Behavioral and cognitive strategies that can help those suffering from Alzheimer's.
Latest Research News
A new review from The Cochrane Library, based on six trials involving 289 people, has concluded that exercise can improve cognition and the ability of older people with dementia to carry out daily activities, such as walking short distances or getting up from a chair. However, there was no clear effect of exercise on depression in older people with dementia, and the reviewers say that more evidence is needed to understand how exercise could reduce the burden on family caregivers and health systems.
Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. Exercise programs for people with dementia. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD006489. DOI: 10.1002/14651858.CD006489.pub3.
Previous research has indicated that about a quarter of older adults who become mildly depressed will go on to become seriously depressed within a year or two. A study comparing problem-solving therapy for primary care — a seven-step approach delivered by non-mental-health professionals to help patients resolve difficulties and thus improve coping skills and confidence — with a program of dietary coaching (same number of sessions and hours), has found that elderly adults with mild symptoms of depression responded equally well to both treatments.
The study involved 244 participants, of whom 90 were African-American. Only 9% of people in each intervention went on to experience an episode of major depression, and they all had a similar reduction in depressive symptoms over the two-year study period. Both approaches were equally successful among black and white participants.
The benefit of both programs is assumed to lie in the way they give people greater perceived control over their lives.
Sometime ago, I reported on a study showing that older adults could improve their memory for a future task (remembering to regularly test their blood sugar) by picturing themselves going through the process. Imagination has been shown to be a useful strategy in improving memory (and also motor skills). A new study extends and confirms previous findings, by testing free recall and comparing self-imagination to more traditional strategies.
The study involved 15 patients with acquired brain injury who had impaired memory and 15 healthy controls. Participants memorized five lists of 24 adjectives that described personality traits, using a different strategy for each list. The five strategies were:
- think of a word that rhymes with the trait (baseline),
- think of a definition for the trait (semantic elaboration),
- think about how the trait describes you (semantic self-referential processing),
- think of a time when you acted out the trait (episodic self-referential processing), or
- imagine acting out the trait (self-imagining).
For both groups, self-imagination produced the highest rates of free recall of the list (an average of 9.3 for the memory-impaired, compared to 3.2 using the baseline strategy; 8.1 vs 3.2 for the controls — note that the controls were given all 24 items in one list, while the memory-impaired were given 4 lists of 6 items).
Additionally, those with impaired memory did better using semantic self-referential processing than episodic self-referential processing (7.3 vs 5.7). In contrast, the controls did much the same in both conditions. This adds to the evidence that patients with brain injury often have a particular problem with episodic memory (knowledge about specific events). Episodic memory is also particularly affected in Alzheimer’s, as well as in normal aging and depression.
It’s also worth noting that all the strategies that involved the self were more effective than the two strategies that didn’t, for both groups (also, semantic elaboration was better than the baseline strategy).
The researchers suggest self-imagination (and semantic self-referential processing) might be of particular benefit for memory-impaired patients, by encouraging them to use information they can more easily access (information about their own personality traits, identity roles, and lifetime periods — what is termed the self-schema), and that future research should explore ways in which self-imagination could be used to support everyday memory tasks, such as learning new skills and remembering recent events.
 . Imagining a Better Memory Self-Imagination in Memory-Impaired Patients. Clinical Psychological Science [Internet]. 2012 . Available from: http://cpx.sagepub.com/content/early/2012/10/02/2167702612456464
Full text available at http://cpx.sagepub.com/content/early/2012/10/02/2167702612456464
Memory problems in those with mild cognitive impairment may begin with problems in visual discrimination and vulnerability to interference — a hopeful discovery in that interventions to improve discriminability and reduce interference may have a flow-on effect to cognition.
The study compared the performance on a complex object discrimination task of 7 patients diagnosed with amnestic MCI, 10 older adults considered to be at risk for MCI (because of their scores on a cognitive test), and 19 age-matched controls. The task involved the side-by-side comparison of images of objects, with participants required to say, within 15 seconds, whether the two objects were the same or different.
