Keeping your mind and body active
After diagnosis - What next?
"I go to a day care centre twice a week. They organise activities and exercise sessions. There’s no pressure as they’re really easy going. Sometimes I join in and sometimes I just watch. Either way, it’s very stimulating." (Nigel)
"I am a bit sceptical about complementary therapies but last week I answered an advert for an aroma-therapist for my mother who has dementia. My mother loved the whole experience – not just the oils but also the contact with the therapist. She slept much better afterwards and has already asked when the lady will be coming again." (Penelope)
As already mentioned in the first section of this manual, there are a few drugs available on prescription which may have a beneficial effect on the person with dementia, particularly in the early to mid stages of the disease. The following information is about non-medical treatments and therapies which may lead to an improvement in the quality of life and/or level of functioning of the person with dementia and in some cases of the carer. However, the emphasis in this section is on the possible benefits to people with dementia.
The main benefits include relaxation, calmness, less agitation, less anxiety, relief of depression  , improved alertness and less restlessness. Certain techniques or approaches are likely to be more suited to some people than others. For example, one person may appreciate touch whereas another may feel uneasy about this. Some people prefer a group approach whereas others like something more personal or private. Many of these techniques contribute towards increasing self awareness.
Whatever a person decides to try, it is important not to pin all one’s hopes on one approach. There is no single approach that is “the right one” for all people with dementia. On the other hand, so long as something is experienced as positive, it is worthwhile continuing. Some caution is needed, however, when deciding on an approach. Everything that is natural is not necessarily harmless. A person may find that they are allergic to certain substances and a natural preparation may contain toxins. People should therefore be a little bit cautious and talk to their doctor about any concerns they may have.
Some people find that the relationship that develops between the therapist and themselves contributes greatly to their sense of well-being. Nevertheless, it would be advisable to check whether the therapist or person offering the service is qualified or has been sufficiently trained.
Below you will find a brief explanation of some of the non-medical approaches. This is just a small sample of the numerous approaches available. The list is therefore not exhaustive.
Based on movement, self-expression and the arts
There is a wide range of therapeutic activities based on different forms of exercise and self expression, e.g. dance, drama, keep-fit, music, singing, tai chi chuan and art. Such activities may be therapeutic in the broadest sense of the word but do not necessarily offer the possibility of long-term change or benefit. Drama therapy, for example, may through the use of metaphor and imagery provide the means and a safe distance to communicate painful experiences such as loss, fear and anxiety. Art work may provide a lasting tool which can be a helpful reminder of personal issues being dealt with.
Music may evoke memories and enhance wellbeing. Some people may find the rhythm stimulating or the melody relaxing but care must be taken as an inappropriate choice may cause agitation in some people. The volume should also be carefully controlled. Some people with hearing difficulties may need quite loud music even though generally speaking, loud music and loud noises can make people with dementia agitated.
Another interesting approach involves breaking activities down into manageable stages, using real life materials that are pleasant to work with, arranging them in a sequence and practising one component at a time. This approach can be adapted to everyday activities such as polishing silverware, baking bread or putting together fishing bait.
Based on communication and understanding
Counselling is useful particularly in the early stages of dementia when a person has sufficient mental capacity, insight and self-awareness to be able to deal with personal issues. It can also be helpful just after diagnosis. Sessions are generally available on a group or individual basis depending on each person’s particular needs. Sometimes the emphasis is on coping and adjusting to changes; sometimes it is on sharing feelings about the experience of having dementia (or being a carer). With individual therapy or counselling, there can be a greater concentration on the client’s own personal issues and problems.
Reminiscence therapy is an approach which concentrates on people’s long-term memory which in the case of Alzheimer’s disease and some other forms of dementia generally remains more intact than their memory of recent events. It involves the recall by various means of events in a person’s life and can be carried out with conversation or silently, alone or in the company of other people. It can help to use prompts provided that they are relevant to the age of the person with dementia. Positive effects such as improved humour and increased alertness, responsiveness and interaction have been observed in people taking part in reminiscence therapy.
Reality Orientation (RO) involves providing the person with dementia with information (e.g. linked to time and place, the identification of objects or person-related) in order to help them to understand better their surroundings. For example, someone could remind the person with dementia of where they are, what day it is or what they usually do in a particular situation. This may result in an improved sense of control and self-esteem. However, when doing this, it is important to be sensitive to the needs and mood of the person with dementia, to avoid insisting unnecessarily and to avoid conflict.
Cognitive training (exercises aimed at enhancing memory, attention, concentration, thinking and reasoning etc.) may help people with dementia to retain their cognitive abilities i.e. their ability to think, reason and remember. It could be particularly useful in the early stages but for some people, it could lead to frustration. It should therefore be carried out carefully and by a trained therapist.
Other useful activities can be carried out with family and friends e.g. playing cards, memory games, quizzes for long-term memory etc. Of course, such activities should be enjoyable and not too demanding. They should not seem like part of a training course.
Based on touch and smell
Massage may be effective in producing relaxation, improving circulation and reducing pain. People differ as to the amount of touch they appreciate. Some might like a back or shoulders massage whereas others might be more comfortable with a massage of the hands, arms or feet. It is important to respect each person’s limits.
Using essential oils which are reputed to have therapeutic properties is a key element of aromatherapy. The oils may be massaged in, put in baths or sprinkled on tissues. It is believed that they are particularly useful for reducing stress and stimulating the mind. Usually a full assessment is made of the person’s mood, medical history, physical state and current medication before choosing the essential oil to be used.
For the person with dementia
- Try to be open-minded and give things a try.
- On the other hand, don’t be pushed into doing something that you don’t want to do.
- Concentrate on any positive effects that the therapy/approach brings.
- Avoid being competitive e.g. comparing your progress/skills to others.
- Cancel your appointment if you don’t feel up to it on any particular day.
For the carer
- Find out more about any complementary therapies which you think might interest the person with dementia.
- Check the therapist’s training, experience and qualifications.
- Be on the lookout for negative side effects of which the person with dementia may be unaware.
- Consider trying something yourself. In the early stages of dementia, it might be possible to do something together with the person with dementia.
 Certain therapies, which are not based on medication, may help relieve depression. However, people with dementia and carers who suspect that they may have depression should consult their doctor in order to obtain a proper diagnosis. In some cases, it may be necessary to combine medication with other forms of therapy. Depression is quite common in people with dementia, both men and women, and often goes undiagnosed. Please see section on depression on page 29.
Last Updated: vendredi 11 septembre 2009