**4. Sensory and multi-sensory stimulation interventions**

Sensory stimulation and multi-sensory stimulation refer to a variety of techniques used to stimulate the senses in order to increase alertness and reduce agitation [51]. Sensory stimula‐ tion includes auditory, visual, olfactory, tactile, taste and kinaesthetic stimulation [52, 53]. Several studies examined sensorial and multi-sensorial interventions. In this chapter, seven therapy types were identified.

#### **4.1. Art therapy**

symptoms [37]. Another reminiscence group intervention [38] evaluated effectiveness in preventing cognitive impairment progression and enhancing affective function. The results showed improvement in most variables including cognition and depression than controls.

Reality orientation (RO) is a technique of cognitive stimulation [39, 40]. It entails presenting the patient by continuous memory and orientation information associated with personal environment and issues. Several methods of implementing RO have been explained [40–42]. Throughout the treatment sessions, the patient is supported to talk about various arguments linked to his daily routine and recent events. Encouraging the patient to connect socially is a very significant component of the therapy [40, 42, 43]. Following the first publication of a review about RO, interest in the subject increased dramatically and most subsequent articles

RO focuses on new cognitive stimulation strategies emerged in recent studies. The cognitive stimulation therapy (CST) is an example [40, 45]. Beyond the features assessed in RO, the CST

Some reviews about RO confirmed earlier findings of substantial benefits and also identified

The validation therapy (VT) was developed stages: to address the shortcomings of other approaches, such as RO, in approaching patients who have more advanced dementia. The VT was the result of an attempt to provide practical solutions for difficulties experienced by

Important characteristics of VT include: means of classifying behaviours, provision of simple, practical techniques that help restore dignity, provision of an empathic listener, respect and

The way in which these rules are applied to provide specific interventions depends on the dementia severity categorized into mal orientation, time confusion, repetitive motion and vegetation. Each stage is recognized through defined cognitive and behavioural features and defined VT interventions address the various cognitive and neuropsychiatric characteristics showed by dementia people at each stage [47]. Various observational studies have indicated that the application of VT determine positive effects about amount and duration of interactions that participants are able to make during validation groups session [48, 49]. Though, other

Sensory stimulation and multi-sensory stimulation refer to a variety of techniques used to stimulate the senses in order to increase alertness and reduce agitation [51]. Sensory stimula‐

empathy for older adults with dementia and acceptance of the person's reality [47].

reported substantial benefits following the use of these strategies [40, 42, 44].

is based also on multi-sensory stimulation and reminiscence [40, 44, 46].

existing and new areas where further work is required [39–41].

studies showed no significant effects of VT [50].

**4. Sensory and multi-sensory stimulation interventions**

**3.2. Reality orientation therapy**

480 Update on Dementia

**3.3. Validation therapy**

patients and caregivers.

Art therapy is the therapeutic use of art making within a professional relationship. It has been suggested as a treatment for people with dementia as it has the potential to provide meaningful stimulation, improve social interaction and improve levels of self-esteem [54]. Activities such as drawing and painting are thought to provide individuals the opportunity for self-expression and the chance to exercise some choices in terms of the colours and themes of their creations.

#### **4.2. Music therapy**

Music therapy is defined as the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed profes‐ sional [55]. Two studies showed the effect of music on neuropsychiatric symptoms [56, 57]. It was tested a live-music intervention on decreasing anxiety and agitation [55]. Results showed no significant differences in anxiety and agitation. However, a study [56] showed a statistically significant decrease of the agitation in a group music-listening intervention.

#### **4.3. Occupational therapy**

The primary focus of occupational therapy (OT) is to improve patients' ability to perform activities of daily living, promote independence, reduce caregiver burden and ultimately improve quality of life.

OT offers interventions associated with awareness of self-care, leisure activities, occupational identity and productivity [58]. Studies showed an association between cognitive impairment and occupational performance [59, 60]. Therefore, patients with dementia can be assisted through OT trying to preserve an adequate performance level in BADL and IADL [61]. Furthermore, caregivers can adopt OT techniques, in the family or institution, to stimulate patient performing daily activities, preventing disruptive behaviour, wandering and aggres‐ sion.

#### **4.4. Aromatherapy**

Aromatherapy is the fastest growing of all complementary therapies, in terms of public interest [62]. It aids interaction while providing a sensory experience. Aromatherapy appears to have several advantages over the pharmacological treatments used for dementia [63]. It seems to be well tolerated in comparison with sedative or neuroleptic medication [63]. The two essential oils used in aromatherapy for dementia patients are extracted from lavender and Melissa balm and could be administered in numerous methods such as bathing, inhalation, massage and topical application in cream [63]. Aromatherapy can be addressed to patients with several behaviours. Recent controlled trials showed significant reductions in agitation, with excellent compliance and tolerability [63–65].

### **4.5. Bright-light therapy**

Bright light therapy (BLT) consists of exposure to daylight or specific wavelengths of light using polychromatic polarised light, laser, light-emitting diodes, fluorescence lamps, dichroic lamps or very bright, full-spectrum light. Four studies tested the effect of BLT on behavioural symptoms [66–69]. Two studies compared the effect of morning BLT and afternoon/evening BLT with normal light [66, 67]. Other studies compared one single type of BLT with usual light [66], and no differences were found between morning and evening. Limited evidence of reduction in agitation and aggression among those receiving BLT was found [67, 70].

#### **4.6. Activity therapy**

Activity therapy (AT) implicates recreation activities such as dance, sport and drama. It was found that physical exercise can have health benefits for dementia patients, reducing the number of falls and improving mental health, sleep [63, 70] and mood [71]. In addition, it was found that daytime exercise aided to decrease daytime agitation and night-time restlessness [63, 72]. Perrin described an interesting approach to dance therapy: he employed a form of dance known as 'jabadeo', which allows the patients to engage with each other in interactive movements [63, 73].

#### **4.7. Snoezelen multi-sensory stimulation**

Snoezelen is a multi-sensory setting for implementation of several sensory-based tools. Snoezelen offers sensory stimuli to primary senses of hearing, touch, sight, smell and taste, by the use of music, odour of essential oils, lighting effects and tactile surfaces [74]. Several studies define snoezelen approach as a support therapy for dementia patients [75]. The goals of such therapy are to promote positive behaviours and to reduce maladaptive behaviours [76, 77].

Over the past decade, the clinical application of Snoezelen has been extended from the field of learning disability to dementia care. Its use resides in providing a sensory environment that capitalizes on the residual sensorimotor abilities of dementia patients. Moreover, encouraging results were obtained in the area of promoting adaptive behaviours [78]. In practice, snoezelen capitalize on the residual sensorimotor abilities of dementia sufferers and present a few attentional and intellectual demands [76].
