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NON PHARMACOLOGICAL TREATMENTS OF DEMENTIA

Jeremy Thong
Advanced Writing in the Health Professions Section 9
Christen Enos
11/19/14
Public Document Cover Note

Historically medications such as antipsychotics have been used to treat uncooperative and even
aggressive behaviors that are associated with patients who suffer from dementia. Clinical research has
determined that these medications can have harmful side effects, are often not therapeutic and
frequently over prescribed. Many non-pharmacological treatments have been shown to be effective in
reorienting and calming dementia patients, and in this brochure I hope to educate families who have
loved ones with dementia about some of the effective non-pharma logical treatments for dementia. I
hope to target the families because often families are the primary care-takers for dementia patients;
also these treatments can be done without any medical expertise. The document would be handed out
to families by nurses in facilities with high numbers of dementia patients such as long term care facilities
who specialize in care for the elderly, since dementia is most common in the elderly population.

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Could Non- Pharmacological Treatments Be More Effective for Your

Loved One with Dementia?
Medications such as antipsychotics are often used to treat uncooperative and even aggressive
behaviors that are associated with patients who suffer from dementia, yet evidence based practice
indicates that medications should be used
as a secondary treatment. Although
many patients do benefit from these
treatments, the side effects may be more
harmful than the cognitive benefit and
often these medications are masking
hostile behaviors by sedating the patients
rather than effectively treating the underlying issue. If this is the case for your loved one, they may
benefit from alternative therapies that can help to calm, stimulate, emotionally validate or reorient
them. This article will overview some of these therapies. As a family member you can benefit from these
therapies since who know the patient better than any medical professional, and also none of these
therapies require any medical training.

Reality Orientation
Reality orientation helps with some of the most common symptoms of dementia, memory loss
and disorientation, by reminding them of facts about their life and environment. It is one of the most
commonly used dementia treatments. It can be used at any time and in any setting; both with the

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individual as well as in groups. The technique is used by the
patient care-taker, by consistently reminding the patient of
their surroundings using anything from street signs to pictures
of loved ones. As an example, if the patient is claiming that it is
summer yet it is winter, the care-taker could orient them by
saying, look outside, there is snow on the ground and the
trees have no leaves. Or if they are confused about where
their children are the caretaker could show pictures of their
children explain that they have grown up and are raising a family of their own. This kind of treatment
can cause the patient to be saddened in some cases because of the realization of cognitive decline, but

has been overall been shown to be effective in making the patient more cooperative.

Validation Therapy
Memory loss and decline of cognitive function can be very frightening for those who
suffer from dementia, so discrediting what they perceive to be reality can be very frustrating. Therefore
validation therapy is used to help a patient tolerate reality
orientation, by validating their emotions, while not necessarily
validating the patients schemas. The perceived reality created
by someone with dementia is often based on emotion rather
than logic and is used as an escape from the present, which can
be painful for these patients to come to terms with. Through
validation therapy, caretakers can connect with a patient by finding the emotional meaning behind
confused or uncooperative behaviors. This kind of therapy should be used to help patients be more
cooperative and is correlated with increased affect and greater insight into external reality. As an

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example, if a patient thought that they were on a boat that they need to captain, the care-taker could
explain, I know that this must be scary for you and you feel that you need to steer the boat, but we are
in your home. Look at that. That is your kitchen, and out that window is your back yard. You have no
need to fear we are in your house. Validation therapy and reality orientation are particularly effective
together.

Music Therapy
Music therapy can be a strong tool in treating uncooperative behavior and restlessness
associated with dementia. Music is associated with many emotions and important events and can be
used in dementia patients to stimulate memory, enhance mood, facilitate positive interactions, and cue
certain behaviors or activities. Music can be used to make
activates of daily living go more smoothly. As an example, for an
uncooperative patient who loves Frank Sinatra, the caretaker can
play Sinatra during meals, while taking showers, before going to
sleep or any other activity to cue to the dementia patient that a
certain activity is happening. Dementia can be very confusing and
scary for patients and being able to listen to their favorite music,
dance to music or enjoy live musicians can greatly improve mood
and help them feel more rooted in reality. Family members are particularly beneficial in the
implementation of music therapy because they know the patients preferences. Also music can have
many emotional associations, and family members are more likely to know which songs will produce
which kind of response such as excitement, calmness or sadness. Like many therapies, music therapy
takes some experimentation, but after some time, specific associations and the effects of different
musics can be determined in order to effectively treat dementia symptoms.

