Management of cognitive decline in Alzheimer's disease using a non-pharmacological intervention program

Abstract

Introduction: In China, the over 60 population is estimated to grow from 12% in 2010 to 33% of the overall population by 2050. The escalation in the aging population is projected to result in an Alzheimer's disease prevalence of 27.7 million people in China by 2050 causing substantial health and economic burden. While there are some published studies on multicomponent, non-pharmacological interventions for people with dementia, we have found no published community-based approach to care that encompasses personalized selection of non-pharmacological interventions, active social participation, and dementia education. Patient concerns: An elderly female living at home alone in urban Beijing presented with significant short-term memory impairment, episodes of confusion, difficulty with language skills, and episodes of wandering. She had become reclusive and disengaged from her previous social networks, and no longer attended any community activities or events. The patient had no significant past medical or psychiatric history. Diagnosis: The patient was diagnosed with Alzheimer's disease by a local physician based on clinical features of impaired communication, disorientation, confusion, poor judgement, behavioral changes, and difficulty speaking. Depression was considered a differential diagnosis but is also both a risk factor and symptom of dementia. Interventions: A novel, community-based, multicomponent social care program for dementia was used to facilitate implementation of non-pharmacological interventions, gradual socialization and provide supportive carer and community education. Non-pharmacological interventions included a combination of validation therapy, music therapy, art therapy, reminiscence therapy, talking therapy, reality orientation, cognitive training, smell therapy, food therapy, sensory stimulation, garden therapy, and physiotherapy. Outcomes: Improvements in the patient's Geriatric Depression Scale and Mini Mental State Examination scores were noted in association with increased social participation in the community. Conclusion: The community-based, multicomponent dementia social care program described in this case report has enabled a socially isolated patient with Alzheimer's disease to reduce her social isolation with an associated improvement in her mood and prevention of cognitive decline. Educating the community was an essential part of re-integrating the patient into the social setting. Reducing social isolation and increasing community engagement were essential to maintaining the patient's independence in her own home.

The cognitive dysfunction related to Alzheimer disease or cerebral small vessel disease

“…Both AD and CSVD have neurological symptoms including chronic progressive cognitive impairment, dysfunction, and behavioral abnormalities. [ 19 , 20 ] And the patient's condition can progress significantly and its course usually ranges from 8 to 10 years. [ 21 ] It is necessary to take early measures to combat the progress of AD and sporadic CSVD.…”

“…As a common disease of the elderly, AD and sporadic CSVD is manifested by chronic, progressive cognitive decline. Both AD and CSVD have neurological symptoms including chronic progressive cognitive impairment, dysfunction, and behavioral abnormalities [19,20] . And the patient's condition can progress significantly and its course usually ranges from 8 to 10 years [21] .…”

Cardiovascular Comorbidities and Cognitive Impairment

“…Community education is an essential part of re-integrating the patient into the social setting. Reducing social isolation and increasing community engagement are important to maintain the patient's independence in their own homes [15]. A host of non-pharmacological preventive measures have been described, which can address cardiovascular risk factors contributing potentially or actually to cognitive impairment [16].…”

Effectiveness of creative story therapy for dementia: a systematic review and meta-analysis

“…In comparison, non-pharmacological treatments offer higher safety and acceptability [7]. Non-pharmacological approaches such as music therapy and art therapy have numerous advantages in improving the behavior and psychological symptoms of dementia patients, enhancing cognitive functions, promoting well-being, and reducing caregiver burden [8][9][10]. Recently, person-centered care (PCC) has gained increasing attention in dementia care [11,12].…”