Non Pharmacological Treatment For Alzheimer’s Disease

Patient Selection Randomization And Allocation

The definition of the clinical population is a very critical point. Targets of the proposed treatments should be cases of prodromal or probable AD with a clinical diagnosis supported by biomarkers . Over the last decades, the development of subject-selection strategies that strongly maximize the power of treatments by detecting target populations has been an important focus of large international studies such as the Alzheimer’s Disease Neuroimaging Initiative . Abnormal tau and amyloid 42 cerebrospinal fluid levels, baseline MRI atrophy, and apolipoprotein E 4 status have been used as successful stratification strategies and should be applied to define an early clinical population, such as MCI, or at-risk asymptomatic subjects. However, only a few of the reviewed studies used biomarkers in the inclusion process and, for some others, the clinical features of the MCI population were also unclear. While selecting the study sample, the lack of a neat clinical definition together with the absence of biomarkers leads to underpowered and diluted findings.

We have the following suggestions: 1) the population should be well-defined clinically and the AD diagnosis should be biomarker-supported and 2) randomization and allocation must follow recognized guidelines and should be clearly reported in the study description.

Personalised Medicine For Dementia: Collaborative Research Of Multimodal Non

Garuth Chalfont 1, *

1. Centre for Ageing Research, Faculty of Health and Medicine, Lancaster University, Lancaster UK

2. High Lane Medical Practice, Stockport, UK

3. Sedbergh Medical Practice, Kendall, UK

4. Care Force Consulting, Frome, UK

5. Functional Again Medical Practice, Gisborne, NZ

* Correspondence: Garuth Chalfont

Academic Editor: James S. Powers

Received: April 08, 2019 | Accepted: August 01, 2019 | August 07, 2019

OBM Geriatrics 2019, Volume 3, Issue 3, doi:10.21926/obm.geriatr.1903066

Recommended citation: Chalfont G, Simpson J, Davies S, Morris D, Wilde R, Willoughby L, Milligan C. Personalised Medicine for Dementia: Collaborative Research of Multimodal Non-pharmacological Treatment with the UK National Health Service . OBM Geriatrics2019 3: 066 doi:10.21926/obm.geriatr.1903066.

© 2019 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

Evidence Quality Of Outcomes

This overview focused on three outcomes: MMSE, ADL, and ADAS-cog. The evidence synthesis for each outcome by the GRADE system is summarized below and in Table 2. There were 10 moderate-quality evidences, 11 low-quality evidences, and three very low-quality evidence.

Table 2. Quality of evidence by Grading of Recommendations Assessment, Development, and Evaluation system.

MMSE

Nine MAs reported the MMSE. Three of the interventions improved MMSE significantly. Acupuncture vs. drugs and acupuncture vs. no treatment improved the MMSE. A combination of acupuncture and drugs vs. drugs alone improved the MMSE. Exercise intervention and cognitive intervention significantly improved the MMSE.

ADL

Six MAs reported on ADL. Acupuncture and exercise intervention demonstrated a significant effect on ADL. Acupuncture vs. drugs improved the ADL. A combination of acupuncture and drugs vs. drugs alone improved ADL. Exercise intervention improved ADL.

ADAs-Cog

Only four MAs reported the effects of two interventions on ADAS-cog. Two reported superior effects of acupuncture than drugs with regards to ADAS-cog. tTMS compared with sham rTMS decreased the ADAS-cog.

Don’t Miss: How To Make A Memory Book For Dementia

Can Cognitive Techniques Help With Alzheimers Diseaseinformationen About $cms: If$$cms: Valueconvert2$$cms: End: If$

Studies suggest that cognitive interventions can temporarily improve mental performance and language abilities in mild and moderate Alzheimers disease. But they don’t improve a person’s ability to take care of themselves. It is not clear whether the therapies can improve mood or quality of life.

A small number of studies also analyzed therapies where participants trained things like their language skills and memory on a computer. These “web-based cognitive techniques” were only able to improve attention spans a little, though. They hardly had a noticeable effect on memory and everyday abilities.

Side effects of cognitive approaches cant be ruled out. For instance, it could be very frustrating for someone with Alzheimer’s if they fail to complete an exercise again and again. Reality orientation training can be too much for people, making them feel even more confused. Some specialists view this type of training critically because it sometimes involves repeatedly pointing out the obvious, which can be patronizing.

