Non-drug interventions for Alzheimer’s disease

Photo of an older woman playing a board game with a younger woman
PantherMedia / Ramona Heim

There are a number of options for treating Alzheimer's disease other than medication. These include memory training, psychosocial activation and physical exercise programs. Some of these methods 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, and there is no way to stop it from getting worse. But there are medications and non-drug interventions that aim to delay the loss of mental abilities, to help people stay independent in everyday life for longer, and to improve their quality of life. These non-drug interventions include memory and orientation exercises, art therapy, aromatherapy and music therapy, and contact with animals, as well as caregiver training for family members.

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.

Which non-drug interventions are suited for which people?

That depends on things like the person’s symptoms, how far the disease has progressed, and the causes of certain behaviors. Different therapy goals can influence the decision too. The person's life history, personality and current life circumstances 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, and that they allow a sense of achievement. Which non-drug interventions are most suitable for a specific individual and improve that person's quality of life is best found out with the help of specialists, for example in the fields of medicine, nursing, psychology, social work, occupational therapy and physiotherapy.

What are cognitive therapies?

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 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 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.

Can cognitive techniques help with Alzheimer’s disease?

Studies suggest that cognitive interventions can temporarily improve mental performance and language abilities in mild and moderate Alzheimer’s 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 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 can be patronizing.

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

What are the effects of physical, mental 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 amount of care needed. No studies carried out thus far have been able to say whether these kinds of activities can also help with problems like challenging behavior (such as aggression or severe restlessness).

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. 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.

The effect of sport and exercise on the mental performance of people with Alzheimer's is still unclear. Studies have produced inconsistent results.

How do emotion-oriented treatments work?

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 caregivers do not judge the behavior of those with the disease, and accept them and their feelings as they are. The aim is to make them feel understood, safe and comfortable.

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 . Studies point out that reminiscence therapy can improve mood and mental performance, even though the studies found those effects to be rather minor.

What can caregiver training for family members offer?

The increasing amount of care that people with Alzheimer's need can become a big burden and challenge for family members. 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 to suggest that special training in how to deal with challenging behavior has a positive effect. It could help to reduce aggression and restlessness, and also help caregivers to cope better with this kind of behavior.

Although caring for a loved one 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 they know. But 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.

Can occupational therapy or psychotherapy help?

Occupational therapy is an effective treatment method to train everyday abilities, such as getting dressed and housework. Occupational therapists help people with Alzheimer's to keep on living as independently as possible. They offer a number of exercises and activities, provide advice, and suggest adjustments in everyday life. Occupational therapy can also include concentration and memory training.

Psychological treatment may be considered if the disease causes severe mental health issues. It might aim to help people cope with the illness better and remain independent in everyday life for as long as possible. Anxiety disorders and depression are also common in people with Alzheimer's and can be treated with psychotherapy.

How important is diet?

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 that other dietary supplements had any benefits, either.

Can technical support systems like robots be beneficial?

Technical support systems for people with Alzheimer's include virtual solutions (like apps) as well as robots which provide support for everyday activities but also therapy and emotional support. They aim to help to structure days, but also to relieve anxiety, apathy, restlessness, aggressive behavior and sleep problems. Only a few comparative studies have looked into whether technical options can relieve these kinds of symptoms. Most of those studies looked into the effects of what are known as 'care robots (such as "paro" robots and "human" robots). The studies did not identify any benefits to these robots, though.

Dementia Care Management

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.

What other non-drug interventions are there?

A large number of other non-drug interventions are available for the treatment of Alzheimer’s disease, such as aromatherapy. It is thought to help relax people who are restless or aggressive. Studies carried out so far have not been able to find any benefits to this treatment, though. The benefits of animal-assisted therapies, with dogs for instance, are also not clear.

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on March 29, 2022
Next planned update: 2025

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Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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