... Consistent with our results, M. officinalis extract and aromatherapy with the essential oil of M. officinalis have been shown to have a positive effect on agitation in patients with mild to moderate AD and severe dementia, respectively 16,18 . In addition, M. officinalis essential oil was reported to decrease NPI scores in patients without dementia, implying that it reduces agitation 19 . M. officinalis has both nicotinic and muscarinic acetylcholine receptor binding activity; however, the specific action of M. officinalis on acetylcholine receptors remains unknown 20 , and whether it shows efficacy in the treatment of patients with AD with respect to not only their behavioral and psychological symptoms of dementia, such as irritability, but also their cognition is unclear 20 . ...
We conducted a randomized placebo-controlled double-blind 24-week trial using Melissa officinalis ( M. officinalis ) extract richly containing rosmarinic acid (RA) on patients with mild dementia due to Alzheimer’s disease (AD) with the aim to examine the safety and tolerability (primary endpoint) of RA (500 mg daily) and its clinical effects and disease-related biomarker changes (secondary endpoints). Patients ( n = 23) diagnosed with mild dementia due to probable AD were randomized to either the placebo or M. officinalis extract group. No differences in vital signs or physical and neurologic examination results were detected between the M. officinalis and placebo groups. No serious adverse events occurred. There were no significant differences in cognitive measures; however, the mean Neuropsychiatric Inventory Questionnaire (NPI-Q) score improved by 0.5 points in the M. officinalis group and worsened by 0.7 points in the placebo group between the baseline and 24-week visit, indicating a significant difference ( P = 0.012). No significant differences were apparent in disease-related biomarkers between the groups. M. officinalis extract containing 500 mg of RA taken daily was safe and well-tolerated by patients with mild dementia due to AD. Our results suggest that RA may help prevent the worsening of AD-related neuropsychiatric symptoms.
Trial registration: The registration number for this clinical trial is UMIN000007734 (16/04/2012).
... In this case, the study sought to understand staff perspectives, their understanding of agitation and how this can influence their decision-making when selecting management strategies of agitation for people living in residential aged care. The study was part of a larger project that explored the use of essential oils for management of agitation in older people (Watson et al., 2019). ...
Background
Agitation in older people is commonly associated with cognitive decline, complex medical diagnoses and polypharmacy. Impaired communication and comprehension within a dementia trajectory adds complexity to assessment and management. Despite high prevalence, agitated behaviours remain challenging to manage in residential aged care settings.
Aim
To explore staff perceptions of agitation in residents of aged care facilities, including the influence of dementia, when selecting management strategies to reduce agitated behaviour.
Design
Qualitative descriptive.
Methods
Semi‐structured interviews with 11 aged care staff were conducted at two aged care sites. Transcripts were examined using content analysis to identify common issues and categories. The study complied with COREQ guidelines (see. Appendix S1).
Results
Participants reported managing resident agitation at least once per shift; most frequently manifesting as wandering, restlessness or aggression. Management strategies included distraction, providing space, knowing the resident, identifying causative factors, spending individual time and if necessary medication administration. Agitation management was more challenging for residents with dementia due to impaired communication or comprehension of instruction.
Conclusions
While participants strived to deliver individualized person‐centred care, this was difficult given time and resource constraints. Contemporary management of agitation therefore remains variable in everyday practice, with resident preference used when causative factors were known. Conversely, for residents with impaired communication and/or comprehension, distraction and chemical restraint were commonly used. Nuanced education for assessment and management is recommended to better address this unmet need for some residents.
Relevance to clinical practice
For optimal care, appropriate allocation of time and resources is necessary to identify causative and contextual factors for individual residents. Recommendations are for additional staff training in communication and attitude, and collaborating with frontline staff to develop a practical guide for management of agitation in aged care. These simple initiatives may help to improve consistency of care delivery and resident outcomes.
... (Celastraceae) (Malik et al., 2017), Convolvulus pluricaulis Wall. ex Choisy (Convolvulaceae) (Kizhakke et al., 2019), Evolvulus alsinoides (L.) L. (Convolvulaceae) (Siripurapu et al., 2005), Glycyrrhiza glabra L. (Fabaceae) (Guo et al., 2016), Ginkgo biloba L. (Ginkgoaceae) (Liu et al., 2020), Crocus sativus L. (Iridaceae) (Wang et al., 2019), Melissa officinalis L. (Lamiaceae) (Watson et al., 2019), Salvia officinalis L. (Lamiaceae) (Miroddi et al., 2014), Punica granatum L. (Lythraceae) (Yuan et al., 2016) , Cissampelos pareira L. ...
Alzheimer's disease is the most common form of dementia and is highly prevalent in old age. Unlike current drugs, medicinal plants can have preventive and protective effects with less side effects. Given the great number of bioactive substances, plants from the Zingiberaceae Family have medicinal potential and currently are widely studied regarding its anti-Alzheimer's disease effects. The objective of this study was to provide an overview of advances in phytochemical composition studies, in vitro and in vivo pharmacological studies, and toxicological effects of the Zingiberaceae Family on Alzheimer's disease. Information was obtained from relevant papers i n electronic databases. Most of the studies of Zingiberaceae effects on Alzheimer's disease pathogenesis theory are related to cholinergic, β amyloid cascade, tau, inflammation, and oxidative stress hypothesis. Also, in vitro and in vivo preclinical studies on the effect of Alpinia, Curcuma, and Zingiber genera have been reported as harmless and safe, with potential for anti-Alzheimer treatment.
... This will make experiments comparable and help to determine the influences of each chemical compound and the concentration dependency of its effect. anxiolytic-like effect not through GABA system; anosmia does not impair anxiolytic effect; pain suppression; reduced agitation and physical non-aggressive behavior in older people with dementia [43,[144][145][146][147][148][149] Lippia alba Bushy lippia Silver catfish In water Anesthetic effect through GABA system; S-(+)-linalool in lippia has sedative and anesthetic effect; citral and linalool in it have anesthetic effect [ SC: subcutaneous, IP: intraperitoneal injection, TBPS: tert-butylbicyclophosphorothionate, 5HT: 5-hydroxytryptamine serotonin receptor, 2A, 2B, 2C are subtypes, GABA: ...
Essential oils have been used in multiple ways, i.e., inhaling, topically applying on the skin, and drinking. Thus, there are three major routes of intake or application involved: the olfactory system, the skin, and the gastro-intestinal system. Understanding these routes is important for clarifying the mechanisms of action of essential oils. Here we summarize the three systems involved, and the effects of essential oils and their constituents at the cellular and systems level. Many factors affect the rate of uptake of each chemical constituent included in essential oils. It is important to determine how much of each constituent is included in an essential oil and to use single chemical compounds to precisely test their effects. Studies have shown synergistic influences of the constituents, which affect the mechanisms of action of the essential oil constituents. For the skin and digestive system, the chemical components of essential oils can directly activate gamma aminobutyric acid (GABA) receptors and transient receptor potential channels (TRP) channels, whereas in the olfactory system, chemical components activate olfactory receptors. Here, GABA receptors and TRP channels could play a role, mostly when the signals are transferred to the olfactory bulb and the brain.
