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Laughter Might Be Good Medicine for Alzheimer's Patients

By Alan Mozes
HealthDay Reporter

FRIDAY, Sept. 30 (HealthDay News) -- Exposing Alzheimer's patients to "humor therapy" appears as effective as psychiatric drugs in reducing the agitation that often plagues those struggling with dementia, new Australian research suggests.

In a three-month period, nursing home residents who actively participated in a weekly two-hour clowning session involving music, mime and humorous props showed a significant reduction in both physically and verbally aggressive behavior.

What's more, the 20-percent plunge in overall agitation, which the team attributed to humor therapy, lasted for at least 14 weeks beyond the conclusion of the clowning program, the investigation team found.

"Normally, nursing homes are a little like being stuck on a bad cruise where you can't get off," said study co-author Jean-Paul Bell, creative director at the Arts Health Institute in Avalon Beach, New South Wales, and co-founder of the Australia-wide hospital-based "Clown Doctor" program. "You are getting the creature comforts but no stimulating conversation or playful contact."

Bell and his colleagues sought to implement what he called a "person-centered" therapeutic approach, coupling visual sight-gags -- such as mimicking a conversation through two tin cans -- alongside provocative and irreverent verbal humor to encourage active patient participation and reactions.

The result: "The humor intervention worked well for pretty much everyone," Bell noted, particularly for the "highest-care" patients deemed most debilitated by dementia. As an added bonus, the impact was achieved without running any of the risk for serious side effects, including falling and premature death, that have been previously associated with prescription antipsychotic drugs.

Bell and Australian colleagues (at the Dementia Collaborative Research Centre, the University of New South Wales and Prince of Wales Hospital, among others) recently presented the findings at the National Dementia Research Forum, in Sydney.

The study authors noted that between 70 percent and 80 percent of dementia patients experience some form of agitation and distress, which can include bouts of wandering, screaming and repetitive behaviors.

To explore whether and how much humor might help, the authors focused on 399 nursing home residents with dementia or other "age-associated conditions" living in one of 35 facilities in the Sydney area.

All the patients had lived in their respective facilities for at least three months. However, none was considered to be in an end-of-life situation or suffering from severe psychosis.

An "ElderClown," trained to engage in humor-based therapy in a medical setting, performed the weekly humor sessions.

To a large degree, the sessions relied on humorous improvisation skills, similar to those used by "clown doctors" performing for sick children. The goal: to lift the mood of the patients, while engaging them in both conversation and physical interaction.

In addition, regular facility staff was partnered with these clowns, to continue to promote humor therapy between sessions.

Depression, quality-of-life, social engagement and agitation behaviors were all assessed before therapy, at the end of the three-month program, and 26 weeks after therapy began.

While humor therapy did not appear to affect mood or quality of life, it had a clinically significant impact on patient agitation, on par with what might be expected following administration of standard antipsychotic medications.

However, while agitation itself remained lower 26 weeks following therapy launch, the boost in both happiness and positive behaviors seen during the program faded once the program ended.

Nevertheless, the team suggested that humor therapy should become a first-line treatment choice for dementia patients suffering from agitation.

Sam Fazio, Chicago-based director of medical and scientific relations at the Alzheimer's Association, described the study as "very well-done" and "important."

"I think that the point about it being a good alternative to pharmacological treatment is really something to consider," Fazio said. "We need more of this type of research to show that there are other ways to work with people than simply medication."

Fazio added that humor therapy is just one non-pharmacological approach among a range of viable options, including both art therapy and pet therapy. He said that while all such interventions show promise, they do not replace the overall need to better understand the physiological roots of agitation.

"Reducing agitation is of great benefit," he said. "And I'm not discounting this therapy at all, because it can work for a lot of folks. But we need to also look at what's causing the agitation, what the triggers are. And then decide exactly how we're going to approach it."

More information

Visit the Alzheimer's Association for more on agitation.

SOURCES: Jean-Paul Bell, creative director, Arts Health Institute, Australia; Sam Fazio, PhD, director, medical and scientific relations, Alzheimer's Association, Chicago; September 2011, National Dementia Research Forum, Sydney, Australia

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