In the high-interference condition, the objects were blob-like and presented as black and white line-drawings, with some comparison pairs identical, while others only varied slightly in either shape or fill pattern. Objects were rotated to discourage a simple feature-matching strategy. In the low-interference condition, these line-drawings were interspersed with color photos of everyday objects, for which discriminability was dramatically easier. The two conditions were interspersed by a short break, with the low interference condition run in two blocks, before and after the high interference condition.
A control task, in which the participants compared two squares that could vary in size, was run at the end.
The study found that those with MCI, as well as those at risk of MCI, performed significantly worse than the control group in the high-interference condition. There was no difference in performance between those with MCI and those at risk of MCI. Neither group was impaired in the first low-interference condition, although the at-risk group did show significant impairment in the second low-interference condition. It may be that they had trouble recovering from the high-interference experience. However, the degree of impairment was much less than it was in the high-interference condition. It’s also worth noting that the performance on this second low-interference task was, for all groups, notably higher than it was on the first low-interference task.
There was no difference between any of the groups on the control task, indicating that fatigue wasn’t a factor.
The interference task was specifically chosen as one that involved the perirhinal cortex, but not the hippocampus. The task requires the conjunction of features — that is, you need to be able to see the object as a whole (‘feature binding’), not simply match individual features. The control task, which required only the discrimination of a single feature, shows that MCI doesn’t interfere with this ability.
I do note that the amount of individual variability on the interference tasks was noticeably greater in the MCI group than the others. The MCI group was of course smaller than the other groups, but variability wasn’t any greater for this group in the control task. Presumably this variability reflects progression of the impairment, but it would be interesting to test this with a larger sample, and map performance on this task against other cognitive tasks.
Recent research has suggested that the perirhinal cortex may provide protection from visual interference by inhibiting lower-level features. The perirhinal cortex is strongly connected to the hippocampus and entorhinal cortex, two brain regions known to be affected very early in MCI and Alzheimer’s.
The findings are also consistent with other evidence that damage to the medial temporal lobe may impair memory by increasing vulnerability to interference. For example, one study has found that story recall was greatly improved in patients with MCI if they rested quietly in a dark room after hearing the story, rather than being occupied in other tasks.
There may be a working memory component to all this as well. Comparison of two objects does require shifting attention back and forth. This, however, is separate to what the researchers see as primary: a perceptual deficit.
All of this suggests that reducing “visual clutter” could help MCI patients with everyday tasks. For example, buttons on a telephone tend to be the same size and color, with the only difference lying in the numbers themselves. Perhaps those with MCI or early Alzheimer’s would be assisted by a phone with varying sized buttons and different colors.
The finding also raises the question: to what extent is the difficulty Alzheimer’s patients often have in recognizing a loved one’s face a discrimination problem rather than a memory problem?
Finally, the performance of the at-risk group — people who had no subjective concerns about their memory, but who scored below 26 on the MoCA (Montreal Cognitive Assessment — a brief screening tool for MCI) — suggests that vulnerability to visual interference is an early marker of cognitive impairment that may be useful in diagnosis. It’s worth noting that, across all groups, MoCA scores predicted performance on the high-interference task, but not on any of the other tasks.
So how much cognitive impairment rests on problems with interference?
Newsome, R. N., Duarte, A., & Barense, M. D. (2012). Reducing Perceptual Interference Improves Visual Discrimination in Mild Cognitive Impairment : Implications for a Model of Perirhinal Cortex Function, Hippocampus, 22, 1990–1999. doi:10.1002/hipo.22071
Della Sala S, Cowan N, Beschin N, Perini M. 2005. Just lying there, remembering: Improving recall of prose in amnesic patients with mild cognitive impairment by minimising interference. Memory, 13, 435–440.
A review of 15 randomized controlled trials in which people with mild to moderate dementia were offered mental stimulation has concluded that such stimulation does indeed help slow down cognitive decline.
In total, 718 people with mild to moderate dementia, of whom 407 received cognitive stimulation, were included in the meta-analysis. The studies included in the review were identified from a search of the Cochrane Dementia and Cognitive Improvement Group Specialized Register, and included all randomized controlled trials of cognitive stimulation for dementia which incorporated a measure of cognitive change.
