Aromatherapy as a Safe and Effective Treatment for the Management of Agitation in Severe Dementia: The Results of a Double-Blind, Placebo-Controlled Trial
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BACKGROUND: Behavioral and psychological symptoms in dementia are frequent and are a major management problem, especially for patients with severe cognitive impairment. Preliminary reports have indicated positive effects of aromatherapy using select essential oils, but there are no adequately powered placebo-controlled trials. We conducted a placebo-controlled trial to determine the value of aromatherapy with essential oil of Melissa officinalis (lemon balm) for agitation in people with severe dementia. METHOD: Seventy-two people residing in National Health Service (U.K.) care facilities who had clinically significant agitation in the context of severe dementia were randomly assigned to aromatherapy with Melissa essential oil (N = 36) or placebo (sunflower oil) (N = 36). The active treatment or placebo oil was combined with a base lotion and applied to patients' faces and arms twice a day by caregiving staff. Changes in clinically significant agitation (Cohen-Mansfield Agitation Inventory [CMAI]) and quality of life indices (percentage of time spent socially withdrawn and percentage of time engaged in constructive activities, measured with Dementia Care Mapping) were compared between the 2 groups over a 4-week period of treatment. RESULTS: Seventy-one patients completed the trial. No significant side effects were observed. Sixty percent (21/35) of the active treatment group and 14% (5/36) of the placebo-treated group experienced a 30% reduction of CMAI score, with an overall improvement in agitation (mean reduction in CMAI score) of 35% in patients receiving Melissa balm essential oil and 11% in those treated with placebo (Mann-Whitney U test; Z = 4.1, p < .0001). Quality of life indices also improved significantly more in people receiving essential balm oil (Mann-Whitney U test; percentage of time spent socially withdrawn: Z = 2.6, p = .005; percentage of time engaged in constructive activities: Z = 3.5, p = .001). CONCLUSION: The finding that aromatherapy with essential balm oil is a safe and effective treatment for clinically significant agitation in people with severe dementia, with additional benefits for key quality of life parameters, indicates the need for further controlled trials.
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One high-quality study of person-centred care training found severe agitation significantly improved during the intervention and 8 weeks later.
“One high-quality study of person-centred care training found severe agitation significantly improved during the intervention and 8 weeks later. 35”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [35]
Long-term effects (in months) of changing the way caregivers interact with residents are at least as good as the short-term effects.
“Long-term effects (in months) of changing the way caregivers interact with residents are at least as good as the short-term effects. 35,38”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [35]
One large, high-quality care home study evaluated dementia care mapping; severe agitation decreased during the intervention and 4 months afterwards.
“One large, high-quality care home study evaluated dementia care mapping. The researchers observed and assessed each resident's behaviour, factors improving wellbeing and potential triggers; explained the results to caregivers, and supported proposed change implementation. Severe agitation decreased during the intervention and 4 months afterwards. 35”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [35]
Training paid caregivers in person-centred care, communication skills training or dementia care mapping was investigated in five RCTs, and all interventions included supervision during training and implementation.
“Training paid caregivers in these techniques was investigated in five RCTs. 35-39 All interventions included supervision during training and implementation.”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [35]
The different implementation may have altered the effect.
“this may have altered the effect”
From Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials (2014) · cites this paper as [35]
Aromatherapy has been used to address behavioral and psychological symptoms of dementia, sleep disturbances, and to stimulate motivational behavior in people with dementia.
“Indeed, aromatherapy has been used to address BPSD (181–186) and sleep disturbances (187–189) and to stimulate motivational behavior (190).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [182]
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References 22 · Cited by 396
- Authors
- Ballard, C. G., O'Brien, J. T., Reichelt, K., & Perry, E. K.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2002-07-15
- Volume
- 63
- Issue
- 7
- Pages
- 553-558
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1996742337
- Cited by
- 396
- References
- 22
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 12 · 2023: 9 · 2022: 12 · 2021: 11 · 2020: 18 · 2019: 11 · 2018: 23 · 2017: 24 · 2016: 16 · 2015: 13 · 2014: 14 · 2013: 11 · 2012: 17
- FWCI
- 11.57
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Complementary and alternative medicine › Medicinal Plant Extracts Effects
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- aromatherapy, essential oils, lemon balm, dementia, agitation, behavioral and psychological symptoms of dementia, quality of life, Cohen-Mansfield Agitation Inventory, Dementia Care Mapping, nursing homes, non-pharmacological treatment
- MeSH terms
- Administration, Topical, Aged, Dementia, Double-Blind Method, Emulsions, Female, Humans, Male, Oils, Volatile, Placebos, Plant Extracts, Psychiatric Status Rating Scales, Psychomotor Agitation, Quality of Life, Severity of Illness Index, Treatment Outcome, Aromatherapy, Lamiaceae
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