It’s important for cognitive approaches to be adapted to suit individual options and needs and overseen by a professional.

Discovery Conference 2019 Preview: Non

Discovery Conference 2019 Preview

More than Medications: Non-Pharmacological Treatment of Memory Loss

Without many effective therapeutics for memory loss and dementia, families must often get creative to find solutions beyond the medicine cabinet to manage a loved ones behavioral changes. Fortunately, evidence shows that a variety of non-pharmacological strategies can meaningfully improve the symptoms of people living with the early symptoms of Alzheimers disease and provide ways to adapt or compensate for losses.

At the upcoming 2019 WA Alzheimers Discovery Conference, Dr. Kristoffer Rhoads, UW Memory and Brain Wellness Center/ADRC, will discuss non-pharmacological interventions in the presentation More than Medications: Non-Pharmacological Treatment of Memory Loss. He will delve into current promising options and explain how they can significantly lower the severity and frequency of behavioral and psychological symptoms in patients with dementia, in a variety of care settings.

Non-pharmacological interventions can be simple yet profoundly helpful, such as regular aerobic exercisewhich has shown to be beneficial for cognition in patients with dementia. They can also take the form of assistive home technologies, such as automatic pill dispensers, cognitive rehabilitation therapy, treatment of cardiovascular disease and diabetes, mindfulness meditation, and social engagement programs, among others.

Also Check: First Stages Of Alzheimer’s

Pharmacotherapy For Cognitive And Functional Symptoms

Table 1 summarizes pharmacologic treatments for Alzheimer disease, including cholinesterase inhibitors, memantine , and vitamin E, and describes titration schedules and adverse effects for each medication. There are no curative therapies for Alzheimer disease and other common etiologies of dementia. The goal of current pharmacologic therapies is to delay the progression of symptoms of neurocognitive and physical decline.

Changes In Spontaneous Neural Oscillations

The source intensities were compared between the two scans separately at each frequency band. The alpha1 and alpha2 intensities decreased at the second scan in the right temporal lobe , whereas only the alpha2 intensity exhibited a decline in the right fusiform gyrus . Moreover, following the NPT period, the low-gamma intensity in the right angular gyrus was increased . The results in all other frequency bands did not reveal any significant changes.

Figure 1

Brain regions with changes in source intensity after the NPT period. Red and yellow areas represent regions in which source intensities decreased after the NPT period. The blue area represents the region with an increase in source intensity after the NPT period. The area in cyan represents the region in which the change in source intensity was positively correlated with the change in the DBD-13 score. The 3D image was created using MRIcroGL .

Correlations of the MEG source intensities to the interval between the two scans and the changes in behavioural scores were also examined. Changes in beta source intensity close to the sensorimotor area of the right hemisphere were positively correlated with changes in DBD-13 scores . No other significant correlations were found between source intensities and the time between the scans or the behavioural scores. These results indicate that patients with reduced beta intensity near the right sensorimotor area showed a decline in behavioural disturbances.

Figure 2

Also Check: Do Alzheimer Patients Lose Their Sense Of Taste

Physical Emotional And Social Stimulation

These interventions focus on different types of activities, such as discussion groups on various topics, preparing meals together, practical things like brushing your teeth, making coffee or writing letters but also physical activities to improve strength, endurance and balance, as well as art and music.

Research shows that social activities can improve the quality of life of people with Alzheimer’s and their family members. They can help prevent Alzheimers-related apathy. They can also reduce the need for care.

Just like with other people, physical activity has health benefits for people with Alzheimers. Its important to ensure that older people are able to stay active so they dont become bedridden, for instance. Studies have shown that people with Alzheimers can stay mobile for longer if they take part in exercise programs. Combining different types of exercise to improve strength, agility and balance might help them perform everyday activities on their own for longer. Such exercise programs may include things like walking, strength-building exercises and endurance exercises. People have about two to three exercise sessions per week, lasting between 30 and 60 minutes each.

It isnt clear whether exercise also has a positive effect on the mental performance and mental health of people with Alzheimers disease.