Participants were generally treated in small groups and activities ranged from discussions and word games to music and baking. Treatment was compared to those seen without treatment, with "standard treatments" (such as medicine, day care or visits from community mental health workers), or with alternative activities such as watching TV and physical therapy.
There was a “clear, consistent benefit” on cognitive function for those receiving cognitive stimulation, and these benefits were still seen one to three months after the treatment. Benefits were also seen for social interaction, communication and quality of life and well-being.
While no evidence was found for improvements in the mood of participants, or their ability to care for themselves or function independently, or in problem behaviors, this is not to say that lengthier or more frequent interventions might not be beneficial in these areas (that’s purely my own suggestion).
In one study, family members were trained to deliver cognitive stimulation on a one-to-one basis, and the reviewers suggested that this was an approach deserving of further attention.
The reviewers did note that the quality of the studies was variable, with small sample sizes. It should also be noted that this review builds on an earlier review, involving a subset of these studies, in which the opposite conclusion was drawn — that is, at that time, there was insufficient evidence that such interventions helped people with dementia. There is no doubt that larger and lengthier trials are needed, but these new results are very promising.
 . Cognitive stimulation to improve cognitive functioning in people with dementia. In: The Cochrane Library. The Cochrane Library. John Wiley & Sons, Ltd; Submitted. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005562.pub2/abstract
The study involved 13 patients and 14 controls, who listened to either spoken lyrics or lyrics sung with full musical accompaniment while reading the printed lyrics on a screen. The 40 lyrics were four-line excerpts of children’s songs, all characterized by having simple, unrepeated lyrics, repetitive melodies, and a perfect end-rhyme scheme for the four lines. The participants were then given these 40 lyrics mixed in with 40 other similar lyrics, and asked whether they had heard it earlier. Alzheimer’s patients were markedly more likely to recognize those they had heard sung (40% compared to 28% of the spoken). Interestingly, the controls showed no difference, although of course their performance was considerably better (77% and 74%).
It may be that setting new information, such as simple instructions, to music might help Alzheimer’s patients remember it.
On a side note, a recent study found that classical music (four short pieces by different composers) affected the heart rates of people in a vegetative state in the same way as they did those of healthy listeners, suggesting that music affects emotion at very deep level. (see http://www.newscientist.com/article/dn19123-classical-music-moves-the-he...)
 . Music as a memory enhancer in patients with Alzheimer's disease. Neuropsychologia [Internet]. Submitted ;In Press, Corrected Proof. Available from: http://www.sciencedirect.com/science/article/B6T0D-501FPV3-1/2/c7eb617b4e914310df2eb9f04907ea25
 . Heart rate variability: An index of brain processing in vegetative state? An artificial intelligence, data mining study. Clinical Neurophysiology [Internet]. Submitted ;In Press, Corrected Proof. Available from: http://www.sciencedirect.com/science/article/B6VNP-50BRK07-2/2/a3f34d8d6763522af88cdd29958d40a4
Loss of memory and problems with judgment in dementia patients can cause difficulties in relation to eating and nutrition; these problems in turn can lead to poor quality of life, pressure ulcers and infections. A study used two different step-by-step training programs to help dementia patients regain eating skills. Three institutions, involving 85 patients, were assigned to one of three programs: spaced retrieval training; Montessori-based training; control. Training consisted of three 30-40 min sessions per week, for 8 weeks. Both training programs resulted in significantly improved feeding skills, however the Montessori group needed more physical and verbal assistance. Nutritional status was significantly higher in the spaced-retrieval group compared to the control.
Lin, L., Huang, Y., Su, S., Watson, R., Tsai, B. W., & Wu, S. (2010). Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia. International Journal of Geriatric Psychiatry, 9999(9999), n/a. doi: 10.1002/gps.2433.
