Bergamot Aromatherapy May Decrease Agitation in Patients with Dementia

Dementia is a progressive disease that affects memory, thinking, orientation, comprehension, and communication. More than 50 million people worldwide have been diagnosed with dementia. That number is expected to triple before 2050. Alzheimer’s disease (AD) is the most common form of dementia and accounts for two-thirds of all cases. Quality of life of patients diagnosed with dementia is affected by disturbances of behavior, mood, thought content, and perception. This cluster of symptoms is known as Behavioral and Psychological Symptoms of Dementia (BPSDs) or Neuropsychiatric Symptoms (NPSs). Most patients diagnosed with AD will experience one of these symptoms over the course of the disease. Of these NPSs, agitation is one of the most challenging symptoms which features excessive motor activity, as well as verbal or physical aggression. Agitation is predictive of a worse prognosis and increased risk of injury. Treatment of dementia NPSs remains challenging as pharmaceutical approaches can have serious side effects, including increased risk of death from cerebrovascular events.

Aromatherapy has been used as a complimentary treatment for agitation in dementia. Aromatherapy is a form of phytotherapy using essential oils. In a placebo-controlled trial of 72 care facilities, patients diagnosed with dementia that received an aromatherapy massage using lemon balm (Melissa officinalis, Lamiaceae) essential oil had reduced agitation scores using the Cohen-Mansfield agitation inventory. No significant side effects were reported. Animal studies demonstrated that bergamot (BEO; Citrus bergamia, Rutaceae) essential oil exerted anxiolytic-like activity similar to diazepam, but without the loss of vigilance induced by diazepam. This review discusses the potential therapeutic applications of BEO for alleviating agitation in patients with dementia.

Many patients diagnosed with dementia go under-treated or mistreated for pain because of their diminished communication skills. NPSs, particularly agitation, are linked to misdiagnosed and unrelieved pain. Aromatherapy containing strong analgesic properties may be useful in the management of BPSDs such as agitation. BEO has demonstrated analgesic properties in both inflammatory and neuropathic pain models. Inhalation pathways may be effective due to systemic absorption of BEO, rather than psychological perception of the aroma (fragrance).

The authors recommend future clinical trials to address the use of aromatherapy in the management of dementia. Additional trials need to “assess efficacy and safety of aromatherapy with BEO in the management of the several neuropsychiatric behavioral syndromes related to this neurodegenerative disorder [dementia].”

The authors declare no conflict of interest.

Resource:

Scuteri D, Rombolà L, Morrone LA, et al. Neuropharmacology of the neuropsychiatric symptoms of dementia and role of pain: Essential oil of bergamot as a novel therapeutic approach. Int J Mol Sci. July 2019;20(13). doi: 10.3390/ijms20133327.