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Alzheimer's Patients Can Still Learn

Exercises help them retain memory, cognitive skills

FRIDAY, July 2, 2004 (HealthDayNews) -- People in the early stages of Alzheimer's disease might have more capacity to learn new things than previously thought.

The findings may eventually make life easier for patient and caretaker alike. They are the result of two new studies supported by the National Institute on Aging (NIA).

"This is the first time we've shown that a non-pharmacological intervention can actually augment a pharmacological intervention," said David Loewenstein, lead author of the first study and director of research at the Wien Center for Alzheimer's Disease and Memory Disorders at Mt. Sinai Medical Center in Miami Beach. "As we develop more effective medications and hopefully maybe even start stopping the disease in its tracks, we are still going to have millions of individuals who are going to have cognitive and functional deficits because of brain impairment that has already occurred. This type of intervention may be able to help."

Alzheimer's disease is a progressive deterioration of brain processes whose early trademark symptom is the erosion of a person's memory. Currently, the disease affects about 4.5 million Americans; that number is expected to rise as the population ages.

The first study, appearing in the July-August issue of the American Journal of Geriatric Psychiatry, involved 44 people all taking cholinesterase inhibitor drugs such as Aricept who were randomized into one of two groups. The first group attended 45-minute "cognitive rehabilitation" sessions twice a week for 12 weeks.

The lessons included learning to associate names with facial features (for example, Smiling Sam), ways to make change for a purchase, and how to use a calculator to balance a checkbook after paying three bills. There were also exercises designed to improve attention span and cognitive processing speed.

The second group played computer games requiring memory, concentration and problem-solving skills. They also did crossword puzzles and word scrambles.

People in the cognitive rehabilitation group showed, on average, a 170 percent improvement in their ability to recall faces and names and a 71 percent improvement in their ability to provide the right change for a purchase. The study shows the improvements remained three months later and more recent data shows they are still intact six months on, Loewenstein said.

"The patients and the caregivers got very excited because it's something they're doing that is constructive that is actually dealing with activities that are relevant to everyday life," Loewenstein said. "The alternative is to take medicine and hope for the best. These people are taking charge."

"This study is really the first to combine various techniques and look for outcomes that are more practical, and the effect seems to last at least three months," said Neil Buckholtz, chief of the NIA's Dementias of Aging Branch.

The findings are preliminary, however. "It would be premature to say how what they're doing would be quickly translated into some application, although certainly what they've found gives us an indication of promise for intervention," added Molly Wagster, the NIA's program director for Neuropsychology of Aging Research.

The second study, which appeared in the June 10 issue of Neuron, involved 34 young adults, 33 older adults without any symptoms of Alzheimer's, and 24 older adults with early symptoms of Alzheimer's. They were looking at a type of "implicit" or subconscious memory, which helps people act faster on items they are familiar with than on new items.

All of the groups were faster when asked to categorize repeated words rather than new ones, indicating that this ability remains intact in people with early Alzheimer's. Functional magnetic resonance imaging (fMRI) indicated the brain did not have to work as hard when a word was repeated.

"This kind of memory is automatic, unconscious," said study author Cindy Lustig, who did the research while she was a postdoctoral fellow in psychology at Washington University in St. Louis. "The brain areas involved in high-level, complex thought are affected by aging and Alzheimer's disease, but they can still benefit and show changes related to learning. Our question now is how to best target those preserved abilities so that they can be translated into training and rehabilitation programs to help older adults, especially those with Alzheimer's disease."

More information

To learn about treating Alzheimer's, visit the National Institute on Aging's Alzheimer's Disease Education and Referral Center.

SOURCES: David Loewenstein, Ph.D., professor, psychiatry and behavioral sciences, University of Miami School of Medicine, and director, research, Wien Center for Alzheimer's Disease and Memory Disorders, Mt. Sinai Medical Center, Miami Beach; Neil Buckholtz, Ph.D., chief, Dementias of Aging Branch, National Institute on Aging, Bethesda, Md.; Molly Wagster, Ph.D., program director, Neuropsychology of Aging Research, National Institute on Aging, Bethesda, Md.; Cindy Lustig, Ph.D., former postdoctoral fellow, psychology, Washington University, St. Louis; July-August 2004 American Journal of Geriatric Psychiatry; June 10, 2004, Neuron
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