The Choice Of Outcome Measures

The main difficulty for these studies is to transfer outcome measures from the laboratory to real life. fMRI can contribute to this effort by identifying, through the task or using a resting-state approach, the brain regions or brain networks that are sensitive to treatment and that can predict the everyday activities for which treatment is likely to be effective.

In nonpharmacological studies, the selected task is usually training-driven, i.e., it is built to verify improvement in activity in brain regions known to subtend the training-related functions. For instance, in the Explicit-Memory Training proposed by Hampstead and colleagues , patients acquired mnemonic strategies using face-name associations and the fMRI task used the same paradigm to test its efficacy. However, there are some studies using generic fMRI tasks as well as clinical outcome measures assessing global cognitive status which are not specific and/or unrelated to the performed training. The risk in these latter cases is to observe changes in fMRI activity unrelated to the training.

Finally, no study to date has directly compared clinical/cognitive versus fMRI outcome effect sizes in order to define which marker is the most powerful in reflecting treatment effects over time.

Recommended Reading: Dsm 5 Alzheimer’s Disease Criteria

Dementia Care Managementinformationen About $cms: If$$cms: Valueconvert2$$cms: End: If$

Dementia Care Management is a care concept that was specially developed for people with dementia. They and the people close to them are supported in their home environments by professional caregivers. They check what support is needed and arrange for it to be provided. That can include care provision, respite services for non-professional caregivers, medical measures, or psychosocial support. The first studies into this care concept are positive: Those affected were able to stay living at home for longer and the burden on non-professional caregivers was reduced. People with Alzheimer’s also found it easier to regularly take their medication. There are currently not many Dementia Care Managers in Germany the aim is to increase the number of Dementia Care Management offers in coming years.

Characteristics Of The Included Studies

The 10 selected MAs reported 315 RCTs with 1331,217 AD patients. Four MAs assessed the effects of acupuncture therapy, three assessed exercise , one assessed cognitive stimulation therapy , one assessed music therapy, and one evaluated repetitive transcranial magnetic stimulation . The details of the included MAs are shown in Table 1, and the specific type, content, intensity, and duration of each of the five interventions evaluated in these MAs are shown in Supplementary Material 3.

Table 1. Characteristics of the included meta-analyses.

Don’t Miss: How To Diagnose Early Dementia

The Logic Of Applying Personalised Medicine To Cognitive Decline And Dementia

Personalised medicine addresses chronic disease with a holistic lifestyle approach common to Eastern mind-body-spirit traditions, which emphasise prevention rather than treatment, and focus on the person instead of the disease . Lifestyle recommendations include healthy eating, active living, healthy weight and emotional resilience. A sub-optimal lifestyle is associated with the development and prognosis of long-term conditions. An individuals health metrics are used to design patient-specific prescriptions for diet, exercise, stress and environment. In this way, lifestyle medicine-oriented therapeutic strategies can improve individual health outcomes and manage chronic disease .

Underlying this approach is the bodily process of homeostasis whereby the body self-regulates to changes within or outside the system to maintain a dynamic state of equilibrium called health , also formulated as the ability to adapt and self manage . Normal mental function depends on a balance between synaptoblastic and synaptoclastic activity . When maintenance is unbalanced by deficiencies or pollutants, cells cannot be replaced and synaptoclastic processes win, resulting in cognitive decline. By correcting the environment to support healthy growth and repair while reducing toxins and infections, cells can rejuvenate.

Profile Of Aging And Cognitive Impairment In Missouri

To better understand the realities of caring for older adults living in Missouri, we must consider demographic changes occurring in the state. Older adults currently comprise 15.7% of the population in Missouri, an increase of 4.7% since 20101. This places Missouri as one of eleven states in which the older adult population comprises greater than 14% of the total state population1. With an estimated annual increase of approximately 3%, the total population of older adults in Missouri is expected to increase 41% by 20302.

Compounding the complexities of providing health and social services to our older adult population is the fact that Missouri falls short in multiple areas of health status and health care for older adults. Overall, Missouris older adults are ranked 40th in senior health, having fallen four spots in the past two years2. Moreover, the number of older adults who self-report their health as good or excellent is only 48% and has remained unchanged since 19992. When coupled with the fact that we are ranked 25th in terms of a geriatrician shortfall, 38th in preventable hospitalization, and 35th in unnecessary hospital re-admissions, Missouri health care providers have area for improvement in providing care for older adults2, particularly for those Missourians who are experiencing cognitive impairment.

