Dementia in Alzheimer’s disease: Can non-drug interventions like education programs for family members help people who have Alzheimer’s?

After attending education programs, family members can possibly care for people who have Alzheimer’s at home for a longer time. Some therapies seem to help people who have Alzheimer’s maintain their mental abilities for a longer time. 

Dementia is common in old age: about 1 out of 20 people between the ages of 70 and 79 are affected by it (5%). The figure rises to just under 1 in 6 people between the ages of 80 and 89 (about 18%), and as high as to 1 in 3 people over the age of 90 (32%). In the most common form of dementia, Alzheimer’s disease, more and more brain cells degenerate over time due to various processes in the brain. These processes often already start years before the first symptoms arise.

At first, people who have Alzheimer’s appear to be scatterbrained and forgetful. As the disease progresses, their memory becomes a lot worse, particularly their short-term memory. They start having problems with orientation in time and space and it becomes harder for them to manage everyday situations and processes. Organizing everyday life and doing things like shopping and household chores becomes increasingly difficult. For some people who have Alzheimer’s, their personality will change and they will become depressed or easily irritable, for example.

Alzheimer’s disease progresses over time. There is currently no known cure, but there are different treatment options. You can read more about treating Alzheimer’s disease with medication (anti-dementia drugs) and herbal drugs here (URL: http://www.informedhealthonline.org/index.603.56.en.html) .

There are also strategies such as memory training, doing everyday activities with others, or education programs for family members. The German Institute for Quality and Efficiency in Health Care (IQWiG) – who produce this website – looked at what people who have dementia can expect from these interventions.

Trials on non-drug treatments for Alzheimer’s disease

IQWiG, together with researchers from Freiburg, analyzed 33 trials on non-drug treatments for Alzheimer’s disease involving about 3,800 participants. The participants were randomly assigned to 2 (or more) groups: a treatment group that did memory training exercises, for example, and a control group that did not receive this treatment. You can read more about why this procedure is important for establishing the usefulness of a trial here (URL: http://www.informedhealthonline.org/index.61.en.html) .

The researchers divided the interventions studied in the trials into 4 categories: education programs for family members, cognitive treatments, activation-oriented treatments and emotion-oriented treatments. There are also other non-drug treatments for Alzheimer’s – for example, art, aroma and music therapy as well as the use of animals – but these have not been studied in good quality trials. The benefit of the non-drug treatments covered here has not been directly compared with that of anti-dementia drug therapy in scientific research.

Family education programs

People who have Alzheimer’s need more and more help as the disease progresses, which can be a great burden and challenge for family members. As a way of supporting family members in their role as caregivers, education programs were developed. The aim of these programs is to teach how to assist people who have dementia to maintain their abilities as long as possible. They should also help family members to better understand the disease and learn to solve practical problems related to the care of people with Alzheimer’s, for instance by making the home environment better suited for old people. An important part of many of these programs is also sharing experiences with other family caregivers.

Education programs for family members were tested in 17 trials involving just under 3,000 participants. Most participants had moderate dementia and were between 70 and 80 years old. One large trial suggested that people with Alzheimer’s can live at home for a longer time when the family members who care for them attend education programs. Some important issues for both people who have dementia and their family members were often left unaddressed by these trials: for example, whether educating family members improves the quality of life of both the individuals who have Alzheimer’s and the caregivers, or whether those who have Alzheimer’s end up needing less care.

In 4 trials possible adverse effects of a family member education program on the person receiving care were also studied. In 2 of these trials the people who had Alzheimer’s whose family members had attended an education program were admitted to the hospital or emergency room more frequently – the causes of this were not reported.

Because most of the research on education programs for family members was done in the USA, it is difficult to say how well these results may be applied to circumstances in Germany.

Caring for an individual who has Alzheimer’s is a great challenge. Yet at the same time, many family members do find it to be an enriching experience to care for their own parents or partner. They make it possible for them to remain in a familiar environment and to be cared for by people who are close to them. It is important for these family members to get support and help to be able to better cope with situations that can be stressful and disheartening.

Cognitive treatments

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 different cognitive interventions. These include exercises similar to those in intelligence tests, for instance arithmetic problems and exercises in which series of numbers are to be completed or where images have to be remembered. There are also tasks for practicing activities of daily living, like shopping.