And in another pilot study, people deprived of speech following a stroke were taught to sing words instead of speaking them in a technique known as 'melodic intonation therapy'. Brain scans also showed functional and structural changes in the undamaged hemisphere after they had received the therapy. Doctors are now testing the therapy in 30 stroke patients to assess how many people who lose their speech after a stroke would benefit.
The findings were reported at the American Association for the Advancement of Science meeting in San Diego.
A pilot study suggests that video games for the Nintendo Wii could help stroke victims recover fine motor function (such as finger dexterity) and gross motor function (such as arm movements) two months after a stroke. The ten patients randomly assigned to playing these games for about six hours over the course of two weeks showed significantly better recovery, and none of the adverse effects (like nausea or dizziness) that were reported in the other group assigned to recreational games such as cards or the block-stacking game Jenga. A clinical trial is now underway.
The research was presented February 25 at the American Stroke Association's International Stroke Conference.
Older news items (pre-2010) brought over from the old website
Memory grows less efficient very early in Alzheimer's
A study of 109 healthy older adults (average age 75), 41 older adults with very early Alzheimer's, 13 with early Alzheimer's, and 35 younger adults (25 or younger) has found that those with Alzheimer’s — even those in the very early stages — were significantly less efficient than their healthy age peers at remembering items according to their value. It may be that Alzheimer's makes it harder for people to encode what they learn in a strategic way. This research suggests the potential for improved memory training.
Castel, A.D., Balota, D.A. & McCabe, D.P. 2009. Memory Efficiency and the Strategic Control of Attention at Encoding: Impairments of Value-Directed Remembering in Alzheimer's Disease. Neuropsychology, 23 (3), 297-306.
Pictures better than words for memory-damaged patients
We’ve long known that pictures are remembered better than words. Now a study has found that this picture superiority still exists in those with mild cognitive impairment and very mild Alzheimer’s disease. Moreover, frontally-based brainwave patterns were similar to those of controls when pictures were being retrieved, but not for words. The findings support the idea that those with mild Alzheimer’s can successfully use implicit memory (memory without conscious awareness) to support recognition, and this may point to new strategies for dealing with their memory problems.
Castel, A.D., Balota, D.A. & McCabe, D.P. 2009. Memory Efficiency and the Strategic Control of Attention at Encoding: Impairments of Value-Directed Remembering in Alzheimer's Disease. Neuropsychology, 23 (3), 297-306.
Treating sleep apnea in Alzheimer's patients helps cognition
A study of 52 men and women with mild to moderate Alzheimer's disease and obstructive sleep apnea (OSA) has found significant improvement in patients' neurological test scores after continuous positive airway pressure (CPAP) treatment. CPAP also reduced daytime sleepiness, a common complaint of Alzheimer's patients and their caregivers. The prevalence of OSA in patients with dementia has been estimated to be as high as 70 to 80%.
Ancoli-Israel, S. et al. 2008. Cognitive Effects of Treating Obstructive Sleep Apnea in Alzheimer's Disease: A Randomized Controlled Study. Journal of the American Geriatrics Society, 56 (11),2076-2081.
Hypnosis shown to reduce symptoms of dementia
This one’s really quite weird. A study found that people living with dementia who received hypnosis therapy over a nine month period showed an improvement in concentration, memory and socialization compared to groups receiving the normal treatment (who declined in these measures) and those attending a regular discussion group (who stayed the same). Relaxation, motivation and daily living activities also improved with the use of hypnosis. The findings point to the role of depression and anxiety in worsening the symptoms of dementia. The latest follow-up study has found that many of the benefits in the hypnosis group were maintained 12 months later.
Duff, S.C. & Nightingale, D.J. 2008. Long-term outcomes of hypnosis in changing the quality of life in patients with dementia. European Journal of Clinical Hypnosis, 7 (1)
More sleep improves cognition in Alzheimer patients with OSA
A study involving 52 participants with an average age of 77.8 years who had Alzheimer disease and obstructive sleep apnea (OSA) has found that it was increases in total sleep time in those given continuous positive airway pressure treatment that was associated with improvements in cognition, rather than improvement in oxygen levels. This suggests that the cognitive dysfunction associated with OSA in patients with dementia may be in part an effect of short sleep time.