Günümüzde demografik değişimlerin etkisiyle dünya genelinde yaşlı nüfus artmaktadır. Yaşın artmasıyla beraber yaşlı bireylerde artan kronik hastalıklar ve geriatrik sorunlar, yaşam kalitesini düşürmekte ve sağlık harcamalarını artırmaktadır. Kronik hastalıkların yanı sıra, geriatrik sorunların erken tespiti ve yönetimi önem arz etmektedir. Son yıllarda yaşlı bireylerin sağlık sorunlarının yönetiminde tamamlayıcı ve integratif tedavi yöntemleri daha çok tercih edilmektedir. Tamamlayıcı ve integratif tedavi uygulamaları arasında yer alan aromaterapi, esansiyel yağların kullanımıyla fiziksel ve psikolojik iyilik hali sağlamada etkili bir yöntemdir. Aromaterapi, ağrı, anksiyete, depresyon, uyku bozuklukları ve diğer geriatrik sorunların yönetiminde umut verici sonuçlar ortaya koymaktadır. Araştırmalar, aromaterapinin yaşlı bireylerin sağlık durumunu iyileştirmede olumlu etkiler sağladığını ve yaşam kalitesini artırdığını göstermektedir. Aromaterapinin kullanımının yaygınlaştırılması, yaşlı bireylerin sağlık sorunlarının yönetiminde farmakolojik olmayan yöntemlerin önemini vurgulamaktadır. Aromaterapinin etkili olabilmesi için uzman rehberliğinde ve kişiye özgü uygulanması önemlidir. Bu derlemede, aromaterapinin yaşlı bireylerdeki terapötik etkileri son yıllarda yapılan bilimsel araştırmalar incelenerek sunulmuştur.
Natural raw materials such as essential oils have received more and more attention in recent decades, whether in the food industry, as flavorings and preservatives, or as insecticides and insect repellents. They are, furthermore, very popular as fragrances in perfumes, cosmetics, and household products. In addition, aromatherapy is widely used to complement conventional medicine. This review summarizes investigations on the chemical composition and the most important biological impacts of essential oils and volatile compounds extracted from selected aromatic blossoms, including Lavandula angustifolia, Matricaria recutita, Rosa x damascena, Jasminum grandiflorum, Citrus x aurantium, Cananga odorata, and Michelia alba. The literature was collected from PubMed, Google Scholar, and Science Direct. Blossom essential oils discussed in this work are used in a wide variety of clinical issues. The application is consistently described as safe in studies and meta-analyses, although there are notes that using essential oils can also have side effects, especially dermatologically. However, it can be considered as confirmed that essential oils have positive influences on humans and can improve quality of life in patients with psychiatric disorders, critically ill patients, and patients in other exceptional situations. Although the positive effect of essential oils from blossoms has repeatedly been reported, evidence-based clinical investigations are still underrepresented, and the need for research is demanded.
Introduction Essential oil treatment has been explored as a potential alternative medicine, as these therapies can induce calming and sedative effects by acting on the neuro-limbic system and upregulating neurotransmitter synthesis. Objectives This paper aims to assess the impact of essential oil interventions on aggressive behavior in people with dementia. Methods The literature search was carried out through six databases. The outcomes of interest were the survival risk and post-treatment score of the Cohen-Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory (NPI), and Quality of Life (QoL). Quality appraisal was done using RoB 2.0, while meta-analysis was done using RevMan 5.4. This systematic review has been registered to the PROSPERO database (CRD42023476844). Results We analyzed 11 included studies with 1,418 patients. RoB 2.0 analysis resulted in eight low-risk-of-bias and three high-risk-of-bias studies. This study suggests that essential oil interventions lead to statistically significant improvements in survival risk with moderate heterogeneity [OR = 0.63 (95% CI: 0.41, 0.98, p = 0.04; I2 = 74%)]. This study also found a significant improvement in NPI scores following the use of essential oils [SMD = -2.97 (95% CI = -5.61, -0.32, p = 0.03; I2 = 98%)], but no statistically significant improvements were found in CMAI scores [SMD = 0.17 (95% CI = 0.37, 0.71, p = 0.53; I2 = 74%)]. The QoL assessment showed a trend favoring the control group after implementing essential oil treatments [SMD = 4.89 (95% CI = 1.51, 8.27, p = 0.005; I2 = 98%)]. Conclusions Essential oil is a potential approach in alleviating the agitated behavior of dementia patients considering its survival risk and some parameters, such as NPI, CMAI, and QoL score. However, more studies regarding essential oils on these parameters should be done, especially studies with specific main ingredients of the essential oil.
Agitation and passivity are two of the behavioural and psychological symptoms exhibited by many people with dementia especially in the later stages of the disease. These behaviours are often attributed to a lack of stimulation from their physical and social environments and can lead to a reduced quality of life. The use of non-pharmacological (NP) interventions such as art therapy, music therapy, aromatherapy and reminiscence therapy have proved successful in the mitigation of these symptoms. This chapter describes the development of AMuSED (Active Multi-Sensory Environment for people living with Dementia) as an innovative non-pharmacological intervention that builds upon NP best practice to provide engagement, stimulation, and social interaction to people living with dementia. AMuSED combines, in a tabletop toolkit, the use of cognitive, visual, aural, tactile and gustatory stimulation with a set of themed elements, activities, and reminiscence tools and in doing so crosses the boundaries between art and technology. It can be used in home, community, care home and hospital environments by individuals or groups to help people connect with their pasts and discuss their life lived experiences with their friends and family or those caring for them. AMuSED is affordable, portable, and adaptable to fit differing stages of dementia and can be personalised to an individual’s interests or themed to encourage discussion and engagement in social groups.
Alzheimer’s disease (AD) is a progressive, multifactorial, and unremitting neurodegenerative disease characterized by memory loss, personality changes, and cognitive impairment. It has become more prevalent in recent years. Therefore, understanding the pathophysiology of AD and developing efficient therapeutic strategies are essential. Moreover, the progression of the disease is unaffected by the pharmaceutical approaches discovered to date. Additionally, the failure of over 200 potential drug candidates in clinical trials over the past decade suggests the complexity and difficulty of both the disease and its underlying causes. Therefore, research focused on medicinal plant-based natural products in the search for novel neuroprotective therapeutic candidates for AD is essential. Indeed, several scientific investigations have demonstrated the efficacy of many medicinal plants and their principal phytochemicals in the treatment of AD. This review article covered the pathophysiological mechanisms of AD, the necessity for natural products as anti-AD treatments, and the most recent preclinical studies revealing the function of neuroprotective medicinal plants and their bioactive compounds in the effective management of AD. In addition, the review also presents clinical trial data of promising anti-AD formulations/agents of plant origin. Revealing recent findings and highlighting the clinical trial data related to the development of new treatments for AD would promote further research in this field and pave the way for the development of more effective and safe treatments for this debilitating disease.