Don’t Miss: What Is Considered Early Onset Alzheimer’s

Mental Stimulation Programs And Enjoyable Leisure Activities

RCTs have evaluated cognitive stimulation activities such as puzzles, word games, indoor gardening, discussions of the past/reminiscence therapy, and baking. A 2012 Cochrane review of 15 RCTs concluded that cognitive stimulation programs are beneficial for maintenance of cognitive function and self-reported quality of life in patients with mild to moderate dementia due to Alzheimer disease.37 However, this meta-analysis also noted that cognitive stimulation techniques are highly variable and lack standardization, and that studies evaluating these techniques were of poor quality and found no effects on functional status, behavior, or mood. When cognitive and quality-of-life benefits were observed, they were noted immediately after the programs ended and were sustained for up to three months.

Enjoyable leisure activities have been shown to slow memory loss in patients with mild cognitive impairment and mild to moderate dementia. Enjoyable leisure activities have also been associated with improved functional capacity and reduced neuropsychiatric symptoms in patients with dementia.38

Cognitive stimulation programs and engagement in enjoyable leisure activities are safe and effective interventions in patients with dementia due to Alzheimer disease at any stage of severity. Such programs are most easily implemented in institutional settings, but community-dwelling patients with Alzheimer disease should also be encouraged to engage in these activities.

Strengths And Weaknesses Of The Review

A comprehensive evaluation of the efficacy of multiple non-pharmacologic interventions in patients with AD is currently lacking, so we summarized and compared the determining efficacy of five non-pharmacologic therapies evaluated in 10 MAs. To our knowledge, this overview of MAs is the first to compare multiple non-pharmacologic strategies to facilitate decision making systematically. To reduce the risk of bias, we only included MAs of RCTs and excluded narrative reviews and reviews with non-RCTs and observational cohort studies. We assessed the quality of the reviews against the 16 domains of AMSTAR 2, which, compared with AMSTAR, has a wider range of applications and more scientific evaluation methods . We assessed the significant outcomes by the GRADE system to determine the strength of evidence. Most of the evidence of the included primary trials were acknowledged as of poor quality. We also identified the deficiencies of current studies and make recommendations for further research on non-pharmacological interventions for AD.

Read Also: What Happens In The Last Stage Of Alzheimer’s

Fighting Depression And Anxiety

Other drugs including antidepressants, anticonvulsants, antipsychotics, anti-anxiety drugs, and sleep aids are sometimes used to treat behavioral problems associated with Alzheimers disease.

When counseling, support groups, or other nondrug methods dont help with depression or anxiety, doctors may prescribe one of the following drugs:

Because of potentially dangerous side effects, doctors prescribe other drugs with extreme caution.

Insomnia can be a problem for some people with Alzheimers, but sleep aids such as zolpidem can cause confusion and lead to falls.

Antipsychotics like risperidone can increase the risk of death in some older people with dementia, so doctors prescribe them only as a last resort to alleviate severe hallucinations, paranoia, agitation, and aggression.

Benzodiazepines, such as diazepam , should also be generally avoided in patients with Alzheimers disease. There is also some research that shows a correlation between benzodiazepine use and an increased risk of being diagnosed with Alzheimers.

What Are Cognitive Therapiesinformationen About $cms: If$$cms: Valueconvert2$$cms: End: If$

The term cognitive is used as a collective name for everything that has to do with the mental abilities of an individual, for example perception, thinking and remembering. There are various types of cognitive interventions for people with mild to moderate Alzheimers. They may include things like arithmetic problems, or exercises in which series of numbers are to be completed, or in which images have to be remembered and recognized. There are also exercises involving words and puzzles, as well as interventions in which people practice doing everyday things like shopping. These exercises are offered in either one-on-one or group sessions which usually take place one or two times per week, with each session lasting 30 to 90 minutes.

Another widely used intervention is called reality orientation training. This approach aims to help improve peoples orientation in space and time. It involves repeatedly giving people with Alzheimer’s basic information such as their name, the date or the time. This is done in conversations or by placing orientation aids around the persons home. Orientation aids might include things like large calendars, or door signs with the names of the rooms on them.

Also Check: How To Get Dementia Patients To Take Pills