Management of behavioural and psychological symptoms of dementia (BPSD) by complementary and alternative medicine (CAM) approaches

Abstract

Background: The behavioural and psychological symptoms of dementia (BPSD) remain a major health problem and cause tremendous stress among older adults and caregivers, thereby impeding the healthcare system and increasing the cost burden on the community. Literature review: Aromatherapy, therapeutic massage, and acupressure have received independent support in the literature; however, the quality of evidence is not high. Moreover, the synergistic effects of these three treatment modalities when combined are unknown. Development of an intervention protocol: A complementary and alternative medicine protocol (i.e., the a roma-massage with acupressure protocol) was developed, which combined these three treatments based on the opinions of selected experts and information provided in the literature. The feasibility and safety of this protocol were assessed in a feasibility study with a small group of older adults with dementia. The results show that the protocol is safe and easy to administer. The pilot RCT: A pilot randomized control trial (RCT) with adequate concealment in subject allocation, valid outcome assessments, a sample size based on an effect size calculation, and an intention-to-treat analysis was conducted to evaluate the immediate clinical effectiveness of this new intervention protocol in the management of BPSD and its effect six months after treatment completion. We also investigated the enhancing effect of the protocol on cognitive training, which is regarded as the active control. The results indicated positive effects in reducing the severity and distress of BPSD as assessed at the 3-month follow-up, and the positive effects remained unchanged at the 6-month follow-up. A continual improvement in the MMSE scores was noted. No adverse side effects were observed. The findings supported the safety, clinical efficacy and effectiveness of the aroma-massage with acupressure protocol as an adjunct intervention for BPSD.