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Geriatrics / Neurology

Testing Holistic Approaches to Combating Alzheimer’s

August 26, 2016
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While there are currently many treatment methods to deal with the symptoms and disabilities of Alzheimer’s disease (AD), there is not yet a medical cure or vaccine to prevent or cure the disease. Progress is being made, but as of now, it is best to continue to pursue all avenues to find a definitive method to either reverse progression or altogether prevent development of Alzheimer’s in elderly patients. Listed below are several different approaches to combating or preventing the development of Alzheimer’s, and developments in the quest for a cure.

SOURCE: Clements-Cortes A, Bartel L. Sound stimulation in patients with Alzheimer’s disease. Annals Long-Term Care 2015;23:10-16.

Music Therapy

Despite a relative lack of large, reliable studies investigating music therapy’s impact on Alzheimer’s patients, the currently existing evidence is promising. One such example is a clinical trial that examined music therapy’s effect on patients with AD and agitation to find that 45-minute sessions of music therapy significantly reduce demonstrated agitation and disruptive behavior.

These findings fall in line with many previous studies into the calming effects music has on the psyche. Cognitive performance is significantly improved with background music at almost all ages in the adult lifetime. This cognitive boost has also been demonstrated in patients with Alzheimer’s. This is perhaps related to the peculiar preservation of the brain regions that process music in Alzheimer’s patients.

If clinicians wish to support non-pharmacologic, supplementary therapy-like music, they have their choice of recommending either recreational background music or the more structured music therapy. Despite a lack of clarity on music therapy’s long-term benefits, exposure to music has proven to improve patient condition and elevate quality of life.

Diet and Nutrition

In the hopes of preventing Alzheimer’s development altogether, researchers have continued to look at the roles diet and nutrition play in the incidence rates of Alzheimer’s disease. Nutrition plays an integral role in the majority of biological functions, and it would follow that improper nutrition could make a patient more inclined to the type of cognitive decline that characterizes Alzheimer’s. The primary methods for nutritional intervention are dietary alteration and nutrient supplementation. Of the two, dietary changes have proven to be the more effective in lessening the risk of contracting Alzheimer’s. Three diets have been studied and demonstrated, to varying degrees, the potential to benefit patients wishing to live healthier lifestyles and lower their risks for AD: The Mediterranean diet (MeDi), the DASH diet, and the MIND diet. The Mediterranean diet incorporates myriad plant-based foods and fresh fruits, focusing on lean, white meats, fish and natural carbohydrates, while still allowing for a modicum of red meat and wine. The diet gets its name from its forebears—the healthier aspects of many diets in Mediterranean countries. A key component of MeDi is regular aerobic exercise. Dietary restrictions are commonly used to reduce risk for cardiovascular disease, and MeDi was initially praised primarily for its efficacy in reducing CV risk; however, studies have shown that MeDi can reduce the risk of contracting AD significantly, potentially by upwards of 40%. The diet’s prevention efficacy was also closely related to how strictly patients adhered to the diet.

A similar diet devised initially to combat risk of CV disease, Dietary Approaches to Stop Hypertension (DASH) has been often proposed alongside MeDi as a viable lifestyle option. DASH was likewise shown after its inception to lower risks of AD among those who subscribed to it. Both diets have their merits despite their differences, and a research team from the Rush University Medical Center merged elements of both diets to create the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. The MIND diet was shown in preliminary testing to be more effective than either MeDi or DASH at slowing the rate of cognitive decline. The diet of course still shares many characteristics with both MeDi and DASH, but with an increased emphasis on whole grains, berries, and lean red meat. It also recommends less olive oil than MeDi as well as less overall grains a week than either MeDi or DASH. Morris et al, the team that initially devised the MIND diet, conducted more recent tests to validate MIND’s effects on the neurodegenerative attributes of diseases like Alzheimer’s and to compare the effects of the MIND diet with the results of its predecessors, MeDi and DASH. Their study tracked nearly 1,000 subjects (aged 58-98) over 4.5 years, utilizing routine surveys to track reported adherence to dietary restrictions. Over the course of the study it was reaffirmed that the MIND diet was more effective than either MeDi or DASH. While both MeDi and DASH required patients to be in the upper tertile of adherence to diet regulations to display significant risk reduction, the MIND diet demonstrated risk reduction for Alzheimer’s in both the upper and middle tertiles. This suggests that patients looking to significantly reduce the neurodegenerative risks associated with contracting Alzheimer’s that are considering dietary measures should strongly consider switching to the MIND diet over the DASH and MeDi diets. With any of the diets, however, the efficacy truly is dependent upon consistent adherence to the stipulations of the diet.

Amyloid Therapy Fails to Demonstrate Beneficial Results in Alzheimer’s Patients

Not all methods tested to benefit Alzheimer’s patients prove effective. Recent tests have shown that amyloid therapy does not demonstrate significant beneficial results for patients with AD.

Amyloid therapy utilizes agents that target the amyloid plaque buildup common in Alzheimer’s patients to ideally slow the rate of neurodegeneration that characterizes the disease. Unfortunately, two recent studies from The New England Journal of Medicine cast serious doubt on amyloid therapy’s efficacy in treating patients with Alzheimer’s. The initial test assigned over 2,000 Alzheimer’s patients to either treatment with the monoclonal antibody solanezumab or a placebo. Solanezumab was tested as it preferentially binds soluble amyloid forms, and at least prior to clinical trials had contributed to amyloid’s clearance from the brain. Eighty weeks of study, however, produced no significant difference in cognitive function amongst AD patients compared to either baseline or placebo.

The second study, double-blind randomized, and placebo controlled, tested bapineuzumab, which has similar anti-amyloidal tendencies to solanezumab, to determine if it could benefit AD patients’ cognitive functions. The study lasted nearly as long as the prior, at 78 weeks, but also did not demonstrate significant benefits. At the conclusion of the study there was actually no difference between test and control groups in any measure of cognitive change. These two results when taken together suggest that our understanding of the mechanisms of Alzheimer’s disease are not as concrete as needed. The editorial accompanying the study suggests these studies cast doubt on traditionally trusted biomarkers of the disease. It also indicates that there is still much to be learned about the roles various types of amyloid have in the progression of AD.

 

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