As a cure for Alzheimer’s disease continues to elude scientists, non-drug treatments—including mental and physical exercise and even caregiver support—are emerging as the best proven medicine for the disease, according to many of the latest studies presented at the 25th Conference of the Alzheimer’s Disease International, which opened Wednesday in Thessaloniki, Greece.
Although the impact of these approaches has been understood anecdotally for years, the arc of Alzheimer’s disease research has finally reached a point where non-drug treatment studies have continued long enough to constitute evidence-based research. That means these approaches are proven tools for those working to help people with the debilitating illness, which affects 26 million people worldwide, 5.3 million in the United States alone. An irreversible brain disorder, Alzheimer’s robs people of their memory and eventually impairs most of their mental and physical functions.
The proof that these therapies really work may also be good economic news: Non-drug therapies can save money, for individual families as well as state and local governments, by delaying entrance into nursing homes for those suffering from dementia, experts say.
Sharing and remembering
“Psychological therapies have been used with people with dementia for at least 50 years,” says Robert Woods, a professor at Bangor University in Wales, whose presentation highlighted the fact that behavioral approaches have fewer side effects than drug therapies.
Two of the common therapies are known as “cognitive stimulation” and “reminiscence therapy.” Cognitive stimulation involves a small group of people with dementia meeting a couple of times a week with a care worker, to take part in a range of activities—from word games to a group baking session. The sessions are intended to involve those with Alzheimer’s in activities that are mentally stimulating and enjoyable.
Woods cites studies that found cognitive stimulation groups can actually improve a person’s scores on tests of memory, language and thinking—similar to the changes seen with the currently available medications for Alzheimer’s disease. “More importantly,” Woods says, “participants also reported improved quality of life. Behavioral approaches have been shown to be effective in a number of domains including improved mood.”
Reminiscence therapy groups are similar, but focus on activities and discussions of personal events and experiences. Carefully selected pictures, objects, sound and video recordings, are used to evoke old memories. Caregivers reported improved behavior in those with Alzheimer’s, without the use of drugs. And the patients reported a better quality of life. Both these results help keep men and women at home with their families, rather than in a nursing home.
“Dementia is a complex set of conditions,” he adds. “Building on the person’s life history is always a good starting point, as a guide to their values, interests and preferences. Engaging the person in a positive, constructive approach may be more effective than tackling problem behavior head-on.”
Thinking and walking
Identifying the presence of dementia early appears to be the best weapon in delaying its severity. Even without expensive medical exams, there are markers that might indicate a problem.
“We all forget where we left the keys or remote control from time to time,” says Michael Valenzuela of the University of New South Wales in Sydney, Australia, and author of It’s Never too Late to Change Your Mind. “If, however, we were to forget what the remote control is for, then this is a more serious type of memory issue that would require follow-up investigation.”
In his presentation, Valenzuela cited two studies that demonstrated that physical exercise and brain training using computer programs can delay—and even improve—dementia.
In one study, researchers found that four weeks of computer brain training helped improve the overall cognitive abilities of those with Alzheimer’s disease. Significantly, these improvements continued for three months after the training stopped.
The second study found that six months of simple, self-directed physical exercise resulted in a modest, but persistent, improvement in mental abilities as long as one year later.
“The potential preventative effects of brain training and physical exercise are much stronger before a person is diagnosed with dementia,” Valenzuela cautions. “After diagnosis, these strategies may have some value, but are qualitatively different and lead to less consistent outcomes.”
Caring for the caregiver
Shifting the focus from patient to caregiver, Mary Mittelman of the Center for Excellence on Brain Aging at New York University’s Langone Medical Center reported on a 20-year study of how giving caregivers support helped delay a patient’s entry into a nursing home.
Mittelman’s team monitored Alzheimer’s caregivers (usually family members) who were given counseling and training on how to deal with their patients—and compared them to caregivers who received no such support. The results were encouraging, and showed the support had a significant effect on the caregivers’ emotional and physical health, and even their reactions to their patient’s behavior, which could be distressing and trying. That helped translate to the patients remaining at home about a year and a half longer.
Caregivers, Mittelman says, need ongoing support and help. “Alzheimer’s disease doesn’t remain static,” she says. “ It changes over time. What you learn to deal with today is not what you’re going to confront a year from now.”
Chris Haines is a writer living in New York.
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