Another common strategy is a so-called reality orientation training program, which is intended to help people to orientate themselves in space and time. This program involves, for instance, repeatedly giving basic information to individuals who have dementia in the course of conversation, such as their name, the date or the time. Another strategy could involve placing orientation aids in the apartment or nursing home, like large calendars, or affixing name plates to the doors. Cognitive treatments are mostly used in the early stages of dementia. The hope is that they are able to help maintain the individual’s mental abilities for as long as possible.

Cognitive treatments were tested in 7 trials involving about 400 participants. Many of them also took medication. The participants were between 66 and 78 years old on average, and in an early stage of disease. The trials suggested that cognitive treatments could improve mental abilities in people who have mild Alzheimer’s disease. But they only measured cognitive abilities using questionnaires and did not find out, for instance, whether someone was better able to manage household chores again. For this reason it is not clear how these treatments influence daily life.

The research did not report about adverse effects. It cannot be ruled out however that cognitive treatments might sometimes have adverse effects. For example, it could be very frustrating for someone with dementia if they fail to solve an exercise again and again. A reality orientation training program could possibly lead to even more confusion.

Physical and psychosocial activation

There are treatments in this category that focus on different kinds of activities, for example discussion groups on various topics, preparing food together, practical things like tooth-brushing, making coffee or writing letters, and physical exercises for improving strength, endurance and balance.

The effect of psychosocial activation on people who have Alzheimer’s was tested in 4 trials involving 200 participants between the ages of 68 and 88 years. These trials showed that social activities like discussion groups, listening to music or preparing meals together with caregivers could improve quality of life for the caregivers. What is more, the people who had Alzheimer’s required less care, but there was no evidence of their quality of life improving. But there is not enough research on these treatments either to make any final conclusions.

The effects of physical activity were studied in only one trial that had 134 participants. Some were in the early stages of the disease, while others had advanced Alzheimer’s disease. They had a 60-minute training twice a week in which they moved quickly through a course while making stops to do exercises for strength, agility and balance. At these stops the participants were to do squats, lift their legs sideways or stand on their tiptoes, for instance.

In the trial on physical activity it became apparent that the participants who had been doing the physical exercises were admitted to the hospital more often than those in the control group. The trials did not report what the reasons for this were, but serious problems like falls or broken bones did not occur. More research is needed to find out which physical exercises are suitable for people who have Alzheimer’s disease.

Emotion-oriented treatments

Emotion-oriented treatments are interventions that take the feelings, values and experiences of people who have Alzheimer’s disease as a starting point. One type of intervention is called validation, which attempts to improve the quality of life for individuals who have Alzheimer’s disease by using specific discussion techniques and placing emphasis on personal closeness. In this approach, others act in a caring manner, do not judge the behavior of the person who has Alzheimer’s, and accept the feelings he or she expresses as they are.

Another kind of emotion-oriented treatment is reminiscence therapy. The word “reminiscence” has Latin roots and has a meaning similar to “remembering”. In reminiscence therapy individuals who have Alzheimer’s are encouraged to talk about subjects such as their hometown, school days or work in individual or group settings. This aims to promote mental abilities, but also to improve quality of life and lessen the mental effects of dementia, such as depression. Emotion-oriented treatments were tested in only 3 trials of about 100 participants. This is too little research to be able to properly assess the effect of these therapies.

Possible adverse effects were not recorded in the studies on emotion-oriented treatments, either. It is true here as well that they cannot be ruled out in general.

You can read more about what can be done against Alzheimer’s disease and which options there are for support in our feature (URL: http://www.informedhealthonline.org/index.603.56.en.html) on the topic of dementia.


Author: German Institute for Quality and Efficiency in Health Care (IQWiG)


Note

This health information is a summary of a scientific report published by IQWiG. It is not an assessment of the right to have health care services reimbursed by statutory health insurance funds in Germany. By law, decisions about the reimbursement of diagnostic and therapeutic procedures can only be made by the German Federal Joint Committee (G-BA). The Federal Joint Committee takes IQWiG reports into consideration in its decision-making process. You can find information about the decisions of the German Federal Joint Committee on its English-language website, www.english.g-ba.de (URL: http://www.english.g-ba.de/) .