The findings were presented at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).
Mediterranean diet may help Alzheimer's patients live longer
A study of 192 people with Alzheimer's disease has found that those who most closely followed a Mediterranean diet were 76% less likely to die during the 4 ½ year study period compared to those who followed the diet the least. A previous study by the same researchers found that healthy people who eat a Mediterranean diet lowered their risk of developing Alzheimer's disease. The Mediterranean diet includes a high intake of vegetables, legumes, fruits, cereals, fish, monounsaturated fatty acids; a low intake of saturated fatty acids, dairy products, meat and poultry; and a mild to moderate amount of alcohol.
Scarmeas, N., Luchsinger, J.A., Mayeux, R. & Stern, Y. 2007. Mediterranean diet and Alzheimer disease mortality. Neurology, 69, 1084-1093.
Alzheimer's weight gain initiative improved patients' intellectual abilities
In a small, three-month study, Swedish researchers have found a way to increase the weight of people with Alzheimer's, with consequent improved intellectual abilities, by improving communication and patient involvement, altering meal routines and providing a more homely eating environment.
Mamhidir et al. 2007. Weight increase in patients with dementia and alteration in meal routines and meal environment after integrity promoting care. Journal of Clinical Nursing, 16, 987-996.
Enhanced environment restores memory in mice with neurodegeneration
Research involving genetically engineered mice has found that mice whose brains had lost a large number of neurons due to neurodegeneration regained long-term memories and the ability to learn after their surroundings were enriched with toys and other sensory stimuli. The same effect was also achieved through the use of a drug that encourages neuronal growth. The findings suggest not only new approaches to treatment for those with Alzheimer's or other neurodegenerative diseases, but also supports recent suggestions that "memory loss" may be an inaccurate description of the kinds of mental deficits associated with neurodegenerative diseases. The memories are still there; they are simply inaccessible.
Fischer, A., Sananbenesi, F., Wang, X., Dobbin, M. & Tsai, L-H. 2007. Recovery of learning and memory is associated with chromatin remodelling. Nature, 447, 178-182.
Computer-based 'games' enhance mental function in Alzheimer's patients
An interactive multimedia internet-based game has been shown to benefit cognition in patients with Alzheimer's disease more than classic exercises of mental stimulation commonly used with dementia patients. The study compared patients receiving no cognitive intervention, those enrolled in a daily program that included 2.5 to 3.5 hours of cognitive stimulation tasks, musical therapy, arts and crafts, physical activity and programs that reinforced instrumental activities of daily living, and those who also used an interactive multimedia internet-based system which allowed them to carry out a variety of different cognitive stimulation tasks at varying levels of difficulty throughout the day. After 12 weeks, both intervention groups performed better on tests than the control group; at 24 weeks, the dual-intervention group did better than the program-only group. The study points to the value of cognitive stimulation to slow the rate of cognitive loss.
Tárraga, L. et al. 2006. A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 77, 1116-1121.
Elders with dementia can tap into memory stores to give advice
Surprisingly, it appears that the best way to converse with an Alzheimer’s patient may be to ask them for advice. In two studies, researchers found that adults with moderate to severe symptoms of dementia can still be quite coherent and informative when asked for advice. In the first study, 14 people with early to advanced stages of dementia were asked about marriage, children and church in a purely social way, such as "Tell me about your children," and then later were asked for advice on the same topics, as in, "I'm thinking about having children. What kind of advice can you give me on that?" Patients were more coherent, informative and focused on the topic when asked for advice as opposed to when they were simply asked about their children, church or marriage. In the second study, six adults with dementia and six older adults without dementia, were given a booklet of pictures to guide them in teaching someone a simple recipe. Both groups successfully taught students to prepare the recipes, although those with dementia did need more prompting to finish the task.
Dijkstra, K., Bourgeois, M., Youmans, G. & Hancock, A. 2006. Implications of an Advice-Giving and Teacher Role on Language Production in Adults With Dementia. Gerontologist, 46, 357-366.
