Non-drug interventions for Alzheimer’s disease
Non-drug interventions for Alzheimer’s disease include things like memory training, mental and social stimulation, and physical exercise programs. Some of these strategies could possibly improve people’s cognitive performance and increase their independence.
As Alzheimer’s disease progresses, it becomes more and more difficult for people to do everyday activities on their own. They become forgetful and increasingly have problems expressing themselves in words. Their orientation in space and time gets worse and their personality changes. This makes good-quality care and emotional and social support all the more important: People who have Alzheimer's need loving and stable relationships and an understanding environment.
There is currently no cure for Alzheimer’s disease. As well as medications, there are non-drug interventions that aim to delay the loss of mental abilities, to help people stay independent in everyday life for as long as possible, and to increase their wellbeing and quality of life. These non-drug interventions include memory and orientation exercises, art therapy, aromatherapy and music therapy, and contact with animals. Caregiver training for family members is also offered.
It's often difficult to say how beneficial these common interventions are, though. A few of them have been very well studied. But there is hardly any high-quality research on many of the non-drug interventions. The most suitable options in any given case will depend on things like the person’s symptoms, how far the disease has progressed, the causes of certain behaviors, and their life circumstances. Different treatment goals can influence the decision too. The person's life history and personality play an important role as well.
It’s important to make sure that interventions don't demand too much of the person and aren’t stressful. They should allow a sense of achievement in order to improve quality of life. Which non-drug interventions are most suitable for someone is best found out with the help of specialists, for example in the fields of medicine, nursing, psychology, social work, occupational therapy and physiotherapy.
Cognitive therapy approaches
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 Alzheimer’s. 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 often take place one to 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 people’s 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 person’s home. Orientation aids might include things like large calendars, or door signs with the names of the rooms on them.
Studies suggest that cognitive interventions can improve mental performance in mild and moderate Alzheimer’s disease. They may improve the person's general wellbeing too. But it’s still not clear whether these interventions improve people’s mood or their ability to take care of themselves.
Side effects of cognitive approaches can’t 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 people with Alzheimer’s might consider to be patronizing.
It's important for cognitive approaches to be adapted to suit individual needs and overseen by a professional.
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 Alzheimer’s-related apathy. They can also reduce the need for care.
Just like with other people, physical activity has health benefits for people with Alzheimer’s. It’s important to ensure that older people are able to stay active so they don’t become bedridden, for instance. Studies have shown that people with Alzheimer’s 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.
The studies found that people who took part in some of the exercise programs had to go to the hospital more often, though. It isn’t clear why that happened. Exercise and sports can sometimes be too much for people and lead to injuries, so it’s important to adapt exercise programs based on a person’s abilities and needs.
It isn’t clear whether exercise also has a positive effect on the mental performance and mental health of people with Alzheimer’s disease.
Emotion-oriented treatment approaches focus on the feelings, values and experiences of people who have Alzheimer’s disease, and aim to improve their quality of life. One example is validation therapy. Here the caregivers use special communication techniques, being sure to create an atmosphere of closeness and care when interacting with the person who has Alzheimer’s. The aim is to make them feel understood, safe and comfortable. The caregivers do not judge the behavior of those with the disease, and accept them and their feelings as they are.
An example: A woman with Alzheimer’s can't find her purse and is absolutely sure that it must have been stolen. She is angry and wants to call the police. Telling her that she always forgets where her purse is would just make her even angrier at that point. In a validation approach, the fact that her purse is missing would not be questioned. The caregiver might be understanding and suggest a solution, such as looking for the purse together before contacting the police.
Reminiscence therapy is another kind of emotion-oriented treatment. The word “reminiscence” comes from the Latin word for remembering. In reminiscence therapy, people who have Alzheimer’s are encouraged to talk about topics such as their hometown, school days or work. This is done in individual or group settings. The aim is to improve their mental abilities as well as their quality of life, and lessen the psychological effects of Alzheimer’s, such as depression. Research suggests that reminiscence therapy can have a positive effect on mood and mental performance.
Caregiver training programs
People who have Alzheimer’s need more and more help as the disease progresses. This can be a great burden and challenge for their families and loved ones. Education programs have been developed to provide non-professional caregivers with support. The aim of these programs is to teach them how to help people who have Alzheimer’s to keep their abilities for as long as possible. They also try to help caregivers understand the disease better and solve practical problems related to the care of their loved ones. Sharing experiences with other non-professional caregivers is an important part of many of these programs.
Research has suggested that people with Alzheimer’s can live at home for a longer time if their caregivers take part in training programs. There is also some evidence to suggest that special training in how to deal with challenging behavior has a positive effect. It could help to reduce challenging behavior such as aggression and restlessness, and also help caregivers to cope better with this kind of behavior when it arises.
Although caring for a parent or partner with Alzheimer’s can be very challenging, many people say it is an enriching experience. They make it possible for their loved ones to stay in a familiar environment and to be cared for by people who are close to them. It is important for non-professional caregivers to get support and help so that they are better able to cope with situations that are often stressful and upsetting.