Introduction
Aromatherapy and decoctions of lavender have been traditionally used for their anxiolytic harboring-soothing effects without proper evidence. This study aims to systematically identify and appraise systematic reviews on the anxiolytic effects of Lavandula angustifolia (lavender).
Methods
The study protocol was published in PROSPERO (CRD42021279573). ISI Web of Science, Scopus, PubMed, Embase, Cochrane Library, CINAHL, Google Scholar, and PROSPERO were searched up to August 2022 without any limitation for systematic reviews studying the anxiolytic effects of lavender in humans. The report from each study as whether or not lavender was anxiolytic was considered the primary outcome. The AMSTAR II was utilized for the quality assessment.
Results
Thirty systematic reviews met the inclusion criteria, fifteen of which conducted meta-analyses. All studies were published after 2010 and reported promising effects through different methods of lavender administration—namely: inhalation, massage, and oral routes—on anxiety relief. Oral doses of 80 mg and 160 mg were both effective, the higher dose being more efficient. The studies were conducted on various subjects, including preoperative patients, cardiovascular patients, hemodialysis patients, cancer patients, dental patients, and women in pre-labor. When assessed by AMSTAR II, four studies were of high quality, one had medium quality, and the rest were of low or critically low quality. No major adverse event was reported.
Conclusions
Lavender has shown promising potential for anxiety in various settings. Lavender was effective when inhaled, used as a massage oil, or taken orally. The oral route was the preferred long-term option and inhalation was recommended for the short term.
Essential oils are a mixture of natural aromatic volatile oils extracted from plants. The use of essential oils is ancient, and has prevailed in different cultures around the world, such as those of the Egyptians, Greeks, Persians, and Chinese. Today, essential oils are used in traditional and complimentary medicines, aromatherapy, massage therapies, cosmetics, perfumes and food industries. The screening effect of essential oils has been studied worldwide. They demonstrate a range of biological activities, such as antiparasitic, antifungal, antibacterial, antiviral, antioxidant, anti-inflammatory, anticancer, antiaging, and neuroprotective properties. In this scoping review, we provide a 10-year updated comprehensive assessment of volatile oils and their effects on the nervous system. MEDLINE, Scopus, and Google Scholar were systematically and strategically searched for original studies investigating these effects from 2012 to 2022. Approximately seventy studies were selected as included studies. Among these studies, several outcomes were reported, including antistress, antianxiety, analgesic, cognitive, and autonomic effects. Some essential oils showed developmental benefits, with the potential to induce neurite outgrowth. The neurotransmitter receptor level can also be modified by essential oil application. Physiological and pathophysiological outcome measures were reported. For physiological outcomes, arousal, cognitive performance, circadian eating behavior, emotional modulation, consumer acceptance, preferences, and willingness to buy were investigated. For pathophysiological conditions, pain, depression, anxiety, stress, sleep disorder, mental fatigue, agitated behavior, and quality of life were measured. In conclusion, essential oils showed promising effects on the nervous system, which can be further applied to their use in functional foods, drinks, and alternative therapy.
The present study discusses the relevance of terms “officinale“ and “officinalis“ as plant species names inRomanian flora. Among the species identified in Romanian flora that bear these names and suggestmedicinal properties, literature data confirm them for several species, while medicinal value of other herbalsremains unclear.
Dementia is an illness that not only affects the patients but also forces the caregivers and the near ones to undergo an enormous amount of mental stress and emotional exhaustion. The patient slowly loses his cognitive ability resulting in the impairment of the person’s potential to work independently. Till now, there is no official treatment to cure dementia completely hence the scientists have found an alternative treatment to give symptomatic relief from the disease. Drug-based treatments are there which show some promise. Phytoconstituents are also being explored (Ginkgo biloba) for potential treatment methods. The promise of these drugs remains limited as in most of the cases they cannot pass through the blood–brain barrier (BBB) and hence their potential cannot get converted to good therapeutic results. Conventional noninvasive techniques like scanning ultrasound, light exposure, electromagnetic stimulation, brain stimulation, magnetic stimulation, stimulation generated using an electric field gives temporary relief from the symptoms. Behavioural therapies are also suggested by some scientists to retain cognitive performance. In spite of all the efforts the solution to demetia is yet to be found. Current researches have gone to the molecular level to address the disease. Nanocarriers are now becoming a choice for the scientists given their small size that enables the swift passage through the BBB. This chapter will cover the various invasive and noninvasive approaches used conventionally and also the approaches which are under developmental stages, the rationale involved behind these approaches, their benefits, and their future prospects. The progress in the field of eradicating dementia is giving us new hopes and that day is not far away when we will have the cure for dementia bringing happiness to millions of patients and their families/caregivers.
Purpose of Review
Integrative medicine is the practice of combining conventional medical treatments with “alternative” or “complementary” therapies. Integrative psychiatry is a holistic, person-centered approach to neuropsychiatric disorders that emphasizes a person’s physical, emotional, interpersonal, behavioral, nutritional, environmental, and spiritual dimensions to achieve well-being. Older adults are more prone to physical injury, interpersonal loss, chronic illnesses, and physical and cognitive decline that can manifest as anxiety, depression, with functional decline and inability to care for self. Additionally, stress of caring for older adults with dementia can adversely affect caregivers’ health. Although integrative approaches are perceived as safer and less stigmatizing, it is important to understand the risks and benefits of such therapies for older adults with neurocognitive disorders and their caregivers.
Recent Findings
Here, we summarize the results of the recent clinical trials and meta-analyses that provide evidence for integrative approaches to treating older adults with cognitive disorders and their caregivers which include the use of diet and supplements, and mind–body therapies.
Summary
Dietary and mind-body therapies have become increasingly popular and show the strongest evidence of effectiveness for cognitive disorders and caregiver stress. Vitamins and supplements are the most popular integrative intervention, but there is mixed evidence supporting their use and the concern for herb (supplement)-drug interactions. While there is increasing popularity of integrative treatments, information to guide clinicians providing care for older adults remains limited, with variable scientific rigor of the available RCTs for a large number of commonly used integrative interventions particularly for cognitive disorders and caregiver stress and well-being.
This scoping review focused on the existing scholarly literature exploring sensory interventions and immersive environments developed for, and used by, older adults living with dementia. The purpose of the scoping review is 1) to understand the various sensory interventions that have been developed, used, and have provided data to show how such interventions are expected to impact the lives of individuals living with dementia; and 2) to understand how the field is moving forward. We chose to map the literature to understand the types of interventions, the types of outcomes measured, and the contexts of their implementation. Our search was constrained to references from 1990 to 1 June 2019 in the following databases: Academic Search Complete, CINAHL Complete, MEDLINE, PsycINFO databases, and Summon Search discovery layer. We screened 2305 articles based on their titles and abstracts, and 465 were sent to full text review, of which 170 were included in our full text extraction. Once the data were extracted, we created emic categories, which emerged from the data, for data that were amenable to categorization (e.g., study setting, intervention type, and outcome type). We developed ten different categories of interventions: art, aromatics, light, multi-component interventions, multisensory rooms, multisensory, music, nature, touch, and taste. Sensory interventions are a standard psychosocial approach to managing the personal expressions commonly experienced by people living with dementia. Our findings can help providers, caregivers, and researchers better design interventions for those living with dementia, to help them selectively choose interventions for particular outcomes and settings. Two areas emerging in the field are nature interventions (replacing traditional "multisensory rooms" with natural environments that are inherently multisensory and engaging) and multi-component interventions (where cognitive training programs are enhanced by adding sensory components).
