The Tangled Neuron

Beyond Drugs: Other Ways To Treat Alzheimer's and Dementia (Part 5 - The Seattle Protocols)

Summary:  Based on more than twenty years of clinical trials, Dr. Linda Teri and colleagues have developed a series of behavioral techniques and caregiver training programs know as the Seattle Protocols.  Their research has shown that nondrug treatments for people with dementia can reduce depression, anxiety and general behavioral problems in people with dementia, decrease disability, delay institutionalization and reduce burden and depression in caregivers.

This is the last in a series of posts about presentations during the Psychosocial Issues and Neuropsychology session at ICAD 2008.  We hear a lot about clinical trials of Alzheimer's drugs, but there isn't much coverage of clinical trials of the nondrug treatments discussed in this session.  Maybe this is because nondrug treatments don't promise a cure.  But they can reduce health problems in people with dementia and their caregivers, whether those problems are physical or psychological.

Beyond Drugs: Other Ways to Treat Alzheimer's and Dementia (Part 4 - Pyschosocial Risk Factors in African-Americans)

Summary:  The level and effect of psychosocial risk factors for Alzheimer's may not be the same for African-Americans and Whites.  This could mean we need different methods to prevent, diagnose and treat cognitive problems in African-American and White populations.  Large-scale studies are needed to confirm this finding.

Alzheimer's is equal opportunity and color blind, right?  Well, not exactly.  We already know that some risk factors, such as diabetes, are more common among African-Americans.  And we know that other risk factors, such as the APOE4 gene variation, may affect African-Americans differently than Whites.  But what about psychosocial factors such as emotional states or the strength of social networks? 

Lisa Barnes, Ph.D.

Dr. Lisa Barnes gave a presentation on "Psychosocial Factors and Cognition in African-Americans and Whites" during the "Psychosocial Issues and Neuropsychology" session at ICAD 2008.  Dr. Barnes, who is Associate Professor of Neurological Sciences and Behavioral Sciences at the Rush Alzheimer's Disease Center, sent me some additional information via email to round out my understanding of her work.

The data she presented at ICAD was from participants in three large, ongoing studies at Rush:  the Chicago Health and Aging Project, the Memory and Aging Project and the Minority Aging Research Study.  In these populations, she and her colleagues (including Dr. Robert Wilson) have found the following differences in the level of psychosocial risk factors between the two races:

• African-Americans are more likely to experience negative emotions or distress than Whites
• African-Americans tend to experience more depression than Whites
• African-Americans report lower levels of social engagement than Whites. 

Beyond Drugs: Other Ways To Treat Alzheimer's and Dementia (Part 3 - Cognitive Rehabilitation)

Summary:  Preliminary results of a large trial of cognitive rehabilitation for people with Alzheimer's are encouraging.  Cognitive rehabilitation could help keep people with mild Alzheimer's functioning in the community and at home.

Another great presentation in the "Psychosocial Issues and Neuropsychology" session at ICAD 2008 was Dr. David Loewenstein's update on a clinical trial of cognitive rehabilitation for people with Alzheimer's.  Dr. Loewenstein is Director of Research and Neuropsychology at the Wien Center for Alzheimer's Disease and Memory Disorders, and professor of Psychiatry and Behavioral Sciences at the University of Miami's Miller School of Medicine.

The value of cognitive rehabilitation is well-established for people with brain injuries and for older adults in general, he said.  But for people with Alzheimer's, it's a bit more complicated.  This is because rehabilitation must be designed to work even as the disease may be progressing, and because the parts of the brain affected in Alzheimer's make it hard to use standard rehabilitation methods.

Beyond Drugs: Other Ways To Treat Alzheimer's and Dementia (Part 2 - The Problems with Drug Treatments for Psychological Symptoms)

In a previous post on the "Psychosocial Issues and Neuropsychology" session at ICAD, I wrote about Dr. Alistair Burns' presentation on  how caregiver interventions and nondrug therapies can help reduce dementia-related psychological symptoms like agitation and anxiety.  During the same session, Dr. Clive Ballard, Director of Research for the Alzheimer's Society and a Professor at Kings College London Institute of Psychiatry, made the case for why we need nondrug interventions.  Dr. Ballard focused on reviewing the evidence that drug treatments are often sub-optimal.