Group therapy combining regular physical activity, cognitive tasks and active discussion can postpone the progression of cognitive decline in elderly dementia patients, and these therapy sessions appear to be as effective at improving cognitive function as anti-dementia drugs.
By Bob DeMarco
Alzheimer's Reading Room
Particularly, exercise, balance exercise, cognitive stimulation, continuing to live life the way you always have, diet, bright light, and the importance of socialization (use the search box on the right hand side of this webpage to learn more).
I'm not the only one. Many of us learned there is more there than can be imagined when it comes to a person living with Alzheimer's. For me this is very exciting research.
The MAKS system consists of motor stimulation(M), including games such as bowling, croquet, and balancing exercises; cognitive stimulation (K), in the form of individual and group puzzles; and practicing 'daily living' activities (A), including preparing snacks, gardening and crafts.
The therapy session began with a ten minute introduction, which the researchers termed a 'spiritual element' (S), where the participants discussed topics like 'happiness', or sang a song or hymn.
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MAKS: Drug-free prevention of dementia decline
There are many different causes of dementia and, although its progression can be fast or slow, it is always degenerative. Symptoms of dementia include confusion, loss of memory, and problems with speech and understanding. It can be upsetting for both the affected person and their relatives and carers. New research published in BioMed Central's open access journal BMC Medicine shows that a regime of behavioral and mental exercises was able to halt the progression of dementia.
Researchers led by Prof. Graessel, from Friedrich-Alexander-Universität Erlangen, included in their study patients with dementia from five nursing homes in Bavaria. After random selection, half the patients were included on the year-long MAKS 'intervention' consisting of two hours of group therapy, six days a week. In addition all patients maintained their normal treatment and regular activities provided by the nursing home.
The MAKS system consists of motor stimulation(M), including games such as bowling, croquet, and balancing exercises; cognitive stimulation (K), in the form of individual and group puzzles; and practicing 'daily living' activities (A), including preparing snacks, gardening and crafts. The therapy session began with a ten minute introduction, which the researchers termed a 'spiritual element' (S), where the participants discussed topics like 'happiness', or sang a song or hymn.
After 12 months of therapy the MAKS group maintained their level on the Alzheimer's Disease Assessment Scale (ADAS) and, even more importantly maintained their ability to carry out activities of daily living, while the control group all showed a decrease in cognitive and functional ability.
Prof. Graessel explained, "While we observed a better result for patients with mild to moderate dementia, the result of MAKS therapy on ADAS (cognitive function) was at least as good as treatment with cholinesterase inhibitors. Additionally we found that the effect on the patients' ability to perform daily living tasks (as measured by the Erlanger Test of Daily Living (E-ADL)) was twice as high as achieved by medication. This means that MAKS therapy is able to extend the quality of, and participation in, life for people with dementia within a nursing home environment. We are currently in the process of extending these preliminary results to see if this prevention of dementia decline can be maintained over a longer time period."
Currently available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia. Our objective was to assess the impact of a long-term non-pharmacological group intervention on cognitive function in dementia patients and on their ability to carry out activities of daily living compared to a control group receiving the usual care.
A randomised, controlled, single-blind longitudinal trial involving 98 patients (follow-up: n=61) with primary degenerative dementia in five nursing homes in Bavaria, Germany. The highly standardised intervention consisted of motor stimulation, practice in ADL, and cognitive stimulatio (acronym MAKS). It was conducted in groups of 10 patients led by two therapists for two hours, six days a week for 12 months. Control patients received treatment as usual. Cognitive Function was assessed using the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog), and the ability to carry out activities of daily living using the Erlangen Test of Activities of Daily Living (E-ADL test) at baseline and after 12 months.
Of the 553 individuals screened, 119 (21.5%) were eligible and 98 (17.7%) were ultimately included in the study. At 12 months, the results of the per protocol analysis (n=61) showed that cognitive function and the ability to carry out activities of daily living had remained stable in the intervention group but had decreased in the control patients (ADAS-Cog: adjusted mean difference: -7.7, 95% CI -14.0 to -1.4, P=0.018, Cohen's d=0.45; E-ADL test: adjusted mean difference: 3.6, 95% CI 0.7 to 6.4, P=0.015, Cohen's d=0.50). The effect sizes for the intervention were greater in the subgroup of patients (n=50) with mild to moderate disease (ADAS-Cog: Cohen's d=0.67; E-ADL test: Cohen's d=0.69).
A highly standardised, non-pharmacological, multicomponent group intervention conducted in a nursing-home setting was able to postpone a decline in cognitive function in dementia patients and in their ability to carry out activities of daily living for at least 12 months. Trial Registration www.isrctn.com Identifier: ISRCTN87391496
Source Non-pharmacological, multicomponent group therapy in patients with degenerative dementia: a 12-month randomised, controlled trial
Non-pharmacological, multicomponent group therapy in patients with degenerative dementia: a 12-month randomised, controlled trial
Elmar Graessel, Renate Stemmer, Birgit Eichenseer, Sabine Pickel, Carolin Donath, Johannes Kornhuber and Katharina Luttenberger
BMC Medicine (in press)
BMC Medicine - the flagship medical journal of the BMC series - publishes original research articles, commentaries and reviews in all areas of medical science and clinical practice. To be appropriate for BMC Medicine, articles need to be of outstanding quality, broad interest and special importance. BMC Medicine (ISSN 1741-7015) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, CAS, EMBASE, Scopus, Current Contents, Thomson Reuters (ISI) and Google Scholar.
BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.
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Original content Bob DeMarco, the Alzheimer's Reading Room