Lavender aroma therapy for behavioral and psychological symptoms in dementia patients

Behavioral and psychological symptoms of dementia (BPSD) are a significant burden to caregivers and the major reason for early institutionalization of patients with Alzheimer’s disease. Moreover, it consistently relates to poor performance of activities of daily living (ADL). Antipsychotics have been used in these cases but these drugs often induce other adverse events such as extrapyramidal symptoms, falls and aspiration pneumonia. Recently, Iwasaki et al. reported that a Chinese herbal medicine, Yi-Gan San, improves BPSD and ADL without the adverse side-effects usually observed with antipsychotics. Hatakeyama et al. observed that azelastine hydrochloride, an anti-allergic medicine for bronchial asthma, allergic rhinitis and atopic dermatitis, significantly improved BPSD without significantly influencing cognitive function and other side-effects. If there were other medicines such as Yi-Gan San and azelastine to treat incurable diseases such as BPSD, AD patients could be more easily cared for and it would be beneficial for both patients and caregivers. Lavender (Lavedula angustifolia) has been used in aromatherapy as a relaxant. It has a wide range of clinical applications and has been shown to be effective for use in depression and anxiety in cancer patients. Recently, the benefit of lavender for the treatment of agitation in patients with dementia has been reported. However, the effectiveness of lavender is controversial. A combination of aromatherapy and massage was effective for agitation of dementia but not only aromatherapy. Even a combination of aromatherapy and massage showed modest benefit for the agitation of dementia. Because the above reports were observed in Western countries and the search for tools against BPSD were so needed, we restudied the effect of lavender aromatherapy for BPSD. We randomly assigned patients with BPSD into two groups. One was treated with lavender aroma therapy and another group was not, to assess the efficacy and safety of lavender aroma therapy in the treatment of BPSD. All subjects were recruited from the long-term care Sendai Tomizawa Hospital, Sendai, Japan. The diagnosis of dementia was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The physical condition of all patients had been stable for the past 3 months. At baseline, each patient received a uniform evaluation, including a medical history, physical and neurological examination, and brain computed tomography (CT) scan, as well as Mini-Mental State Examination (MMSE) to assess cognitive function and the Barthel Index for ADL (higher scores indicate better performance). BPSD was assessed and evaluated using the Neuropsychiatric Inventory (NPI; lower scores indicate better performance). Patients with dementia of either Alzheimer’s disease or vascular dementia or a combination of both were involved. MMSE scores were less than 20 and concomitant BPSD with a NPI scores were more than 6 on delusion, hallucination, violent behavior, or apathy subscales. We excluded patients if they had a major medical illness such as neoplastic disease, acute inflammation, or any other disease that would be likely to prevent completion of this study. Twenty eight patients with moderate to severe dementia (nine men and 19 women; mean 1 standard deviation [SD], 78 1 10 years; mean 1 SD, MMSE 9 1 8) were investigated. Written informed consent was obtained from participants or their families following a detailed explanation of the study. Tiapride hydrochloride (25 mg), a dopamine D1 selective classical neuroleptic, was used as necessity. Patients were randomly assigned lavender aroma therapy three times a day approximately 1 h after meals (n = 14) or no active treatment (n = 14) and were observed for 4 weeks (Table 1). Two drops of lavender oil odorant (Farm Tomita, Hokkaido, Japan) was given to sink into the collar of the hospital underwear of the patients. Care staffs could smell lavender odor around the beside of the patients for Geriatr Gerontol Int 2008; 8: 136–138