British researchers are making that argument in an editorial in tomorrow's British Medical Journal, but experts this side of the Atlantic are skeptical.
"I think the likelihood that this is going to revolutionize the care and treatment of Alzheimer's is very small," says William Thies, vice president for medical and scientific affairs at the Alzheimer's Association. But he adds, "It's good that people are talking about these kinds of issues. Enriching these kinds of environments is a good idea, especially if you can do it in a way that not only improves people's quality of life but is cost-effective."
Older people with dementia, such as that associated with Alzheimer's disease, often have psychiatric and behavioral problems, including agitation, delusions, wandering, hallucinations, and depression. These issues make caring for the person extremely difficult, often prompting caregivers to confine the patient in an institutional setting.
According to the journal authors, neuroleptic drugs (antipsychotics) and sedatives are often prescribed to deal with these symptoms, but they don't always work and come with side effects. And only two alternative therapies -- aromatherapy and bright light therapy -- appear to have any promise, the article says.
Aromatherapy is the use of essential oils (either extracts or essences) from flowers, herbs, and trees to treat mental and physical disorders. The editorial cites three trials in the last year that found it had significant benefits on agitation with almost complete compliance and virtually no side effects.
The two main agents in the studies were lemon balm and lavender oil, delivered either by smelling or absorbed via the skin. Although the researchers were not sure why the agents worked, they speculate that it was probably a direct chemical.
Dr. Alan Hirsch, neurological director of the Smell and Taste Treatment and Research Foundation in Chicago, has "mixed feelings" about the efficacy of such treatments.
"People with degenerative brain diseases have impaired olfactory ability," he says. "Also, the sense of smell drops down in older people. Half of people over age 65 and three-quarters of those over 80 have a reduced ability to smell."
The British Medical Journal article also found three controlled studies finding bright light therapy to be effective, this time on sleep disturbance. This type of therapy, which involves training a special light on the patient, is typically used for people with seasonal affective disorder (SAD).
The studies cited in the article all appear to have been conducted in Europe, and it's not clear how much research is ongoing in North America. "I hadn't heard of these particular studies," says Dr. Ellen Drexler, associate attending neurologist at Maimonides Medical Center in Brooklyn, N.Y. "I'm not that surprised that people are trying, but you're not going to find it too much in mainstream academic centers."
The studies cited also were not particularly large and, as Thies points out, many people with Alzheimer's and other dementias are often surviving in a fairly unstimulating environment. "It doesn't take much to show some improvement," he says.
That said, it's important to be researching such questions. "There are environments that are better, and I think the real problem is we don't know what all of those are and -- even more importantly -- we don't know the relative value of one intervention over another," Thies says.
What To Do
For more on different alternative therapies, visit the National Center for Complementary and Alternative Medicine. For more on Alzheimer's, visit the Alzheimer's Association.