Behavior-Based Interventions to Enhance Cognitive Functioning and Independence in Older Adults
Sally A. Shumaker, PhD; Claudine Legault, PhD; Laura H. Coker, PhD
JAMA. 2006;296:2852-2854.
The current and projected financial and emotional burden of cognitive impairment to individuals and their families, as well as the financial burden to society are staggering.1-2 There are 24 million individuals with dementia in the world and 4.6 million new cases are diagnosed annually.
1 The combined worldwide prevalence of age-associated cognitive impairment and cognitive disorders is predicted to reach 84 million individuals affected by 2040.1 In 2000, more than 4 million US adults had Alzheimer disease; by 2050, this will increase to 13 million.3 Furthermore, declines in specific cognitive domains (e.g., memory, executive functions) are predictive of deficits in the performance of instrumental activities of daily living (IADL) in older adults,4 an outcome that seriously threatens the ability of the aging population to live independently.
Studies Suggest People with Early AD Can Still Learn
People who have early stage Alzheimer's disease (AD) could be more capable of learning than previously thought, according to two new studies supported by the National Institute on Aging (NIA) a part of the National Institutes of Health. The promising studies suggest that some people with early cognitive impairment can still be taught to recall important information and to better perform daily tasks.
In a July 2004 report, researchers in Miami, FL, found mildly impaired AD patients who participated in 3 to 4 months of cognitive rehabilitation had a 170 percent improvement, on average, in their ability to recall faces and names and a 71 percent 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 compared to a similar group of AD patients who did not receive this targeted intervention. These improvements were still evident 3 months after the cognitive training ended.
The findings, by David A. Loewenstein, Ph.D., and colleagues at the University of Miami School of Medicine and Mount Sinai Medical Center, Miami Beach, are reported in the July-August 2004 issue of the American Journal of Geriatric Psychiatry.
The Loewenstein report follows a recent study by researchers at Washington University in St. Louis who found that older people with early-stage AD retained functioning levels of implicit memory similar to young adults and older adults who did not have AD. Implicit memory is relatively unconscious and automatic: Information from the past "pops into mind" without a deliberate effort to remember. This unconscious, implicit memory is important for common skills and activities, such as speaking a language or riding a bicycle. In many cases, people implicitly remember how to perform these activities without being able to deliberately remember when or where they learned them. The study by Cindy Lustig, Ph.D., and Randy Buckner, Ph.D., appeared in the June 10, 2004, issue of Neuron.
"Taken together, these studies introduce the exciting notion that older people who are in the early stages of AD can be taught techniques to help stay engaged in everyday life," says Neil Buckholtz, Ph.D., head of the Dementias of Aging Branch at the NIA. "These findings show it is possible to pinpoint what memory capabilities are preserved in early AD and suggest ways to target those memory functions and make the most of them."
Source: http://www.nih.gov/news/pr/jul2004/nia-02.htm