The number of mental illnesses has been rising for years. The corona crisis has significantly exacerbated this development - especially among children and adolescents (21). A good sense of smell has a great influence on the ability to enjoy life and thus on the quality of life. We absorb 20% of our environment with our sense of smell and 15% of the population suffers from olfactory impairment (17). The sense of smell is directly connected to our emotional centre and can therefore be helpful in treating depression, stress symptoms or anxiety. Scents work in two ways: On the one hand, certain ingredients in essential oils have a relaxing and anxiolytic effect on a pharmacological level (e.g. monoterpenesters, monoterpenols), on the other hand, scents can evoke pleasant memories and thus create positive mood-lifting feelings (2, 3, 7, 11–14, 19, 22, 24, 25).
Lemon balm (Melissa officinalis) is a perennial herb in the mint family. In addition to its anxiolytic and gastro-intestinal effects, it has cognitive, anti-diabetic, and anti-thyroid effects and demonstrates antiviral efficacy against herpes simplex. It may be beneficial for bruxism, benign palpitations, dyslipidemia, diabetes, functional gastrointestinal disorders, premenstrual syndrome, dysmenorrhea, female sexual dysfunction, menopause, agitation of dementia, anxiety, insomnia, depression, attention-deficit/hyperactivity disorder, and HSV. This chapter examines some of the scientific research conducted on lemon balm, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several human studies of the herb’s use in treating oral and dental, cardiovascular, cardiometabolic, gastrointestinal, genitourinary, neurological, and psychiatric disorders, among others. Finally, the chapter presents a list of lemon balm’s active constituents, different Commonly Used Preparations and Dosage, and a section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
Zusammenfassung
Aus der Fülle der Veröffentlichungen der letzten ca. 30 Jahre zur klinischen Forschung mit Aromatherapie bzw. ätherischen Ölen werden ausgewählte Einzelstudien wie Reviews kurzreferiert. Es besteht nicht der Anspruch einer systematischen Erfassung und Beschreibung dieser Forschung, vielmehr soll die Breite der Indikationen, der verwendeten Pflanzen und der methodologischen Ansätze vermittelt werden. Der Schwerpunkt der untersuchten Indikationen liegt dabei bislang bei wahrnehmbaren bzw. psychischen Qualitäten wie Schmerzen, Schlafstörungen, Depressivität, Agitiertheit und neuerdings auch demenziellen Prozessen.
Aims and objectives:
To evaluate the effectiveness of aromatherapy on agitation and aggression in patients with cognitive impairment.
Background:
The impact of aromatherapy on agitation and aggression has been evaluated in various studies, but there is uncertainty about their impact.
Design:
A meta-analysis of randomised controlled trials was undertaken.
Methods:
This meta-analysis was conducted under PRISMA guidelines. Following eight electronic literature databases were searched: Web of Science, PubMed, PsycINFO, Embase, Cochrane Library, Chinese Wanfang database, CNKI and VIP digital database from the inception of the databases up to 27 February 2021. Two reviewers assessed the risk of bias of the included studies independently using the Cochrane Collaboration tool. Overall, meta-analysis and three subgroup analyses regarding the type of aroma preparations, delivery mode and session length were performed using RevMan5.3 and stata14.0. Publication bias was assessed by visual inspection of the funnel plot asymmetry and Egger's regression test.
Results:
Fifteen studies comprising 693 participants were included. The meta-analysis indicated that aromatherapy could ameliorate agitation and aggression for cognitive impairment. The subgroup analysis based on the type of aroma preparations showed that lavender oil could significantly improve agitation and aggression. Most delivery modes of aromatherapy, including smearing and inhalation, were effective. Moreover, less length (≤4 weeks) aromatherapy showed a better effect on agitation behaviour than aromatherapy more than 4 weeks.
Conclusions:
Despite the meta-analysis indicating that aromatherapy could alleviate agitation and aggression especially short-term (≤4 weeks) aromatherapy inhalation in different conditions, further researches are needed to investigate the appropriate dosage of essential oils and the side effects. More well-designed randomised controlled trials containing participants from more countries are needed to verify our findings before we can make strong recommendations.
Relevance to clinical practice:
This meta-analysis suggested that aromatherapy should be considered as a complementary programme for patients with cognitive impairment patients. Medical workers could apply aromatherapy into daily routine cares for cognitive impairment patients.
A number of complementary medicines have been investigated for their neuroprotection and treatment of neurodegenerative diseases. This study aimed to analyze the chemical compounds and the neuroprotective activity Piper sarmentosum Roxb. fruit essential oil. The essential oil from the fruits of P. sarmentosum (Piperaceae) was extracted by hydrodistillation. Chemical components of the oil were analyzed by Gas chromatography-Mass spectrometry (GC-MS). The effects of essential oil from P. sarmentosum fruit on P19-derived neuron cell viability, neuron length, and branching numbers were investigated. The results showed that the yield of essential oil obtained from P. sarmentosum fruit distillation was 1.47% w/w. The essential oil from P. sarmentosum fruit contained major compounds, namely; myristicin (88.9%), E-caryophyllene (3.7%), elemicin (1.4%), pentadecane (1.0%), apiole (1.0%), α-copaene (0.7%), and β-copaene (0.2%). The essential oil at 1 and 10 ng/mL significantly increased cell viability, elongated neuron length, and enhanced branching numbers. Therefore, it was suggested that the oil extracted from P. sarmentosum fruit may have promising neuroprotective and neuritogenic effects on neurons and prevent neurodegenerative diseases.
Stress and hemodynamic changes are among the most significant symptoms and signs that could be observed in patients with acute coronary syndrome (ACS) upon admission to the emergency department. The present study was conducted to determine the effect of the fragrance of lemon balm (Melissa Officinalis) essential oil on stress level and hemodynamic parameters in patients with ACS in the emergency department.
Methods
In this double-blind clinical trial, 72 patients were allocated to two groups of Melissa and placebo based on stratified block random sampling. The Melissa group inhaled two drops of Melissa essential oil, whereas the placebo group inhaled two drops of sunflower oil in two aromatherapy phases for 10 min with 90-min intervals. Stress level was measured using the depression, anxiety and stress scale (DASS-21), and hemodynamic parameters were measured and recorded in six time points by a cardiac monitoring system. Data analysis was carried out using descriptive statistics and ANOVA statistical tests, Chi-square test, independent t-test, and post-hoc Tukey's test.
