title: Aromatherapy for dementia.
abstract: BACKGROUND
  Complementary therapy has received great interest within the field of dementia treatment and the use of aromatherapy and essential oils is increasing. In a growing population where the majority of patients are treated by US Food and Drug Administration (FDA)-approved drugs, the efficacy of treatment is short term and accompanied by negative side effects. Utilisation of complimentary therapies in dementia care settings presents as one of few options that are attractive to practitioners and families as patients often have reduced insight and ability to verbally communicate adverse reactions. Amongst the most distressing features of dementia are the behavioural and psychological symptoms. Addressing this facet has received particular interest in aromatherapy trials, with a shift in focus from reducing cognitive dysfunction to the reduction of behavioural and psychological symptoms in dementia.
  
  
  OBJECTIVE
  To assess the efficacy of aromatherapy as an intervention for people with dementia.
  
  
  METHODS
  ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, was searched on 26 November 2012 and 20 January 2013 using the terms: aromatherapy, lemon, lavender, rose, aroma, alternative therapies, complementary therapies, essential oils.
  
  
  METHODS
  All relevant randomised controlled trials were considered. A minimum length of a trial and requirements for follow-up were not included, and participants in included studies had a diagnosis of dementia of any type and severity. The review considered all trials using fragrance from plants defined as aromatherapy as an intervention with people with dementia and all relevant outcomes were considered.
  
  
  METHODS
  Titles and abstracts extracted by the searches were screened for their eligibility for potential inclusion in the review. For Burns 2011, continuous outcomes were estimated as the mean difference between groups and its 95% confidence interval using a fixed-effect model. For Ballard 2002, analysis of co-variance was used for all outcomes, with the nursing home being treated as a random effect.
  
  
  RESULTS
  Seven studies with 428 participants were included in this review; only two of these had published usable results. Individual patient data were obtained from one trial (Ballard 2002) and additional analyses performed. The additional analyses conducted using individual patient data from Ballard 2002 revealed a statistically significant treatment effect in favour of the aromatherapy intervention on measures of agitation (n = 71, MD -11.1, 95% CI -19.9 to -2.2) and behavioural symptoms (n = 71, MD -15.8, 95% CI -24.4 to -7.2). Burns 2011, however, found no difference in agitation (n = 63, MD 0.00, 95% CI -1.36 to 1.36), behavioural symptoms (n = 63, MD 2.80, 95% CI -5.84 to 11.44), activities of daily living (n = 63, MD -0.50, 95% CI -1.79 to 0.79) and quality of life (n = 63, MD 19.00, 95% CI -23.12 to 61.12). Burns 2011 and Fu 2013 found no difference in adverse effects (n = 124, RR 0.97, 95% CI 0.15 to 6.46) when aromatherapy was compared to placebo.
  
  
  CONCLUSIONS
  The benefits of aromatherapy for people with dementia are equivocal from the seven trials included in this review. It is important to note there were several methodological difficulties with the included studies. More well-designed, large-scale randomised controlled trials are needed before clear conclusions can be drawn regarding the effectiveness of aromatherapy for dementia. Additionally, several issues need to be addressed, such as whether different aromatherapy interventions are comparable and the possibility that outcomes may vary for different types of dementia.
authors.affiliation: Department of Anaesthesia, NHS Grampian, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Aberdeenshire, UK, AB25 2ZN.
authors.forename: Lene Thorgrimsen
authors.initials: LT
authors.lastname: Forrester
authors.forename: Nicola
authors.initials: N
authors.lastname: Maayan
authors.forename: Martin
authors.initials: M
authors.lastname: Orrell
authors.forename: Aimee E
authors.initials: AE
authors.lastname: Spector
authors.forename: Louise D
authors.initials: LD
authors.lastname: Buchan
authors.forename: Karla
authors.initials: K
authors.lastname: Soares-Weiser
mesh_terms: D019341:Aromatherapy; D001526:Behavioral Symptoms / Q000628:therapy; D003704:Dementia / Q000628:therapy*; D006801:Humans; D009822:Oils, Volatile / Q000627:therapeutic use; D011595:Psychomotor Agitation / Q000628:therapy; D016032:Randomized Controlled Trials as Topic
chemical_list: D009822:Oils, Volatile