Beneficial Effects of an Integrated Psychostimulation Program in Patients with Alzheimer’s Disease

Article type: Research Article

Authors: Ibarria, Marta^{a; b} | Alegret, Montserrat^b | Valero, Sergi^{c; d} | Morera, Amèrica^a | Guitart, Marina^a | Cañabate, Pilar^{a; b} | Moreno, Mariola^{a; b} | Lara, Susana^a | Diego, Susana^{a; b} | Hernández, Joan^a | Tantinyá, Natàlia^a | Vera, Maribel^a | Hernández, Isabel^{a; b} | Becker, James T.^e | Ruíz, Agustín^b | Boada, Mercè^{a; b} | Tárraga, Lluís^{a; b; *} | for the Fundació ACE Alzheimer Research Center and Memory Clinic

Affiliations: [a] Alzheimer Center Educational, Day Care Centers of Fundació ACE, Barcelona, Spain | [b] Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Barcelona, Spain | [c] Department of Psychiatry, Hospital Universitari Vall d’Hebron. Universitat Autònoma de Barcelona, Spain | [d] Hospital Universitari Vall d’Hebron -Institut de Recerca, Universitat Autònoma de Barcelona (VHIR-UAB), Spain | [e] Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

Correspondence: [*] Correspondence to: Lluís Tárraga, Memory Clinic of Fundació ACE, Institut Catalá de Neurociències Aplicades, Gran Via de Carles III, 85 bis, 08028 Barcelona, Spain. Tel.: +34 93 4304720; Fax: +34 93 4193542; E-mail: ltarraga@fundacioace.com.

Abstract: Background:The existing pharmacological treatments for Alzheimer’s disease (AD) can only slow the progression of symptoms or delay admission to long-term care facilities. The beneficial effects of non-drug treatments are poorly studied. Objective:To describe the effects of an Integrated Psychostimulation Program (IPP) in patients with mild-moderate AD treated with acetylcholinesterase inhibitors; and to identify factors related to greater benefit of the IPP. Methods:206 patients (mean age = 75.9 years; MMSE = 19.6) were evaluated before starting the IPP and 3, 6, 9, and 12 months later. Measures included: Mini-Mental State Examination (MMSE), Cognitive Subscale of Alzheimer’s Disease Assessment Scale (ADAS-Cog), Rapid Disability Rating Scale (RDRS-2), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Results:Patients remained cognitively stable (MMSE/ADAS-Cog) for more than 6 months and significantly worsened at 9-month and 12-month follow-ups, without clinically significant functional changes (RDRS-2) or psychiatric symptoms(NPI-Q). The mean annual change on MMSE and ADAS-Cog were 2.06 and 3.56 points, respectively, lower than the annual decline demonstrated previously in similar patients (2.4 and 4.5, respectively). 42.7% of patients maintained or improved global cognitive scores between baseline and 12-month follow-up. The patients who maintained cognitive functions were older than those who did not (77.5 versus 74.7 years). Conclusions:The IPP may be an effective treatment to maintain cognition, functionality, and psychiatric symptoms in AD patients pharmacologically treated, and older age seems to increase beneficial effects of IPP.

Keywords: Alzheimer’s disease, cognition, cognitive stimulation, dementia, functionality, Integral Psychostimulation Program, non-pharmacological therapy

DOI: 10.3233/JAD-150455

Journal: Journal of Alzheimer's Disease, vol. 50, no. 2, pp. 559-566, 2016