I keep hoping for more useful research on treatments and management techniques that may potentially benefit those with memory loss and their caregivers.  There are three recent studies that caught my attention as examples of movement in the right direction.

First, “The effect of stimulation therapy and donepezil on cognitive function in Alzheimer’s disease” (BMC Neurology, 2012, 12, 59).  The study compared the effects of stimulation therapy, treatment with donepezil (Aricept), or to combined treatment during the first year after diagnosis with mild to moderate Alzheimer’s disease.  Stimulation therapy consisted of multiple elements including physical activity (e.g., dancing, walking, fitness training), as well as cognitive and social activities (e.g., reading, listening to music, crossword puzzles, reminiscence) for at least 30 minutes each day 5 times per week.  Donepezil (or placebo) was started at 5 mg and increased after four weeks to 10 mg for the duration of the study.

Interestingly, all treatments faired the same after one year.  On average, all participants had similar cognitive scores at the beginning and the end of the year.  Although there are many limitations and interpretations of these findings, I was surprised that the combination of drug therapy and stimulation therapy did not improve outcome at one year.  We need more of this type of studies with better client selection and over a much longer duration.

Second, there is widespread and prolonged use of antipsychotic medications in persons with dementia to manage such behaviors as agitation, aggression, delusions, hallucination, and/or mood changes despite warnings and cautions.  Even more troubling to me is that once these medications are started, they are continued indefinitely.  According to a recent literature review in the Cochrane Database Systematic Review (“Most dementia patients can safely stop antipsychotics,” Medscape, April 02, 2013) discontinuation of these medications does not cause relapse in most patients in skilled nursing.  This review should help remind us that all medications should be reviewed often and that antipsychotics in the demented should be written from the beginning with a taper/stop date.

Third, common clinical lore suggests that use of antipsychotics to treat behavioral disturbances in dementia may increase mortality.  A large prospective study in Japan compared those who were treated with antipsychotics with those who were not.  There was no greater mortality after 10 weeks for those on antipsychotics.   The most common causes of death were pneumonia, cardiovascular events, and cancer, respectively.

We need to extend and broaden our working knowledge through studies like these that challenge our assumptions and address practical issues regarding treatment and management of progressive memory disorders.  There are many questions; there is too much emphasis on finding the elusive cure and too little use of scientific methodologies to gather data that guide our day-to-day treatment decisions.