Physical and mental exercises in combined rehabilitation model in dementia/depression for a modification of cerebral blood flow in home base program.
Valentin Bragin M.D., PhD, Ilya Bragin M.D.
Stress Relief and Memory Training Center, Brooklyn, NY, USA
Poster presentation at the 6th Canadian Conference on Dementia, Montreal, Canada, October 27-29, 2011
Purpose: There is ever-growing attention to integrative treatment models utilizing a combination of medications with non-pharmacological interventions for Alzheimer’s Disease (AD). Preliminary results of clinical and animal research are encouraging. Despite this, there is no standard-of-care model, where multiple available treatment modalities are implemented simultaneously. In our center, we have developed and continue to refine a working rehabilitation program to investigate the possibility of preventing cognitive decline in demented depressed seniors by using all available tools. Here we present a part of this model, the combination of a mild, mainly non-cardiovascular set of physical exercises in conjunction with cognitive training for seniors with limited physical capacity.
Methods: The rehabilitation model of AD/depression consists of five pillars: medications and vitamin supplementation, physical exercises, sensory stimulation, memory training and life style/diet modification. These five modalities are used in the office (the educational part of the program) and at home (the hands-on, implementation part of the program). Patient encounters consist of two parts. Initially, patients are asked to pay attention and commit to memory a series of simple movements during the light physical exercise portion of training in either individual or group sessions. Subsequently, patients engage in cognitive training involving primarily working memory training with different targets.
Findings: We have demonstrated the delay of cognitive decline in patients with AD and depression for up to 60 months using this model. Additionally, both parts of the protocol have immediate positive effects on emotions. Patients report having fewer intrusive thoughts, being more relaxed, and feeling less depressed and anxious. Similar feedback is given about the home-based activities.
Discussion/Conclusion: A disease modifying strategy for dementia using currently available tools and medications in an integrative treatment framework is promising. This working rehabilitation model is flexible and suitable for outpatient memory clinics, rehabilitation facilities and nursing homes. Implementation of this model in various settings requires further investigation.