Reviewed: Holmes C, Hopkins V, Hensford C, MacLaughlin V, Wilkinson D, Rosenvinge H. Lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. International Journal of Geriatric Psychiatry 2002;17:305-8.

Between 18—65 percent of people with dementia exhibit agitated behavior. Pharmacological treatment using neuroleptics (antipsychotic drugs that reduce confusion, delusions, hallucinations, and psychomotor agitation in patients with psychoses; also known as major tranquilizers and antipsychotic drugs) is often the first line of treatment. However, neuroleptics have only modest efficacy, are not approved in the U.S. for this indication, and can result in severe adverse side effects, including stroke.

Essential oil of English lavender (Lavandula angustifolia Mill., Lamiaceae) flower, used in aromatherapy as a relaxant, has been shown in animal and human studies to have sedative qualities upon inhalation. According to Dr. Duke’s Phytochemical and Ethnobotanical Databases <www.ars-grin.gov/duke/plants>, lavender contains cholinesterase inhibitors – 1,8-cineole, borneol, coumarin, and limonene – that also have analgesic, anesthetic, antinociceptive (reduces perception of pain), myorelaxant, narcotic, and tranquilizing effects.

The authors hypothesized that inhaled lavender oil would have a beneficial effect on agitated behavior in patients with severe dementia. Fifteen patients (mean age 79 years) with severe dementia and agitated behavior participated in this placebo-controlled study. The common area of a long-term care unit was diffused for two hours with either standard 2 percent concentration of lavender oil (Tisserand; Tunbridge Wells, Kent, England) or water (placebo) on alternate days. During the final hour, an independent blinded (wearing nose clips) rater, unaware of the study design, assessed individual behavior of the patients with the Pittsburgh Agitation Scale (a 16-point observer rating scale of four domains: aberrant vocalization, motor agitation, aggression, and resistance to care). Five treatments and five placebo periods were carried out for each patient over two-weeks.

During aromatherapy, nine patients (60 percent) showed improvement, five (33 percent) showed no change, and one patient (less than 7 percent) showed a worsening of agitated behavior compared to placebo. Results were described as "modest efficacy" by the authors. This was the first published placebo-controlled study of lavender oil in agitated dementia patients. Even though the patient number is small, essential oil of lavender may be a non-invasive, beneficial method for treating agitated behavior in patients with severe dementia. Since one patient worsened following aromatherapy, a group setting may not be the best way to administer treatment.

This study focused on patients with severe dementia. Lavender oil aromatherapy may benefit patients with mild to moderate dementia as well. A larger study exploring different modes of administration and different degrees of dementia is needed.

–Heather S. Oliff, Ph.D.

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