Missing eyeglasses impair activities for a third of nursing home patients with Alzheimer's disease
A study of nearly 100 Alzheimer’s patients in nursing homes has determined that one third of them were not using or did not have glasses that were strong enough to correct their eyesight. Apart from causing disorientation, limiting mobility and increasing the chance of falls, the loss of vision is likely to impact on mental stimulation, by making it difficult or impossible to engage in mentally stimulating activities such as reading or watching television.
Koch, J.M., Datta, G., Makhdoom, S. & Grossberg, G.T. 2005. Unmet Visual Needs of Alzheimer’s Disease Patients in Long-term Care Facilities. Journal of the American Medical Directors Association, 6(4), 233-237.
New memory aid helps dementia sufferers remember
An innovative memory aid based on an interactive multimedia computer system aims to stimulate more enjoyable, rewarding conversation between sufferers and those who care for them. CIRCA (Computer Interactive Reminiscence and Conversation Aid) involves a simple touch-screen with easy-to-follow instructions; it displays a choice of three random categories (entertainment, local life etc) and three media (music, photo, video). The images, video or sound clips then act as a memory trigger and conversation prompt. During development, CIRCA was tested on 40 dementia sufferers with very encouraging results. CIRCA could become available on the market in 2-3 years.
Weight loss may be an early sign of dementia in the elderly
An analysis of data from 1,890 men who were participants in The Honolulu-Asia Aging Study has found that the weight loss common in people with dementia begins 2-4 years before the onset of clinical dementia symptoms. It’s possible that treatment interventions directed toward maintaining optimal nutrition and preventing excess weight loss could slow the disease.
Stewart, R., Masaki, K., Xue, Q-L., Peila, R., Petrovitch, H., White, L.R. & Launer, L.J. 2005. A 32-Year Prospective Study of Change in Body Weight and Incident Dementia: The Honolulu-Asia Aging Study. Archives of Neurology, 62, 55-60.
Studies suggest people with early AD can still learn
A new study suggests that people who have early stage Alzheimer's disease could be more capable of learning than previously thought. The study found that mildly impaired Alzheimer’s patients who participated in 3-to-4 months of cognitive rehabilitation had a 170% improvement, on average, in their ability to recall faces and names and a 71% improvement in their ability to provide proper change for a purchase. The participants also could respond to and process information more rapidly and were better oriented to time and place. These improvements were still evident 3 months after the cognitive training ended.
Loewenstein, D.A., Acevedo, A., Czaja, S.J. & Duara, R. 2004. Cognitive Rehabilitation of Mildly Impaired Alzheimer Disease Patients on Cholinesterase Inhibitors. American Journal of Geriatric Psychiatry, 12(4), 395-402.
Alzheimer's may leave some forms of memory intact
A new study has demonstrated that people with Alzheimer's disease retain the capability for a specific form of memory used for rote learning of skills, despite their other memory loss. The finding suggests new strategies to improve training and rehabilitative programs for Alzheimer's sufferers. It also confirms other studies suggesting that a number of brain systems are more intact in Alzheimer's than previously thought.
 . Preserved Neural Correlates of Priming in Old Age and Dementia. Neuron [Internet]. 2004 ;42(5):865 - 875. Available from: http://www.cell.com/neuron/retrieve/pii/S0896627304002612
Program helps physical and behavioral well-being of Alzheimer's patients
A controlled trial of 153 community-dwelling patients diagnosed with Alzheimer’s examined the effectiveness of a home-based exercise program combined with caregiver training in behavioral management techniques in reducing functional dependence and delay institutionalization. The program resulted in improved physical health and less depression. Specifically, after three months, those receiving the training were more likely to exercise at least 60 minutes a week, to have fewer days of restricted activity, to have improved scores for physical role functioning, and improved Cornell Depression Scale for Depression in Dementia scores, and have less institutionalization due to behavioral disturbance.
Teri, L. et al. 2003. Exercise Plus Behavioral Management in Patients With Alzheimer Disease: A Randomized Controlled Trial. JAMA, 290, 2015-2022.
