The effect of therapeutic touch on agitated behavior and cortisol in persons with Alzheimer's disease

Abstract

Agitated behavior in persons with Alzheimer's disease (AD) presents a challenge to current interventions. Recent developments in neuroendocrinology suggest that changes in the hypothalamic-pituitary-adrenal (HPA) axis alter the responses of persons with AD to stress. Given the deleterious effects of pharmacological interventions in this vulnerable population, it is essential to explore noninvasive treatments for their potential to decrease a hyperresponsiveness to stress and indirectly decrease detrimental cortisol levels. This within-subject, interrupted time-series study was conducted to test the efficacy of therapeutic touch on decreasing the frequency of agitated behavior and salivary and urine cortisol levels in persons with AD. Ten subjects who were 71 to 84 years old and resided in a special care unit were observed every 20 minutes for 10 hours a day, were monitored 24 hours a day for physical activity, and had samples for salivary and urine cortisol taken daily. The study occurred in 4 phases: 1) baseline (4 days), 2) treatment (therapeutic touch for 5 to 7 minutes 2 times a day for 3 days), 3) posttreatment (11 days), and 4) post- "wash-out" (3 days). An analysis of variance for repeated measures indicated a significant decrease in overall agitated behavior and in 2 specific behaviors, vocalization and pacing or walking, during treatment and posttreatment. A decreasing trend over time was notedfor salivary and urine cortisol. Although this study does not provide direct clinical evidence to support dysregulation in the HPA axis, it does suggest that environmental and behavioral interventions such as therapeutic touch have the potential to decrease vocalization and pacing, 2 prevalent behaviors, and may mitigate cortisol levels in persons with AD.