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Recall Tricks Can Help Memory in Alzheimer's Patients

Drilling leads to some improvements on specific tasks

MONDAY, Oct. 21, 2002 (HealthDayNews) -- Some Alzheimer's patients can be taught to associate names with faces, suggesting they may be able to improve their memory even as the disease attacks their brain.

A new study by British researchers has found that standard face-recognition coaching used to help brain injury patients also works in people with dementia linked to Alzheimer's. The effects don't seem to benefit other areas of memory besides the specific task drilled -- in this case, identifying people. Nor are the effects enhanced by drugs that can slow the progression of the disease, a puzzle to the researchers.

Still, the scientists say the findings should be encouraging, not only to psychologists but to people who care for Alzheimer's patients.

Linda Clare, a psychologist who led the study, says that while the gains were "quite modest in a way, they could be quite important" for people with early dementia, especially since they become easily discouraged by their worsening memory woes.

Clare's group reported its findings in the latest issue of the journal Neuropsychology.

She and her colleagues studied 12 men and women with early stage dementia consistent with Alzheimer's disease. They drilled each volunteer for up to an hour once a week for six weeks, each time showing them a different picture of a famous person or someone from their social circle. To prompt their memory, they used mnemonic devices and other techniques.

The researchers then tested the subjects on their recall after a month, and then periodically throughout the following year.

At the start of the study, the subjects couldn't remember even one face. But after the training sessions, they were able to recall an average of about three faces each, the researchers say. Their ability to remember other items was basically unchanged.

Ten of the 12 volunteers improved at least somewhat as a result of the coaching. However, those on medication for the dementia did no better than those not taking drugs. Clare calls that "a bit of a surprise," and adds she would have expected that drugs would augment the drilling. "I think that we need some more research to really see what's going on there," she says.

In an unrelated study in tomorrow's issue of Neurology, researchers reported that draining brain and spinal fluid from Alzheimer's patients -- which some scientists believe draws away toxic proteins that worsen the disease -- can be done safely enough to warrant additional trials of the procedure.

Whether the so-called "Cognishunt" device -- tubing used to drain away the fluid -- works is another matter. However, the researchers say the procedure is safe enough to justify a larger study, despite several serious adverse reactions, including seizures, severe headache and infection around the tubes.

Dr. David A. Bennett, director of the Rush Alzheimer's Disease Center in Chicago, isn't so sure. "Safe is in the eye of the beholder," says Bennett, co-author of an editorial accompanying the journal article.

The researchers compared adverse reactions in shunting -- using the tubing -- for dementia with the use of the technique for elderly people with hydrocephalus, or water on the brain, which has long-lasting and clear benefit. For Alzheimer's patients, however, the gains from the technique, if they exist, would be temporary because of the irreversible nature of the disease.

The study taps into a roiling debate in Alzheimer's research over whether people with dementia can truly give informed consent for clinical studies, particularly studies with the potential for serious side effects. One side is adamant that the answer is "no," that anything other than the mildest dementia robs volunteers of the necessary understanding of the risks they're facing. Others, equally insistent, believe the trials can be conducted ethically.

"It's making research tough," Bennett says.

Bill Thies, vice president for medical and scientific affairs for the Alzheimer's Association, says some U.S. states now legally recognize the caregivers or family members of people with dementia for the purposes of making decisions about their treatment. However, not all do, and this concept of "proxy consent" is also a hot topic, he says.

"Being in a clinical trial is a wonderful public service. But the fact is that you shouldn't enter into any of these trials without understanding the risks," Thies says. And that's a much more complex caveat for someone with cognitive impairment, he adds.

The Cognishunt is made by Eunoe Inc., of Redwood City, Calif., which helped fund the latest work. The company is conducting other trials with the device.

What To Do

Alzheimer's disease, which is thought to be caused by buildup in the brain of protein plaques, affects an estimated 4 million Americans, but the number of patients is expected to soar as the population ages. For more on the degenerative nerve disorder, try the Alzheimer's Association. You can also try the Alzheimer Research Forum, or this site at the University of California, Irvine.

SOURCES: Linda Clare, Ph.D. lecturer, clinical psychology, University College London; David A. Bennett, M.D., director, Rush Alzheimer's Disease Center, Chicago; Bill Thies, Ph.D., vice president, medical and scientific affairs, Alzheimer's Association, Chicago; October 2002 Neuropsychology; Oct. 22, 2002, Neurology
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