Nondrug Treatments for Alzheimer's: A New Systematic Review

Summary:  A systematic review of clinical trials of nondrug treatments for Alzheimer’s disease found good evidence that a program of caregiver education and support lengthens the time a person with dementia can be cared for at home, rather than in an institution.  The same review found evidence (although not from large, well-designed trials) that some nondrug treatments for people with dementia and their caregivers may improve patients’ memory, mood, behavior and functionality as well as improve caregivers’ mood, psychological well-being and quality of life.  More research is needed to investigate the costs and benefits of nondrug treatments.

Research on drugs to treat memory loss dominates the headlines, but some researchers think nondrug treatments may be just as effective.  Sometimes called “nonpharmacological therapies” or “psychosocial interventions,” these nondrug treatments include physical exercise, caregiver education, cognitive stimulation, counseling, music therapy, reminiscence therapy and training on completing “activities of daily living” (ADLs).   Unlike drug-based treatments, these treatments are often for caregivers, as well as for people with memory loss.

“Psychosocial interventions can make a huge difference in people’s lives,” says Mary Mittelman, Director of Psychosocial Research and Support, Center of Excellence on Brain Aging and Research Professor, Department of Psychiatry at New York University.  “There should be more funding for them and they should be more reimbursable by insurance companies or government healthcare programs.”

Dr. Mittelman is one of 22 researchers who, after a 2005 conference on the topic, decided to systematically analyze existing clinical trials of nondrug treatments to evaluate how effective they are.

The group found more than 1300 studies on 26 types of nondrug treatments, and analyzed the 179 of those studies judged to be of high quality.  They found good evidence that a program of caregiver education and support lengthens the time a person with dementia can be cared for at home, rather than in an institution.  [This is a goal of drug-based treatments as well.]  They found lower quality evidence (generally from smaller or less well-designed trials) that caregiver education and support improves patients’ memory, mood, behavior and functionality about as much as drug treatments do.

The researchers also found some evidence for the effectiveness of other nondrug treatments including:

• Cognitive training and stimulation to improve memory and thinking in people with dementia
• Cognitive training to lessen behavioral problems in people with dementia
• Training to improve the ability of people with dementia to complete “activities of daily living”
• In- home counseling for people with dementia and their caregivers to improve caregiver quality of life
• Various combination treatments for people with dementia and caregivers.

It’s hard to draw overall conclusions about these studies because they didn’t all use the same measures of effectiveness.   In addition, the studies often involved combinations of treatments, so it was hard to say whether individual parts of that combination treatment were effective. 

The researchers did not find enough evidence for the effectiveness of other therapies when used alone, including transcutaneous electrical stimulation, physical exercise, music therapy, reminiscence, massage and touch, recreation therapy, use of light, multisensory stimulation, support and psychotherapy, validation, case management and respite care.   Some of these therapies were part of combination treatments that were judged effective, however.  The review authors emphasize that this doesn’t mean these therapies don’t work -- it simply means that there weren’t any large, well-designed studies completed by their 2008 cutoff date that showed they worked.

Nondrug treatments are worthy of more research, the study authors wrote.  Many of the treatments cost less than drugs, and involve more time than money.  Because there is little to no money to be made on these treatments, though, research funding will have to come from governments and charities.  But the benefits for patients and families could be significant.

 “Research suggests that Alzheimer’s pathology starts years before symptoms are apparent,” says Dr. Mittelman.  “So by a certain age, prevention won’t work, and treatment is the only possibility.  Sometimes drug treatments don’t make much difference, but no one is talking about the fact that psychosocial interventions do work.”  Maybe this new analysis will encourage more discussion of and more research on nondrug treatments.

Comments

[Marty]

Richard Taylor would love to see this! This is in line with what psychologists are pushing for in Alzheimer's treatment. See this piece in Psychology Today: http://www.psychologytoday.com/blog/fulfillment-any-age/201008/medicalization-the-mind
Thanks

[richard taylor]

Hello, yes this is a step ion the right direction. Why we need to "prove" to others that psycho social interventions work, and work better than drugs, are are less costly than drugs, and have fewer short and long term side effects than drugs escapes me. What about you?
Richard

[Mona Johnson]

Hi Richard and Marty,

Richard, I guess the problem is that psychosocial interventions take more effort than swallowing a pill, and are not always "one size fits all." And there's no easy way to make money from them.

Also, it seems to me that some promising interventions, including cognitive rehabilitation, need more research, and it's worthwhile to try to prove that they work.

[Karin Gatch]

Hello all,
My father and I used very few meds. over the nearly 9 year journey of Alzheimer's with my mother. We did keep her very active and stimulated right up until her journey ended on Jan. 3, 2011. The "experts" gave her 1 to 2 years. We certainly showed them and chose to be very active in her journey even when we used adult day care and during her 2 years and 3 months in a home designed for Dementia and Alzheimer's care only. Her eyes and smile lit up right up to the last five days of her life by knowing how to stimulate her positively each and every day. This method also gives the caregiver the strength and joy needed to join their loved one's journey.

[Diane]

Thank you for the positive comments. I was diagnosed with MCI 9 months ago. I'm socially active with friends and in my church. I plan to do all I can as long as I can. I've worked as a nurse in care centers and enjoyed the dementia patients very much. I plan to enjoy my life. I'm physically healthy and will probably outlive my spouse. I'm 70 and I don't wish to worry over something I can't change.