Results
Interaction between the time and group indicated the significant decrease in the mean score of stress and heart rate in the time points 2 and 5 (5 min after every occasion of aromatherapy) (p < 0.001) and also the remarkable decrease in the mean arterial pressure (MAP) in the time point 2 in the Melissa group in comparison with the placebo group (p < 0.001). There were no significant differences between the mean changes in stress, heart rate and MAP in the two group (P > 0.05).
Conclusion
Aromatherapy via the inhalation of Melissa essential oil with temporary impacts on certain time points could relieve stress and regulate hemodynamic changes in patients with ACS in emergent and acute conditions.
Geriatric syndromes are symptoms and signs, such as falls, incontinence, delirium, pressure ulcers, dysphagia and so on, that often threaten the independence of older adults, rather than the disease itself. Although the syndromes are very common in older people, it is difficult to treat those by modern medicine due to their complexity. To mitigate the intractable geriatric symptoms, we review the efficacy of aromatherapy, especially for dysphagia, dyspnea, cognitive dysfunction and falls in geriatric syndrome. Olfactory stimulation using a volatile black pepper oil on institutional residents improved the swallowing reflex, which is a crucial risk factor of aspiration pneumonia. Brain imaging study showed that olfactory stimulation using volatile black pepper oil activated cerebral regions of the anterior cingulate and the insular cortex, which play a role in controlling appetite and swallowing. Also, aromatherapy with volatile l‐menthol decreased the sense of dyspnea and improved the efficacy of exercise therapy. The fragrance of the combination of rosemary and lemon oils in the morning, and the combination of lavender and orange oils in the night‐time were reported to improve cognition and behavioural and psychological symptoms of dementia, respectively. Also, the combination of lavender and lemon balm oils was reported to be effective for irritability‐related agitation in older adults. Furthermore, aromatherapy with lavender fragrance could improve both static and dynamic balance, resulting in a reduction in the number of fallers and the incidence rate in older people. Thus, aromatherapy is a promising remedy for geriatric syndrome. Geriatr Gerontol Int 2021; ••: ••–••.
Background:
Medications licensed for the treatment of dementia have limited efficacy against cognitive impairment or against the distressed behaviours (behavioural and psychological symptoms, or behaviour that challenges) which are also often the most distressing aspect of the disorder for caregivers. Complementary therapies, including aromatherapy, are attractive to patients, practitioners and families, because they are perceived as being unlikely to cause adverse effects. Therefore there is interest in whether aromatherapy might offer a safe means of alleviating distressed behaviours in dementia.
Objectives:
To assess the efficacy and safety of aromatherapy for people with dementia.
Search methods:
We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, on 5 May 2020 using the terms: aromatherapy, lemon, lavender, rose, aroma, alternative therapies, complementary therapies, essential oils. In addition, we searched MEDLINE, Embase, PsycINFO (all via Ovid SP), Web of Science Core Collection (via Thompson Web of Science), LILACS (via BIREME), CENTRAL (via the Cochrane Library), ClinicalTrials.gov and the World Health Organization (WHO) trials portal (ICTRP) on 5 May 2020.
Selection criteria:
We included randomised controlled trials which compared fragrance from plants in an intervention defined as aromatherapy for people with dementia with placebo aromatherapy or with treatment as usual. All doses, frequencies and fragrances of aromatherapy were considered. Participants in the included studies had a diagnosis of dementia of any subtype and severity.
Data collection and analysis:
Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias in included studies, involving other authors to reach consensus decisions where necessary. We did not perform any meta-analyses because of heterogeneity between studies, but presented a narrative synthesis of results from the included trials. Because of the heterogeneity of analysis methods and inadequate or absent reporting of data from some trials, we used statistical significance (P ≤ or > 0.5) as a summary metric when synthesising results across studies. As far as possible, we used GRADE methods to assess our confidence in the results of the trials, downgrading for risk of bias and imprecision.
Main results:
We included 13 studies with 708 participants. All participants had dementia and in the 12 trials which described the setting, all were resident in institutional care facilities. Nine trials recruited participants because they had significant agitation or other behavioural and psychological symptoms in dementia (BPSD) at baseline. The fragrances used were lavender (eight studies); lemon balm (four studies); lavender and lemon balm, lavender and orange, and cedar extracts (one study each). For six trials, assessment of risk of bias and extraction of results was hampered by poor reporting. Four of the other seven trials were at low risk of bias in all domains, but all were small (range 18 to 186 participants; median 66), reducing our confidence in the results. Our primary outcomes were agitation, overall behavioural and psychological symptoms, and adverse effects. Ten trials assessed agitation using various scales. Among the five trials for which our confidence in the results was moderate or low, four trials reported no significant effect on agitation and one trial reported a significant benefit of aromatherapy. The other five trials either reported no useable data or our confidence in the results was very low. Eight trials assessed overall BPSD using the Neuropsychiatric Inventory and we had moderate or low confidence in the results of five of them. Of these, four reported significant benefit from aromatherapy and one reported no significant effect. Adverse events were poorly reported or not reported at all in most trials. No more than two trials assessed each of our secondary outcomes of quality of life, mood, sleep, activities of daily living, caregiver burden. We did not find evidence of benefit on these outcomes. Three trials assessed cognition: one did not report any data and the other two trials reported no significant effect of aromatherapy on cognition. Our confidence in the results of these studies was low.
Authors' conclusions:
We have not found any convincing evidence that aromatherapy (or exposure to fragrant plant oils) is beneficial for people with dementia although there are many limitations to the data. Conduct or reporting problems in half of the included studies meant that they could not contribute to the conclusions. Results from the other studies were inconsistent. Harms were very poorly reported in the included studies. In order for clear conclusions to be drawn, better design and reporting and consistency of outcome measurement in future trials would be needed.
Essential oils (EO), produced from isoprenoid pathways are a blend of hydrocarbons and its oxygenated derivatives, which possess many biological properties. EO are conventionally used in medications, and also for sanitary, cosmetic, fragrance, essence, preservatives, and food additives. In pharmaceutical applications, they are used as antimicrobial (viricidal, fungicidal, bactericidal), antiseptic, anti-parasitical, insecticidal, pesticidal, and herbicidal agents. Owing to the complexity and stability (singly or combinations) exhibited by EO, they have crossed the conventional boundaries, and are now explored for their efficacy against neurological disorders. EO are reported to exhibit antioxidant, anti-inflammatory, neuroprotective, anxiolytic, anticonvulsant or antiepileptic, memory enhancing, anticholinesterase, cognitive and mood effects, antidepressant, neuropathic, antinociceptive, anti-psychosis, anti-Parkinson’s, antimigraine, anti-meningitis, anti-dementia, and anti-Alzheimer’s properties. This has favored the use of EO in the prevention and cure of neurological disorders. Moreover, the mode of action of EO for these arrays of biological properties is identified, and several unknowns are being investigated. With the advent of modern technologies and methodologies, EO from many aromatic and medicinal plants are now isolated, characterized, and explored against many neurological disorders, and some have succeeded to reach the phases of clinical trials. Furthermore, EO pose negligible side effects, and are permeable to blood–brain barrier. Efforts are in progress to further increase their stability, release, and potency against neurological disorders. Thus, in this chapter, an updated summary of EO explored against some common neurological disorders along with their possible mode of action has been presented.
