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ALZHEIMER TREATMENT AND
TRAINING
COGNITIVE TRAINING ON THE COMPUTER EXERCISES AND GAMES TO IMPROVE MEMORY AND COGNITIVE FUNCTION USE IT OR LOSE IT! SUMMARY OF RESEARCH FINDINGS The following research studies summarize the current research on the viability of applying cognitive rehabilitation techniques to the Alzheimer patient. Material presenting the rationale of cognitive habilitation focusing on the elasticity of brain structure, can be found on the web site www.brain.com, which also presents many exercises that could be used to increase cognitive functioning. The research studies could direct the reader to the research supporting the beneficial effects of practice or "exercising the brain" to maintain cognitive functioning. The phrase often repeated in the literature is "Use it or Lose it." The material in our training program teaches you how to Use It. Arkin (2001) found that rehabilitation interventions consisting of memory and language stimulation for mild to moderate Alzheimer patients for 28 weeks of treatment produces higher cognitive performance than a control group who only received physical stimulation. Moore, Sandman, and McGrady (2000) found that after participating in a 5-week memory training program Alzheimer patients showed improved performance on recall of names and faces, recognition memory and memory of significant events. They also improved their scores on a memory functioning test and decreased their reported depression. Their conclusion was that behavioral cognitive intervention in conjunction with pharmacological therapies will enhance cognitive function in patients with dementia. Davis, Masseman, and Doody (2000) found increases in learning personal information and attention after specific cognitive training in face-name association, spaced retrieval, and cognitive stimulation. Quayhagen and Quayhagen (2000) in a single subject design found that caregivers trained in cognitive therapy can improve the cognitive functioning of Alzheimer patients and can maintain those gains over a 2-year period. Claire, et al., (1999) and Claire, Wilson, Carter, et al., (2000) further examined the length of a treatment effect with home-based cognitive treatment with a single subject over a 2-year period and supported the prior study results that found a maintenance of improved memory after initial treatment. A summary of the results over the past decade is provided in a recent meta-overview of the clinical effectiveness of memory rehabilitation for mild to moderate Alzheimers patients by De Vreese, Nen, Fioravanti, et al. (2001). They examined three levels of memory rehabilitation with proven clinical efficacy; the facilitation of residual explicit memory at encoding and subsequent recall; priming and procedural memory and coping with limited explicit memory through the use of external memory aids. Their conclusion was that memory rehabilitation is clinically effective and pragmatically useful and should be employed to establish a proactive type of Alzheimer care. MEMORY TRAINING MAY HELP SOME ALZHEIMER'S PATIENTS IN THE EARLY STAGES OF THE DISEASE Simple, systematic memory training can help some people with early-stage Alzheimer's disease (AD). This finding points to a possible psychological intervention early in the course of this devastating brain disease. It also lends some urgency to early diagnosis, when patients who still have the ability to learn can use it to sharpen their memories and reduce disability. This encouraging news appears in the October issue of Neuropsychology, which is published by the American Psychological Association (APA). In London, neuropsychologists affiliated with University College London, The Open University, and the Medical Research Council Cognition & Brain Sciences Unit in Cambridge, England, were intrigued by anecdotal "success stories" of memory training provided by rehabilitation experts. Explains lead researcher Linda Clare, Ph.D., the evidence suggested that even without medicine, "There is a good deal that can be done to improve well-being [in AD]." To assess the validity of such training if standardized, Clare's team conducted a controlled study to see whether it would work with a larger group of people. They also wanted to learn whether the benefits of training endured. The researchers studied 12 participants (average age: 71) who were diagnosed with probable Alzheimer's Disease (AD) at the minimal or mild stage, when they still had some capacity for learning. Participants took neuropsychological tests of their general intellectual ability, memory, naming, visuospatial perception, attention and executive function. All of the participants were impaired on at least one of the memory tests, and some also were impaired on naming and perceptual tasks. Researchers also evaluated their mood, behavior, awareness of their memory problems, and the strain on the caregiver (usually the wife or husband) before and after the intervention. The researchers then trained participants to remember the names of people whom they had difficulty naming from a set of 12 photos that included people in their social network and famous people. They used such memory aids as mnemonic devices, which use the image to jog memory through some kind of meaningful association; "vanishing cues," a method in which participants fill in more and more letters in the person's name, until they can recall that name without any help; and "expanding rehearsal," in which people test themselves on what they've learned, in spaced intervals over time. All training minimized the chance of errors, which helped to reduce distress and raise confidence. By training participants' memory for just half of their photo sets, researchers were able to compare memory training with no training, for each participant. The memory training produced a statistically significant improvement in group performance on free recall of trained items. Participants kept their memory gains six months after training, and scores remained above baseline levels after 12 months -- even without further practice. These promising results suggest that clinicians may be able to design programs to help people hang on to their memory gains through ongoing new learning. "These methods could be applied very effectively by non-professionals such as friends, volunteers and family members," Clare points out. The authors speculate that the rehabilitation strategy might have worked by slowly re-establishing links between phonological (name) and semantic (person-specific) representations in the parts of the brain's neocortex, surface areas that deal with language and problem-solving, and are less damaged early in AD than areas known to be the most involved in forming new memories, such as the hippocampus. "This suggests that learning or relearning can take place without involving the hippocampus," says Clare, "albeit perhaps a little slower or less efficient. Although at this point we can only speculate, if other brain areas can take over some of the functions of damaged areas, then this opens up new directions for rehabilitation." In an important secondary finding, people who were more aware of their memory problems were more likely to respond well to memory training. The authors comment that, "Careful assessment of awareness could assist clinicians in determining the suitability of this form of intervention for individual patients." Another related recent finding is found in the Journal of the American Medical Association by Sherry Willis and Robert Wilson. They report that seniors over 60 benefit from memory training and that they retain the benefits long after the training program is completed. Both articles can be viewed on the APA Web site and the full text of the article is available from the APA Public Affairs Office at http://www.apa.org/journals/neu/press_releases/october_2002/neu164538.html A more telling report is found on the Novaritis website, www.alzheimersdisease.com. Although Novartis plugs their medication for Alzheimers, Exelon, they also advocate memory training and mental exercise to maintain memory skills. |