Some experts believe that eating a healthy diet helps to prevent or slow down Alzheimer's. A Mediterranean diet in particular is supposed to have a positive effect on memory and cognitive abilities. This sort of diet mainly includes a lot of vegetables, fruits, legumes, nuts, olive oil, whole grain products, fish and poultry. But there is no scientific proof that eating a Mediterranean diet can prevent or slow down Alzheimer's.
Various dietary supplements are claimed to improve mental performance. Some research has looked into whether fish oil capsules (omega-3 fatty acids) have benefits for people with Alzheimer's. They had no effect on the disease, though. There was no evidence that other dietary supplements had any benefits, either.
Other treatment options
A large number of other non-drug interventions are available for the treatment of Alzheimer’s disease. Some of these, such as reflexology and aromatherapy, have been tested in scientific studies. It isn’t clear how reflexology affects the symptoms. Aromatherapy is supposed to help relax people who are restless or aggressive, but studies on it haven’t determined whether or not it can help.
Occupational therapy, involving things like practicing everyday activities, is an effective treatment option. Psychological treatment may be considered if the disease causes severe mental health issues.
Burckhardt M, Herke M, Wustmann T, Watzke S, Langer G, Fink A. Omega-3 fatty acids for the treatment of dementia. Cochrane Database Syst Rev 2016; (4): CD009002.
Cheston R, Ivanecka A. Individual and group psychotherapy with people diagnosed with dementia: a systematic review of the literature. Int J Geriatr Psychiatry 2017; 32(1): 3-31.
Ernst E, Posadzki P, Lee MS. Reflexology: an update of a systematic review of randomised clinical trials. Maturitas 2011; 68(2): 116-120.
Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev 2015; (4): CD006489.
Forrester LT, Maayan N, Orrell M, Spector AE, Buchan LD, Soares-Weiser K. Aromatherapy for dementia. Cochrane Database Syst Rev 2014; (2): CD003150.
Goris ED, Ansel KN, Schutte DL. Quantitative systematic review of the effects of non-pharmacological interventions on reducing apathy in persons with dementia. J Adv Nurs 2016; 72(11): 2612-2628.
Hill NT, Mowszowski L, Naismith SL, Chadwick VL, Valenzuela M, Lampit A. Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis. Am J Psychiatry 2017; 174(4): 329-340.
Huang H-C, Chen Y-T, Chen P-Y, Huey-Lan Hu S, Liu F, Kuo Y-L et al. Reminiscence Therapy Improves Cognitive Functions and Reduces Depressive Symptoms in Elderly People With Dementia: A Meta-Analysis of Randomized Controlled Trials. J Am Med Dir Assoc 2015; 16(12): 1087-1094.
Huntley JD, Gould RL, Liu K, Smith M, Howard RJ. Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression. BMJ Open 2015; 5(4): e005247.
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Non-drug therapies in Alzheimer´s disease; commission A05-19D. January 13, 2009. (IQWiG reports; volume 41).
Korczak D, Habermann C, Braz S. The effectiveness of occupational therapy for persons with moderate and severe dementia. 05.08.2013 GMS Health Technol Assess 2013; 9: Doc9.
Leung P, Orrell M, Orgeta V. Social support group interventions in people with dementia and mild cognitive impairment: a systematic review of the literature. Int J Geriatr Psychiatry 2015; 30(1): 1-9.
Littbrand H, Stenvall M, Rosendahl E. Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review. Am J Phys Med Rehabil 2011; 90(6): 495-518.
Orgeta V, Qazi A, Spector A, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: systematic review and meta-analysis. Br J Psychiatry 2015; 207(4): 293-298.
Petersson SD, Philippou E. Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence. Adv Nutr 2016; 7(5): 889-904.
Potter R, Ellard D, Rees K, Thorogood M. A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia. Int J Geriatr Psychiatry 2011; 26(10): 1000-1011.
Rijpma A, Meulenbroek O, Olde Rikkert MG. Cholinesterase inhibitors and add-on nutritional supplements in Alzheimer's disease: a systematic review of randomized controlled trials. Ageing Res Rev 2014; 16: 105-112.
Travers C, Brooks D, Hines S, O'Reilly M, McMaster M, He W et al. Effectiveness of meaningful occupation interventions for people living with dementia in residential aged care: a systematic review. JBI Database System Rev Implement Rep 2016; 14(12): 163-225.
Van der Steen JT, van Soest-Poortvliet MC, van der Wouden JC, Bruinsma M, S., Scholten RJ, Vink AC. Music-based therapeutic interventions for people with dementia. Cochrane Database Syst Rev 2017; (5): CD003477.
Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012; (2): CD005562.
Zhang Y, Cai J, An L, Hui F, Ren T, Ma H et al. Does music therapy enhance behavioral and cognitive function in elderly dementia patients? A systematic review and meta-analysis. Ageing Res Rev 2017; 35: 1-11.
Zhu X-C, Yu Y, Wang H-F, Jiang T, Cao L, Wang C et al. Physiotherapy intervention in Alzheimer's disease: systematic review and meta-analysis. J Alzheimers Dis 2015; 44(1): 163-174.
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