Lavender essential oil shows evidence of sedative properties in neurophysiological and animal studies but clinical trials of its effectiveness as a treatment of agitation in people with dementia have shown mixed results. Study methods have varied widely, however, making comparisons hazardous. To help remedy previous methodological shortcomings, we delivered high grade lavender oil in specified amounts to nursing home residents whose agitated behaviours were recorded objectively.
64 nursing home residents with frequent physically agitated behaviours were entered into a randomized, single-blind cross-over trial of dermally-applied, neurophysiologically active, high purity 30% lavender oil versus an inactive control oil. A blinded observer counted the presence or absence of target behaviours and rated participants' predominant affect during each minute for 30 minutes prior to exposure and for 60 minutes afterwards.
Lavender oil did not prove superior to the control oil in reducing the frequency of physically agitated behaviours or in improving participants' affect.
Studies of essential oils are constrained by their variable formulations and uncertain pharmacokinetics and so optimal dosing and delivery regimens remain speculative. Notwithstanding this, topically delivered, high strength, pure lavender oil had no discernible effect on affect and behaviour in a well-defined clinical sample.Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN 12609000569202).
Aromatherapy and hand massage therapies have been reported to have some benefit for people with dementia who display behavioural symptoms; however there are a number of limitations of reported studies. The aim is to investigate the effect of aromatherapy (3% lavender oil spray) with and without hand massage on disruptive behaviour in people with dementia living in long-term care.
In a single blinded randomised controlled trial 67 people with a diagnosis of dementia and a history of disruptive behaviour, from three long-term care facilities were recruited and randomised using a random number table into three groups: (1) Combination (aromatherapy and hand massage) (n = 22 , (2) Aromatherapy (n = 23), (3) Placebo control (water spray) (n = 22). The intervention was given twice daily for six weeks. Data on residents' behaviour (CMAI) and cognition (MMSE) were collected before, during and after the intervention.
Despite a downward trend in behaviours displayed not one of the interventions significantly reduced disruptive behaviour.
Further large-scale placebo controlled studies are required where antipsychotic medication is controlled and a comparison of the methods of application of aromatherapy are investigated.Trial registration: ACTRN12612000917831.
The purpose of this study was to systematically review the literature regarding the effectiveness of nonpharmacological interventions for agitation in older adults with dementia.
Seven electronic databases (to 2004) were searched, and randomized clinical trials employing nonpharmacologic interventions for agitation in dementia published in English or Korean were selected. In addition, the reference lists from relevant review articles and all eligible studies were searched to identify other trials. Interventions were categorized into seven types: sensory intervention, social contact, activities, environmental modification, caregiver training, combination therapy, and behavioral therapy. Studies were abstracted, and data were pooled by intervention category.
Fourteen studies (n = 586) were included. Sensory interventions were statistically significantly effective in reducing agitation (standardized mean difference: SMD -1.07; 95% confidence interval (CI) -1.76 to -0.38, p = 0.002), while social contact (SMD -0.19; CI -0.71 to 0.33), activities (SMD -0.20; CI -0.71 to 0.31), environmental modification (weighted mean difference: WMD 1.90; CI -2.82 to 6.62), caregiver training (SMD 0.21; CI -0.15 to 0.57), combination therapy (WMD 1.85; CI -1.78 to 5.48), and behavioral therapy interventions (SMD -0.27; CI -0.72 to 0.19) were not significantly effective in reducing agitation. These results were consistent among higher quality studies.
This systematic review indicated that among the seven types of nonpharmacological interventions available for agitation in older adults with dementia, only sensory interventions had efficacy in reducing agitation. More trials are needed to confirm this finding and future research should use more rigorous methods.
Both Melissa officinalis (Mo) and Lavandula angustifolia (La) essential oils have putative anti-agitation properties in humans, indicating common components with a depressant action in the central nervous system. A dual radioligand binding and electrophysiological study, focusing on a range of ligand-gated ion channels, was performed with a chemically validated essential oil derived from La, which has shown clinical benefit in treating agitation. La inhibited [35S] TBPS binding to the rat forebrain gamma aminobutyric acid (GABA)(A) receptor channel (apparent IC50 = 0.040 +/- 0.001 mg mL(-1)), but had no effect on N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) or nicotinic acetylcholine receptors. A 50:50 mixture of Mo and La essential oils inhibited [3H] flunitrazepam binding, whereas the individual oils had no significant effect. Electrophysiological analyses with rat cortical primary cultures demonstrated that La reversibly inhibited GABA-induced currents in a concentration-dependent manner (0.01-1 mg mL(-1)), whereas no inhibition of NMDA- or AMPA-induced currents was noted. La elicited a significant dose-dependent reduction in both inhibitory and excitatory transmission, with a net depressant effect on neurotransmission (in contrast to the classic GABA(A) antagonist picrotoxin which evoked profound epileptiform burst firing in these cells). These properties are similar to those recently reported for Mo. The anti-agitation effects in patients and the depressant effects of La we report in neural membranes in-vitro are unlikely to reflect a sedative interaction with any of the ionotropic receptors examined here. These data suggest that components common to the two oils are worthy of focus to identify the actives underlying the neuronal depressant and anti-agitation activities reported.
Linalool is a monoterpene compound reported to be a major component of essential oils in various aromatic species. Several Linalool-producing species are used in traditional medical systems, including Aeolanthus suaveolens G. Dom (Labiatae) used as anticonvulsant in the Brazilian Amazon. Psychopharmacological in vivo evaluation of Linalool showed that this compound have dose-dependent marked sedative effects at the Central Nervous System, including hypnotic, anticonvulsant and hypothermic properties. The present study reports an inhibitory effect of Linalool on Glutamate binding in rat cortex. It is suggested that this neurochemical effect might be underlining Linalool psychopharmacological effects. These findings provide a rational basis for many of the traditional medical use of Linalool producing plant species.
The effect of orally administrated gamma-aminobutyric acid (GABA) on relaxation and immunity during stress has been investigated in humans. Two studies were conducted. The first evaluated the effect of GABA intake by 13 subjects on their brain waves. Electroencephalograms (EEG) were obtained after 3 tests on each volunteer as follows: intake only water, GABA, or L-theanine. After 60 minutes of administration, GABA significantly increases alpha waves and decreases beta waves compared to water or L-theanine. These findings denote that GABA not only induces relaxation but also reduces anxiety. The second study was conducted to see the role of relaxant and anxiolytic effects of GABA intake on immunity in stressed volunteers. Eight acrophobic subjects were divided into 2 groups (placebo and GABA). All subjects were crossing a suspended bridge as a stressful stimulus. Immunoglobulin A (IgA) levels in their saliva were monitored during bridge crossing. Placebo group showed marked decrease of their IgA levels, while GABA group showed significantly higher levels. In conclusion, GABA could work effectively as a natural relaxant and its effects could be seen within 1 hour of its administration to induce relaxation and diminish anxiety. Moreover, GABA administration could enhance immunity under stress conditions.
