Coupling the drug Aricept (search) with regular mental stimulation dramatically slows the decline of Alzheimer's (search) disease in people with mild or moderate disease compared with medications alone, new research shows.

When Alzheimer's patients participated in weekly sessions — which involved reading and writing — they retained more communication skills, functional abilities, emotional well-being, and quality of life, compared with those patients who were simply taking Aricept, reports researcher Sandra Bond Chapman, PhD, with the Center for Brain Health at the University of Texas at Dallas.

Aricept is widely used because it helps people with Alzheimer's disease retain memory and improves performance in other mental functions, writes Chapman. However, the improvements are fleeting; in Alzheimer's disease, a progressive brain disease, Aricept reduces functional decline by only 38 percent over one year's time when compared with placebo.

Patients with Alzheimer's disease rarely get any treatments beyond medications like Aricept. However, a growing number of studies have shown that mental exercises can help with memory, verbal abilities, problem solving, calculations, overall functioning, and quality of life, Chapman notes.

But if patients take Aricept plus get regular mental stimulation, is there an added benefit? Hers is the first study to examine that question. It appears in the latest issue of the Journal of Speech, Language, and Hearing Research.

Slowing Alzheimer's Disease Decline

In her study, Chapman enrolled 54 patients — all with mild to moderate Alzheimer's disease and taking Aricept. Each was randomly assigned to either get the "mental stimulation program" plus Aricept or to just take Aricept.

The two-month intervention program involved once-a-week sessions with each patient. Examples of the mental exercises included: verbally creating a story about a Normal Rockwell painting, providing detailed directions in scrambling eggs, interpreting proverbs, and choosing appropriate meanings for words. Each patient got weekly homework assignments, to work out with their caregivers.

At the program's end, and during the next 10 months, each patient took a battery of tests to determine their progress.

In the mental stimulation Alzheimer's group, Chapman found a slower rate of decline in communication ability, functional ability, and emotional well-being. These patients also showed less apathy and irritability, and improved quality of life.

"Whereas we expected the greatest benefit to appear immediately after the active intervention, the evidence of later-emerging benefits may arise from slowly changing habits in daily life," she writes.

The homework assignments provided stimulation for good conversation with caregivers, Chapman explains. The exercises also helped them stay involved in their environment, she notes. "We believe this helped to maintain abilities and slow the rate of decline associated with Alzheimer's disease," she writes.

Greater benefits are likely possible with more frequent sessions, she says. The effects of mild-to-moderate Alzheimer's disease are not yet overwhelming for patients, so their willingness helps them follow through with the exercises, Chapman notes.

By  Jeanie Lerche Davis, reviewed by  Brunilda Nazario, MD

SOURCE: Chapman, S. Journal of Speech, Language, and Hearing Research, October 2004: vol 47.