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Art Therapy
At home, in a care facility and in a community setting, art therapy can enrich the lives of
dementia patients by empowerment through expression. Art provides the patient with an outlet to
explore their imagination and boost their self-esteem in a
non-threatening environment. Art can provide a coping
mechanism as the cognitive decline and memory loss
associated with dementia can be terrifying. Creating art work
can stimulate cognitive function and memory, and artwork
can be a less threating way to start discussion about what
the patient is thinking. For example, the care taker can ask, What are you drawing?, Who is that a
picture of? or How did you come up with that? This can be less threatening than one to one
conversation for many people.

Exercise and Activity

Exercise has benefits in virtually every aspect of health, from cardiovascular to cognitive. In
every stage of dementia, exercise and activity can help to improve memory and cognitive function. Your
family member may be apprehensive to exercise , so phrasing this as activity or recreation or
asking Would you like to go on a walk? can be very beneficial. Exercise can include any kind of
movement based activity from dancing to gardening to bowling to tai chi.
Before exercise, it is important to assess
the ability of the patient and their preferences.
Consider their cardiovascular health, risk of falls,
balance ability and any other relevant health

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history. A physical or occupational therapists guidance will be useful in determining individual ability.

Conclusions and Further Information

There are methods of dementia treatment which require no medication, that your loved one
can use in practically any setting. Although medication can be useful and sometimes necessary, side
effects can cause these medications to be sub therapeutic and often non-pharmacological treatments
can be just as beneficial. Some of these non-pharmacological therapies include: reality orientation,
validation therapy, music therapy, art therapy, exercise and activity. These therapies focus on improving
cognitive ability, promoting self-esteem, calming, validating and providing effective coping mechanisms.
For more information on non-pharmacological therapies and the risk-vs-benefit of antipsychotics,
consult your primary health care provider and please visit the following websites:
http://www.nps.org.au/publications/health-professional/health-news-evidence/2013/antipsychoticdementia
http://apt.rcpsych.org/content/10/3/171.full
http://www.alz.org/what-is-dementia.asp
http://www.alzfdn.org/EducationandCare/musictherapy.html
http://www.alzheimers.org.uk/factsheet/529
http://www.alzfdn.org/EducationandCare/art_therapy.html

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References
Antipsychotic overuse in dementia - is there a problem? (2013, September 12). Retrieved November 27,
2014, from http://www.nps.org.au/publications/health-professional/health-newsevidence/2013/antipsychotic-dementia
Douglas, S., James, I., & Ballard, C. (2004). Non-pharmacological Interventions In Dementia. Advances in
Psychiatric Treatment, 171-177. Retrieved November 27, 2014, from
http://apt.rcpsych.org/content/10/3/171.full
Education and Care: Art. (2014, November 20). Retrieved November 27, 2014, from
http://www.alzfdn.org/EducationandCare/art_therapy.html
Education and Care: Music. (2014, November 20). Retrieved November 27, 2014, from
http://www.alzfdn.org/EducationandCare/musictherapy.html
Exercise and physical activity for people with dementia. (2011, November 13). Retrieved November 27,
2014, from http://www.alzheimers.org.uk/factsheet/529

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Response Letter
Kathleen, Kim and Professor Enos, I would like to thank you very much for the revisions and
suggestions about my non-pharmacological dementia treatment public document. I believe that the
final draft is great improvement and I owe much of that to your time and effort. Unfortunately Kathleen,
I was unable to open your revisions on my computer because of the file type, but I still appreciate your
time and effort.
Kim, I took your advice and further explained art therapy and exercise therapy where in my draft
I only put headings. This suggestion helped to make the document more informative and also helped me
satisfy the word count requirement. Thank you for highlighting the usefulness of real life situations in
discussing the different therapies, as I made a point to add in more of these real life situations. I also
tried to better differentiate reality orientation and validation therapy; I know you said that that was
confusing before. I totally agree that the initial draft did not have an appealing visual aesthetic, so in the
final draft Ive added pictures, a nicer background. Ive also added a conclusion with a summary of the
therapies mentioned and links for further information. Lastly I tried to shorten sentences to make the
information more direct.
Professor Enos, I found your suggestions on motive very helpful and I have decided that
this document is needed to educate the families of dementia patients who may think that medication is
the best and only option. This is also important information for the family to know that they can utilize
these therapies in any setting, regardless if they use medication or not. This contemplation of motive
also obviously helped me define the audience as family members of dementia patients. Knowing this
audience, Ive tried to make this pamphlet informative but spared details of the manifestations of
dementia as they will be given other information about dementia itself and are probably already aware
of the manifestations because of their loved one. I read my final draft out loud, as you suggested, and it
was very useful and improving the flow and catching errors.

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Again, thank you all, and have a great Thanksgiving.
Best Wishes,
Jeremy