Nonpharmacologic Treatment of Alzheimer's disease

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Following are the discussions on the nonpharmacological treatment of Alzheimer's disease and dementia.

Recreation and therapeutic activities

Recreation therapy can be provided as treatment or as recreation for patients with Alzheimer's disease. The recreational/therapeutic activities reviewed were: music therapy, cognitive therapy, reminiscence therapy, validation therapy, and other approaches.

Music therapy

Music therapy includes singing, instrument playing, dance or movement, listening to music (classical, calming or favorite music), musical games, and/or composing. Music of the patient's choice reduced agitation, aggression and mood disturbances under various conditions, including eating and bathing, in patients with Alzheimer's disease. A review of previous studies showed that music therapy is an effective method for treating symptoms of dementia. Another systematic review showed that music stimulated cognition and emotional response, and encouraged movement.

Cognitive therapy

Cognitive therapy is an intervention to facilitate learning and retain information. It uses a spaced-retrieval method for retention of names of common objects, location of objects and face-name association, and cognitive stimulation. Only one well-made study on cognitive intervention in Alzheimer's disease was reviewed. The results suggest that the small gains in learning personal information does not generalize to overall better functioning or improvement in patient quality of life.

Reminiscence therapy

Reminiscence therapy has been defined as vocal or silent recall of events in a person's life, either alone, or with another person or group of people. It typically involves group meetings, held at least once a week, in which participants are encouraged to talk about past events, often assisted by aids such as photos, music, objects and videos of the past. Reminiscence therapy is a program based heavily on long-term memory, providing a means for the elderly to present their lives and themselves in a way that draws insight to the present.

A review of studies on reminiscence therapy showed that its benefits are unclear, although it may improve sociability, orientation, and information sharing.

Validation therapy

Validation therapy is used for communicating with old patients with Alzheimer's disease. The benefits for patients include: restoration of self-worth; minimization of the degree to which patients withdraw form the outside world; promotion of communication and interaction with other people; reduction of stress and anxiety; stimulation of dormant potentials; and help in resolving unfinished life tasks. A review of the studies showed that there is insufficient evidence to make conclusions about the efficacy of validation therapy for patients with dementia or cognitive impairment, although observational studies suggest there may be some positive effects.

Other approaches

A strong study demonstrated that a program of walking while engaged in conversation improved communication function. Another study found that skills-training program appeared to improve self-care ability.

Patient education, support and counseling

As Alzheimer's disease is an insidious disease recognizable at its moderate stage and a chronic illness with a terminal course, the practitioner whom the patient was referred to should carefully consider certain factors. Early detection and accurate diagnosis are crucial in chronic illness management to prevent progression of the disease to a state of irreversibility. In Alzheimer's disease cases, this is also true. However, once certain practitioners are cautioned against delivering the diagnosis quickly and offering a brief statement that nothing can be done. Given the opportunity, many patients will discuss their thoughts and feelings -- shock, anger, disbelief, fear and despair -- after receiving the bad news. Some patients feel that they have been given a death sentence, a loss of self.

The Alzheimer's Disease Association of the Philippines believes that it is the patient's right to be informed of his or her diagnosis. Disclosing the disease gently and slowly with a listening attitude is, more often than not, the beginning of a successful treatment program with the active participation of informed patients. Alzheimer's disease patients have the right to determine how they will live their remaining years while they still have cognitive capacity in the early stages. Realistic discussions about the nature of their illness can be the basis for future plans. Qualified professionals aware of the emotional impact of Alzheimer's disease on patients should also be available to assist them, and help them adjust to and accept the realities surrounding their illness.

Maintaining physical health

Maintaining, if not improving, physical health and function through physical and occupational therapy or with the trained family caregiver is still the primary management goal for the elderly demented patient. A nutritionally complete diet, adequate exercise and immunizations to maintain wellness are not only for disease-free elderly people. Demented persons with depression are at higher risk for protein-energy malnutrition and functional decline, especially for the basic tasks of self-care and hygiene; hence a preventive attitude by healthcare providers will greatly improve the quality of life of the patient and family.

Ignoring intercurrent disease in general, especially in the early stages, is likely to have great negative impact on the quality of the remaining existence of the patient and caregiver. Dementia worsens rapidly with the following: adverse drug effects, infection, pain, cardiorespiratory problems or a subdural hematoma. Sleep deprivation and sensory deprivation can also worsen agitation and confusion so these factors have to be addressed accordingly.

Psychological approaches

An example of a training program that uses systematic behavioral approaches to behavior problems is titled “Managing and Understanding Behavior Problems in Alzheimer's Disease and Related Disorders.” The program consists of a series of ten videotapes and a written trainer's guide designed to provide background information about the disease, teach caregivers skills to modify behavior problems that interfere with proper care, and identify and address special needs of caregivers. through a systematic approach called the “ABCs of Behavior Change,” caregivers learn that “A” is the antecedent of a triggering event that precedes the problem behavior; “B” is the behavior of concern; and “C” is the consequence of that behavior. Once the chain of behavior occurrence and response is understood, caregivers are provided with methods to change either the antecedents or the consequences of the problem behavior.

Once the caregiver understands and is able to identify the ABCs of a problem, a step-by-step problem-solving strategy is implemented involving five steps:

  • Identify the problem.
  • Gather information about the circumstances surrounding the problem.
  • Set realistic goals and make plans to achieve those goals.
  • Encourage rewards for the patient and the caregiver for small successes.
  • Continually evaluate and modify plans.

Excerpt from Recommendations on the Treatment of Alzheimer's Disease, Alzheimer's Disease Association of the Philippines