Computer-based tasks aimed at increasing mental activity and enhancing mental function can improve cognition in patients with Alzheimer's disease, serving as an effective addition to medications commonly used to treat the disease. Researchers found that the internet-accessible computer activities were even more successful than classic exercises of mental stimulation commonly used with dementia patients. The findings, from the Fundació ACE, Institut Català de Neurociències Aplicades in Barcelona, Spain, and the University of Pittsburgh School of Medicine, are published in the October issue of the Journal of Neurology, Neurosurgery and Psychiatry.
"The interactive multimedia internet-based system, in combination with the standard pharmacological treatment of Alzheimer's disease, provides for better cognitive function in these patients, demonstrating that they are capable of benefiting from cognitive stimulation, even after the disease has advanced," said Mr. Lluís Tárraga, lead investigator of the study and developer of the IMIS tool.
"This study shows that tasks aimed at increasing or maintaining mental function have a place in treating Alzheimer's alongside pharmacotherapy," said Oscar Lopez, M.D., professor of neurology at the University of Pittsburgh School of Medicine, and a co-author on the study. "While further study is needed, it is encouraging to find that an internet-based program can work for cognitive stimulation, making it easily available and accessible to many people."
The study, conducted at an adult daycare center and referral clinic for community-dwelling persons with dementia in Barcelona, enrolled 46 people who were diagnosed with Alzheimer's disease. All were being treated with cholinesterase inhibitors, the most common pharmacological treatment for Alzheimer's, for at least one year prior to enrolling in the study; all participants remained on the drug for the duration of the study.
Participants were randomized to one of three groups. The first received no cognitive intervention; these participants lived at home and did not participate in the daily activities at the daycare center. The second group participated in an Integrated Psychostimulation Program (IPP), which was a daily program that included 2.5 to 3.5 hours of cognitive stimulation tasks, musical therapy, arts and crafts, physical activity and programs that reinforced instrumental activities of daily living. The third group participated in IPP as well, and used an interactive multimedia internet-based system (IMIS) which allowed them to carry out a variety of different cognitive stimulation tasks at varying levels of difficulty throughout the day. IMIS sessions (20 minutes each) were held three times a week for 24 weeks.
At baseline and after 12 and 24 weeks of treatment, participants were assessed using standard measures of cognitive function and performance including the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) and the Mini-Mental State Examination (MMSE). After 12 weeks of treatment, the group that received both IPP and IMIS had improved outcome scores on both tests as compared to control; these improvements were maintained at 24 weeks. The group that received only IPP, showed improvement over the control group at 12 weeks, but the effects diminished by 24 weeks.
"While Alzheimer's disease is a progressive degenerative condition, studies have shown that in the early stages, the brain is still able to learn and change. This indicates that increasing brain activity, especially in regards to memory and cognition, may help stave off cognitive loss in people with Alzheimer's," said James T. Becker, Ph.D., professor of psychiatry, neurology and psychology at the University of Pittsburgh, and a co-author on the study.
The study was funded through an unrestricted grant from Fundació ACE, Institut Català de Neurociències Aplicades.
Co-authors of the study include Mercè Boada, Gemma Modinos, Ana Espinosa, Susana Diego, América Morera, Marina Guitart and Jaume Balcells from Institut Català de Neurociències Aplicades.
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