Non-pharmacological treatments for dementia

Why non-pharmacological matters

NICE NG97 places non-pharmacological treatments at the centre of dementia care, alongside medication where appropriate. The reasons are practical:

• The effect size of some non-pharmacological interventions (Cognitive Stimulation Therapy in particular) is comparable to Cholinesterase Inhibitors;
• Side effects are minimal;
• Benefits extend beyond cognition to mood, behaviour, quality of life and the carer relationship;
• The interventions can be sustained through the entire trajectory of the illness.

The recommended interventions

Cognitive Stimulation Therapy

Cognitive Stimulation Therapy is specifically recommended by NICE NG97 1.5.5 for cognitive symptoms in mild to moderate dementia. The structured 14-session group programme has the strongest evidence base of any non-pharmacological treatment.

Reminiscence Therapy

Reminiscence Therapy uses memories, photographs and music to support engagement, identity and mood.

Music therapy

Music therapy is one of the most consistent non-pharmacological interventions for mood, engagement and behavioural symptoms. Personalised music (chosen by the person or by family) has the strongest evidence.

Validation Therapy

Validation Therapy is a communication approach that prioritises emotional truth over factual correction. It substantially reduces distress in moderate to severe dementia.

Aromatherapy

Aromatherapy (lavender, lemon balm) has a modest but consistent evidence base for agitation.

Pet therapy

Pet therapy (animal-assisted intervention) improves mood and engagement. Robotic pets show emerging evidence too.

Mindfulness

Mindfulness-based interventions have evidence in mild dementia, in carers and in mood and anxiety.

Physical and social interventions

Beyond the specific therapies, several broader approaches are core to dementia care:

• Exercise: regular aerobic and resistance exercise improves mood, sleep, behavioural symptoms and overall trajectory;
• Social engagement: regular social contact slows decline;
• Routine and structure: a consistent daily pattern reduces anxiety and behavioural symptoms;
• Sensory optimisation: hearing aids, glasses, lighting;
• Home environment: dementia-friendly adaptation supports independence.

How to access

UK access varies:

• Memory clinics often run Cognitive Stimulation Therapy groups directly;
• Alzheimer's Society runs Memory Cafes, Singing for the Brain and many community groups;
• Local authorities and Age UK often co-ordinate day services with music, art and gentle activity;
• Private occupational therapy and Speech and Language Therapy for individual programmes;
• Online resources and apps for home use.

What works less well

Some marketed interventions have minimal supporting evidence:

• Most commercial brain-training apps (specific effect on game performance, not on dementia or daily function);
• Routine multivitamins and "brain support" supplements;
• Reality orientation when delivered confrontationally;
• Coconut oil and similar unevidenced dietary interventions.

The lack of evidence is not the same as proof of no effect, but the limited resources of family time and energy are better directed to the interventions with stronger evidence.

For Carers

Carers benefit from non-pharmacological interventions as much as the person with dementia. The combination of structured self-care, supportive communication training, peer support and time off is the most evidence-backed approach to carer wellbeing.