Alzheimer patients who scored well on memory tests show unique compensatory brain activity
A study of 12 healthy older adults and 11 older patients with probable early-stage Alzheimer's compared their performance in a series of semantic and episodic memory tasks on a computer screen, using PET scans. Overall, Alzheimer's patients performed less accurately on the semantic and episodic tasks compared to the normal controls. However, the range of scores was quite large in the Alzheimer group, with some performing poorly and others performing within the normal range. For those patients who did better on the memory tasks, researchers found that their prefrontal network activity was more expansive compared to the error-prone patients. This additional activity was happening in the right frontal and temporoparietal areas. It was a unique neural pattern not found in the controls either. This provides the most direct evidence to date that Alzheimer's patients can use additional neural resources in the prefrontal cortex to compensate for losses attributable to the degenerative process of the disease.
Grady, C.L., McIntosh, A.R., Beig, S., Keightley, M.L., Burian, H. & Black, S.E. 2003. Evidence from Functional Neuroimaging of a Compensatory Prefrontal Network in Alzheimer's Disease. Journal of Neuroscience, 23, 986-993.
Memory training may help some Alzheimer's patients
Following anecdotal "success stories" of memory training provided by rehabilitation experts, researchers in London conducted a controlled study to see whether such training could be standardized for a larger group of people, and whether the benefits of training endured. The study involved 12 participants with probable Alzheimer's Disease (AD) at the minimal or mild stage, when they still had some capacity for learning. The researchers then trained participants to remember the names of people whom they had difficulty naming from a set of 12 photos that included people in their social network and famous people. They used such memory aids as mnemonic devices, which use the image to jog memory through some kind of meaningful association; "vanishing cues," a method in which participants fill in more and more letters in the person's name, until they can recall that name without any help; and "expanding rehearsal," in which people test themselves on what they've learned, in spaced intervals over time. All training minimized the chance of errors, which helped to reduce distress and raise confidence. By training participants' memory for just half of their photo sets, researchers were able to compare memory training with no training, for each participant. Participants learned the face-name association at the rate of one per week, adding each new pair to their practice until they worked at all six pairs. They continued practicing until a one-month follow-up test of the face-name pairs. Testing was repeated at three, six and 12 months. The memory training produced a statistically significant improvement in group performance on free recall of trained items. Participants kept their memory gains six months after training, and scores remained above baseline levels after 12 months -- even without further practice. Not all participants benefited from the training. Further research is needed to discover what distinguishes those who benefitted from those who didn’t. One factor that was found, was that those who were more aware of their memory problems were more likely to respond well to memory training.
Clare, L.,Wilson, B.A., Carter, G., Roth, I., Hodges & J.R. 2002. Relearning Face-Name Associations in Early Alzheimer's Disease. Neuropsychology, 16 (4), 538-47.
Helping Alzheimer's sufferers remember
Alzheimer sufferers recalled significantly more details of long-ago events when music was played during recall. Recent memory was not affected. It is suggested that music could be played at particular times when better recall is desirable, such as when relatives visit.
The study involved 23 older adults with mild-to-moderate dementia. Participants were tested in each of four auditory background conditions presented randomly, one week apart: quiet; cafeteria noise; familiar music (first movement of Vivaldi's “The Four Seasons”); novel music (Fitkin's “Hook”). Questions were drawn from three life eras: up to age 20; around ages 20—50; and recent past and present. Sound conditions (music or noise) were significantly better than quiet (mean recall 67% vs 61%). There was no difference between familiar and novel music, but there was a small difference between noise and music (66% vs 68%). This difference was greater for remote memory; there was no difference between noise and music for memory of recent past. Overall, the Alzheimer's patients had much better recall for older memories.
The improvement in recall for the sound conditions over quiet, and the similarity between all sound conditions, points to arousal as the crucial factor. The greater effectiveness of music compared to noise may signal an associational effect. Further research exploring the effects of different pieces of music would help clarify this.
Valentine, E. & Foster, N. 2000. Reported at the British Psychological Society's London Conference, December 20.