May 22, 1998 ATHENS, Ohio -- Simple muscle relaxation techniques may help people with Alzheimer's disease control some behavioral problems associated with the disorder while improving their mental performance, according to a new study by an Ohio University researcher.
By helping patients control anxiety, aggression and irritability, the techniques could decrease health care costs and caregiver stress and allow patients to remain at home instead of being moved to a long-term care facility, said Julie Suhr, assistant professor of psychology at Ohio University and lead author of the study.
"Studies suggest that behavioral problems are the reason many people become institutionalized," Suhr said. "It's not the memory problems. It's these other difficult-to-manage behaviors that make it hard for a caregiver to keep their loved one at home."
Most Alzheimer's patients take psychotropic medication for behavioral problems, but these drugs can have negative side effects ranging from drowsiness to increased confusion. Other researchers have examined relaxation therapy as a treatment for all types of stress-related problems, but few have studied the technique's use in Alzheimer's patients, Suhr said.
"The failure to use behavioral or psychological interventions in demented populations appears to stem, at least in part, from the belief that the memory impairment of Alzheimer's disease patients precludes their learning new skills or behavioral repertoires," she said.
Suhr studied two forms of relaxation training in 34 pairs of Alzheimer's patients and caregivers. The patients ranged in age from 65 to 80, were living at home, exhibited behavioral problems that affected daily functioning and had mild to moderate cognitive impairments.
Participants were randomly assigned to either a progressive muscle relaxation training group or a group that used an imagery technique to promote relaxation. With progressive muscle relaxation, patients were trained to tense and relax various groups of muscles. Using the imagery method, patients visualized a calm setting when they began to feel agitated or anxious.
Caregivers in both groups were trained to coach patients through the prescribed relaxation technique at the first sign of aggression or anxiety.
Participants had an average of five treatment sessions with Suhr and practiced at home at least twice a day for six weeks. Caregivers kept diaries of patient activities, response to the relaxation techniques and any changes in behavior.
During the study, some caregivers developed cues to help patients begin their relaxation techniques. Most people used verbal cues, but one woman tried a different tactic. When her husband was becoming agitated or nervous, she would gently squeeze his shoulder, silently telling him to begin his relaxation technique.
After two months, both groups reported a decrease in anxiety symptoms, but only patients in the progressive muscle relaxation group reported fewer behavioral problems. Patients in this group also showed improvement on laboratory tests that measure memory, suggesting that reducing anxiety may make it easier for patients to think more clearly.
"The results we saw in the group that used progressive muscle relaxation suggest that it may be a useful technique to add to a multidisciplinary intervention designed to address all aspects of the behavior disorder seen in Alzheimer's disease," Suhr said.
Suhr conducted the study as a postdoctoral researcher at the University of Iowa. She wants to continue the work at Ohio University, exploring the effectiveness of progressive muscle relaxation on patients with advanced Alzheimer's disease, including patients living in residential care facilities. Suhr would also like to investigate the long-term effects of relaxation training as the disease progresses.
"Progressive relaxation training has the potential to minimize catastrophic reactions and excess disability in an inpatient Alzheimer's disease population, and this may help with professional caregiver burnout, as well as minimize the use of psychotropic medication," she said.
Co-authors of the study, which was supported by the National Institute of Aging and presented at a recent meeting of the International Neuropsychological Society in Honolulu, were Steven Anderson and Daniel Tranel at the University of Iowa College of Medicine.
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