Apathy affects more than half of individuals with Alzheimer’s disease (AD) within the first five years, and is associated with increased functional and cognitive impairment as well as higher levels of stress and burden for caregivers. Despite the fact that apathy leads to more rapid functional decline, it is often overlooked by health care providers, partly due to a lack of evidence-based therapies for apathy. A group of researchers recently published some preliminary findings suggesting that cognitive stimulation activities designed for individuals with early-stage AD might have a strong impact on apathy, depression, and overall quality of life (Buettner et al., 2011).
Older adults with early-stage AD often have unmet needs in the areas of mental stimulation and socialization though they desire mentally stimulating experiences and are quite capable of responding well to them. Based on previous research, instances of apathy may be reduced via activities that provide a combination of physical, cognitive, and emotional engagement. While many individuals with early-stage AD are referred to support groups, it is unclear that individuals prone to apathy are likely to fully benefit from such groups. The researchers of this study hypothesized that participants with early-stage AD would benefit from a program involving several short, goal-driven, and socially interactive games. Such a program might reduce apathy by engaging different aspects of the brain and providing physical and social activity, which can improve motivation, offer enjoyment, and slow functional decline.
The study included randomly selected participants age 60 and better who were showing signs of early-stage AD, and assigned them to either a mentally stimulating activity (MSA) program or a structured support group program. Both the MSA and support group conditions consisted of groups of three to seven participants who met at senior centers and Continuing Care Retirement Communities (CCRCs). Each small group met for one hour, twice per week. The MSA groups engaged in several brief games designed to engage multiple physical and cognitive functions, and the support groups received education and supportive discussion. Thus, the groups were matched in the amount of social contact they received. Over four weeks, 19 individuals dropped out of the support group, while all continued with the MSA group.
After four weeks, individuals in the MSA groups had significantly lower levels of apathy (as measured by the Apathy Evaluation Scale-Clinical Version) and significantly better Mini-Mental State Examination (MMSE) scores than the support groups. Participants in the MSA and support groups both saw improved quality of life scores (measured by the Cornell Brown Quality of Life scale), but the MSA group had significantly higher score improvement. Both MSA and support groups had lower depressive scores after four weeks as well.
A few limitations are mentioned in the study, including the exclusion of individuals with complex physical and neurological problems; the support group drop-out rate (which introduces bias to the results); and the relatively small number of participants in each group. However, these early findings suggest that cognitive stimulation designed to engage individuals with early-stage dementia may improve the quality of life of participants and their caregivers.
Source: Buettner, L.L.; Fitzsimmons, S.; Atav, S.; and Sink, K. (2011). “Cognitive Stimulation for Apathy in Probable Early-Stage Alzheimer’s.” Journal of Aging Research [e-pub ahead of print] www.sage-hindawi.com/journals/jar/2011/480890/ref/.