Nearly 9 out of 10 patients with dementia also suffer from behavioral symptoms. Several nonpharmaceutical interventions hold promise.
Older people diagnosed with dementia can have complex needs, especially when they exhibit agitated behaviour. Patients with agitated behaviour challenge the delivery of health care. Often the behaviour is a symptom of unmet needs in this population (Dewing 2010). It is important for nurses to understand the underlying causes and apply evidence-based interventions in their nursing practice to promote health, safety and the highest quality of life possible. This article defines and classifies agitated behaviours, discusses implications for their management and then presents evidence-based interventions nurses can use. The interventions are categorised according to each of the five senses.
The reliability and validity of the Cohen–Mansfield Agitation Inventory (CMAI) were studied in residents of a long-term care facility. The CMAI demonstrated high internal consistency, but only marginally adequate interrater reliability. Correlations with the Behavioral Syndromes Scale for Dementia (BSSD) and the Behavioral Pathology in Alzheimer's Disease (Behave—AD) provide support for the contention that the CMAI is valid measure of agitation with nursing home residents.
To investigate the effects of lavender olfactory stimulation intervention on fall incidence in elderly nursing home residents.
Randomized placebo-controlled trial.
Three randomly selected nursing homes in northern Japan.
One hundred and forty-five nursing home residents aged 65 and older.
Participants were randomly assigned to the lavender (n = 73) or placebo group (n = 72) for a 360-day study period. The lavender group received continuous olfactory stimulation from a lavender patch. The placebo group received an unscented patch.
The primary outcome measure was resident falls. Other measurements taken at baseline and 12 months included functional ability (assessed using the Barthel Index), cognitive function (Mini-Mental State Examination (MMSE)), and behavioral and psychological problems associated with dementia (Cohen-Mansfield Agitation Inventory (CMAI)).
There were fewer fallers in the lavender group (n = 26) than in the placebo group (n = 36) (hazard ratio (HR)=0.57, 95% confidence interval (CI) = 0.34-0.95) and a lower incidence rate in the lavender group (1.04 per person-year) than in the placebo group (1.40 per person-year) (incidence rate ratio = 0.51, 95% CI = 0.30-0.88). The lavender group also had a significant decrease in CMAI score (P = .04) from baseline to follow-up in a per protocol analysis.
Lavender olfactory stimulation may reduce falls and agitation in elderly nursing home residents; further research is necessary to confirm these findings.
The aim of this study is to analyze modifiable factors related to agitation of nursing home residents with dementia.
Relationship of agitation with three modifiable factors (depression, psychosis, and pain) was explored using longitudinal Minimum Data Set (MDS) information from 2032 residents of Dutch nursing homes. Presence of agitation and depression was ascertained using validated scales based on MDS information. Presence of psychosis and pain was ascertained from the individual MDS items.
There was a significant correlation between MDS depression and agitation scores. Depression scores increased in residents whose agitation worsened and decreased in residents whose agitation improved. Psychosis scores (combination of delusions and hallucinations) also correlated with MDS depression scores, and psychosis scores increased in residents whose agitation worsened. Pain scores correlated with agitation scores, but the pain scores did not change with changes in agitation. Depression symptoms were present in 51% of residents, while psychotic symptoms were present only in 15% of residents, and two-thirds of these residents were also depressed.
These results indicate that depression may be the most common factor associated with agitation in nursing home residents with dementia.
Agitation in individuals with dementia living in the nursing home environment affects care and quality of life. Relaxation techniques such as music and massage are showing promise to decrease agitation and improve quality of life in individuals with dementia. Using an experimental 3 × 3 repeated measures design, 41 residents with mild to moderate dementia participated in a study to test the effectiveness of favorite music (FM) and hand massage (HM) in reducing agitated behaviors. Agitated residents were randomly assigned to either the treatment or control groups. Residents in the treatment group received each of three treatments, HM, FM, and HMFM, with each treatment lasting 10 minutes. Residents in the control group received no treatment. Agitation was measured using the Cohen-Mansfield Agitation Inventory (CMAI) at three different intervals. The results suggest that FM and HM individually and combined are effective in significantly decreasing agitation immediately following the intervention and also one hour post intervention. © 2008 Sage Publications.
Behavioural and psychological symptoms (BPSD) are frequent in people with Alzheimer's disease and cause considerable stress to patients and their carers. Antipsychotics have been widely used as a first-line treatment, resulting in an estimated 1,800 excess strokes and 1,600 excess deaths in the UK alone. Safe and effective alternatives are urgently needed. Based upon preliminary evidence from clinical trials, aromatherapy with melissa oil may be such an alternative, but initial studies have been modest in size, and adequate blinding has been problematic. Our objective was to assess the efficacy of melissa aromatherapy in the treatment of agitation in people with Alzheimer's disease in an adequately powered and robustly blinded randomized controlled trial comparing it with donepezil, an anticholinesterase drug used with some benefit to treat BPSD.
The study was a double-blind parallel-group placebo-controlled randomized trial across 3 specialist old age psychiatry centres in England. Participants had probable or possible Alzheimer's disease, were resident in a care home, had clinically significant agitation (defined as a score of 39 or above on the Cohen Mansfield Agitation Inventory) and were free of antipsychotics and/or anticholinesterase for at least 2 weeks. Participants were allocated to 1 of 3 groups: placebo medication and active aromatherapy; active medication and placebo aromatherapy or placebo of both.
The primary outcome measure was reduction in agitation as assessed by the Pittsburgh Agitation Scale (PAS) at 4 weeks. This is an observational scale, and raters were required to wear nose clips to ensure that full blinding was maintained. The PAS, Neuropsychiatric Inventory (NPI; another measure of BPSD) and other outcome measures were completed at baseline, 4-week and 12-week follow-ups. 114 participants were randomized, of whom 94 completed the week 4 assessment and 81 completed the week 12 assessment. Aromatherapy and donepezil were well tolerated. There were no significant differences between aromatherapy, donepezil and placebo at week 4 and week 12, but importantly there were substantial improvements in all 3 groups with an 18% improvement in the PAS and a 37% improvement in the NPI over 12 weeks.
When assessed using a rigorous design which ensures blinding of treatment arms, there is no evidence that melissa aromatherapy is superior to placebo or donepezil, in the treatment of agitation in people with Alzheimer's disease. However, the sizeable improvement in the placebo group emphasizes the potential non-specific benefits of touch and interaction in the treatment of agitation in people with Alzheimer's disease.
