This presentation describes results of an integrative treatment for patients with mixed dementia and depression and an arrest of memory loss for 48 months.
Valentin Bragin, MD, PhD(1), Marina Chemodanova, PhD, MEd(1), Ilya Bragin, MD(1), Narmina Dzhafarova, MD, DO(1), Irina Mescher, MD(1), Pavlo Chernyavskyy, BA(1), Gjumrakch Aliev, MD, PhD.(2)
(1) Stress Relief and Memory Training Center, Brooklyn, New York, NY USA,
(2) School of Health Science and Healthcare Administration, University of Atlanta, Atlanta, GA, USA
Poster presentation at the 6th Canadian Conference on Dementia, Montreal, Canada, October 27-29, 2011
Purpose: Alzheimer’s disease is characterized by multiple pathophysiological processes including but not limited to amyloid and tau deposition, inflammatory changes, small vessel disease, hypoxia, oxidative stress and mitochondrial dysfunction. Previously, we have shown the preservation and improvement of cognitive tasks in a cohort of depressed, demented patients for up to 36 months of integrative treatment.
This presentation is a part of an ongoing, naturalistic study, using an integrative treatment model based on medication management and non pharmacological interventions in the treatment of medically ill, physically disabled, depressed, and demented patients in an outpatient setting for 48 months.
Methods and Analysis: This is a naturalistic study of a group consisting of 156 medically ill, physically disabled patients with mild to moderate dementia and depression. Data were pulled from charts of patients who had been in the treatment for 48 month (45 patients) and less. Patients were pharmacologically treated with antidepressants, cholinesterase inhibitors and NMDA antagonists, along with their regular medication regimen.
Non-pharmacological intervention was centered on a home-based program of physical and cognitive exercises along with supplementation (multivitamins, vitamin E, L-methylfolate, alpha-lipoic acid, acetyl-l-carnitine, omega-3, and coenzyme Q-10) and diet modification. Cognitive assessment with the Mini Mental Status Exam, Clock Drawing Task (CDT), Verbal and Category Fluency Task and the Neurobehavioral Cognitive Status Examination (Cognistat) was performed yearly. Statistical analysis was done via SPSS 16 utilizing descriptive and non parametric statistical analysis (Wilcoxon signed-rank test). All statistical analysis was two-tailed with p<.05 considered significant.
Findings: All the participants had depression and memory problems. Most of the cohort suffered from anxiety and insomnia (83.3%, 82.0%, respectfully). A significant amount of patients had hypertension (85.3 %), dyslipidemia (71.8%) and coronary artery disease (58.3 %). For whole period of observation, performance of all tasks in this cohort remained at or above baseline. By 12 months of treatment all parameters showed statistically significant improvement compared to baseline.
This held true at 24 months of treatment with the exception of a single Cognistat subtest (calculation) which had no statistically significant change from the baseline. By 36 months most of the tests were still significantly above baseline, except 3 Cognistat subtests (naming, calculation and similarities).By the end of 48 months significant improvement relative to baseline was seen on the CDT, and Cognistat subtests (orientation, attention, repetition and construction).
Conclusion: Cognitive decline was postponed for 48 months of the integrative treatment in demented, depressed, physically disabled patients with multiple medical co-morbidities.