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Integrative Treatment Postpones Cognitive Decline in Patients with Dementia and Depression: A 72 Month Follow up Observational Study

Arresting of cognitive decline for 72 months: a novel rehabilitation program for Alzheimer’s dementia, based on pathogenesis of Alzheimer’ s disease and multiple intervention modalities.

Valentin Bragin, Gary Shereshevsky, Arina Gorskaya, Elena Dorfman, Ilya Bragin, Frank Copeli, Kevin Vinokur.

Stress Relief and Memory Training Center, Brooklyn, NY, USA

Poster presentation at the Alzheimer’s Association International Conference. Copenhagen, Denmark, July 12- 17, 2014

Background: Alzheimer’ s disease (AD) is a multi-faceted, whole brain and body illness. Given the complexity of the pathogenesis of AD, a multi-faceted approach to therapy makes practical sense for real-life, patient care. In the past several years, we have been testing the hypothesis that integrative treatment could delay the progression of cognitive decline in demented, depressed, and medically ill seniors. The preservation of cognitive performance was demonstrated in demented and depressed patients after 60 months of integrated therapy (Bragin V. et al., 2012). Here we present the results of our ongoing, naturalistic study, in the same outpatient setting, at 72 months of treatment.

Methods: 70 Patients (43 females, 27 males, mean age of 71.4В  В±В  5.94, education “ 13.00В  В± 2.69 with mild to moderate dementia and depression, with multiple chronic medical co-morbidities (hypertension, coronary artery disease, hyperlipidemia, diabetes, arthritis etc.) underwent integrative treatment which consisted of pharmacological therapy (cholinesterase inhibitors, NMDA antagonists, antidepressants, along with their regular medication regimen) and non-pharmacological interventions. The non-pharmacological modalities included office and home-based physical and cognitive exercises aimed at the modification of regional cerebral blood flow.

Diet modifications, vitamins, and nutritional supplements were incorporated as well. Cognitive testing was performed annually and included the MMSE, clock drawing test, verbal fluency tasks, and the Neurobehavioral Cognitive Status Examination (Cognistat), Ruff 2 & 7 Selective Attention and Ruff Figural Fluency tests. Descriptive and non-parametric statistical analysis (Wilcoxon signed-rank test) was performed on SPSS for Windows, version 21.0.

Results Performance on all cognitive tests remained at or improved from their baseline for a period of 72 months. The baseline MMSE was 26.8 В± 7.09 and by 72 months of the treatment, MMSE was 27.6 В± 6.50 (p > 0.05). Significant improvement (p < 0.05) was observed on Cognistat orientation, attention, construction and memory subtests.

Conclusion: The integrative treatment approach postponed cognitive decline in demented and depressed patients with multiple medical co-morbidities for 72 months. Future investigations addressing integrated treatment in AD are warranted.

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