Agitation is a significant problem for elderly persons, their families, and their caregivers. This study describes the agitated behaviors of 408 nursing home residents. Nurses who were familiar with the residents used a 7-point scale to rate how often each resident manifested 29 agitated behaviors. Each resident was rated independently by three nurses, one from each of the three nursing shifts. Results showed that agitated behaviors occurred most often during the day shift (i.e., when residents were most active), and least often during the night shift. The most frequently exhibited agitated behaviors were general restlessness, pacing, repetitious sentences, requests for attention, complaining, negativism, and cursing. Most agitated behaviors correlated significantly across shifts, suggesting that such behaviors occur and reoccur throughout the 24-hour day. Factor analysis yielded three syndromes of agitation: aggressive behavior, physically nonaggressive behavior, and verbally agitated behavior. These results provide a foundation for further studies of agitation in elderly persons.
A 32-bed Behavior Management Unit was opened in a long-term care facility to care for dementia patients who exhibit aggressive, agitated, or disruptive (AAD) behaviors. The purpose of the study was to evaluate the effectiveness of the Behavior Management Program (BMP) in decreasing such behaviors. The sample consisted of all patients (N = 32) who resided in the unit for at least 3 months. The Nursing Home Behavior Problem Scale (NHBPS) was used to collect data.
Hypothesis 1, predicting participation in the BMP would decrease the total number of AAD behaviors was supported, with a significant decrease from the baseline to 6month measurements. Hypothesis 2, predicting participation in the BMP would decrease the frequency of occurrence of specific AAD behaviors was supported, with 7 behaviors being significantly reduced by 6 months.
Nurses in long-term care often treat patients with AAD behavior. Because staff members on general long-term care units and even in dementia units may not be experts in caring for patients with AAD behaviors, the implications of this study might be helpful. The interventions that were effective in reducing AAD behaviors included verbal distraction, time-outs, activity diversion, getting to know the patient well, and managing the environment.
Essential oils distilled from members of the genus Lavandula have been used both cosmetically and therapeutically for centuries with the most commonly used species being L. angustifolia, L. latifolia, L. stoechas and L. x intermedia. Although there is considerable anecdotal information about the biological activity of these oils much of this has not been substantiated by scientific or clinical evidence. Among the claims made for lavender oil are that is it antibacterial, antifungal, carminative (smooth muscle relaxing), sedative, antidepressive and effective for burns and insect bites. In this review we detail the current state of knowledge about the effect of lavender oils on psychological and physiological parameters and its use as an antimicrobial agent. Although the data are still inconclusive and often controversial, there does seem to be both scientific and clinical data that support the traditional uses of lavender. However, methodological and oil identification problems have severely hampered the evaluation of the therapeutic significance of much of the research on Lavandula spp. These issues need to be resolved before we have a true picture of the biological activities of lavender essential oil.
Behavioral and psychological symptoms in dementia are frequent and are a major management problem, especially for patients with severe cognitive impairment. Preliminary reports have indicated positive effects of aromatherapy using select essential oils, but there are no adequately powered placebo-controlled trials. We conducted a placebo-controlled trial to determine the value of aromatherapy with essential oil of Melissa officinalis (lemon balm) for agitation in people with severe dementia.
Seventy-two people residing in National Health Service (U.K.) care facilities who had clinically significant agitation in the context of severe dementia were randomly assigned to aromatherapy with Melissa essential oil (N = 36) or placebo (sunflower oil) (N = 36). The active treatment or placebo oil was combined with a base lotion and applied to patients' faces and arms twice a day by caregiving staff. Changes in clinically significant agitation (Cohen-Mansfield Agitation Inventory [CMAI]) and quality of life indices (percentage of time spent socially withdrawn and percentage of time engaged in constructive activities, measured with Dementia Care Mapping) were compared between the 2 groups over a 4-week period of treatment.
Seventy-one patients completed the trial. No significant side effects were observed. Sixty percent (21/35) of the active treatment group and 14% (5/36) of the placebo-treated group experienced a 30% reduction of CMAI score, with an overall improvement in agitation (mean reduction in CMAI score) of 35% in patients receiving Melissa balm essential oil and 11% in those treated with placebo (Mann-Whitney U test; Z = 4.1, p < .0001). Quality of life indices also improved significantly more in people receiving essential balm oil (Mann-Whitney U test; percentage of time spent socially withdrawn: Z = 2.6, p = .005; percentage of time engaged in constructive activities: Z = 3.5, p = .001).
The finding that aromatherapy with essential balm oil is a safe and effective treatment for clinically significant agitation in people with severe dementia, with additional benefits for key quality of life parameters, indicates the need for further controlled trials.
In this study the antinociceptive and the gastroprotective effects of orally administered or inhaled Lavandula hybrida Reverchon "Grosso" essential oil, and its principal constituents linalool and linalyl acetate were evaluated in rodents. Either when orally administered (100 mg/kg) or inhaled for 60 min lavender essential oil significantly reduced the acetic acid-writhing response in a naloxone-sensitive manner. In the hot plate test, analgesic activity observed after oil inhalation was inhibited by naloxone, atropine, mecamylamine pretreatment suggesting the involvement of opioidergic as well as cholinergic pathways. Regardless of the administration route and the experimental model used both linalool and linalyl acetate did not produce significant analgesic response. Oral or inhalatory treatment with analgesic doses of essential oil did not affect mice spontaneous locomotor activity. Concerning the gastric effects, lavender oil, linalool and linalyl acetate oral administration protected against acute ethanol-induced gastric ulcers but did not prevent indomethacin-induced lesions indicating no interference with arachidonic acid metabolic cascade. In conclusion, besides this gastroprotection, lavender oil reveals an interesting analgesic activity mainly relevant after inhalation, at doses devoid of sedative side effect, suggesting the interest for potential application of this oil in aromatherapy.
Agitated behaviours among persons with dementia are distressing to both patients and their caregivers. As pharmacological interventions may be limited by their potentially adverse effects, the use of complementary therapies for treatment of agitation has become more popular and aromatherapy is the fastest growing one.
This study investigates the effectiveness of lavandula angustifolia (lavender) in treating agitated behaviours of demented people in Hong Kong.
It was a cross-over randomized trial. Seventy Chinese older adults with dementia were recruited; half were randomly assigned to the active group (lavender inhalation) for three weeks and then switched to control group (sunflower inhalation) for another three weeks; the other half did the opposite. Clinical response was evaluated using the Chinese versions of Cohen-Mansfield Agitation Inventory (CCMAI) and Neuropsychiatric Inventory (CNPI).
The mean CCMAI total scores decreased from 24.68 to 17.77(t=10.79, df=69, p<0.001). The CNPI scores changed from 63.17 (SD=17.81) to 58.77 (SD=16.74) (t=14.59, df=69, p<0.001) after receiving Treatment A (Lavandula Angustifolia). There were no period and sequential effects noted.
In summary, lavender is effective as an adjunctive therapy in alleviating agitated behaviours in Chinese patients with dementia. In a patient population particularly vulnerable to side effects of psychotropic medications, aromatherapy using lavender may offer an alternative option.
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