IMIM - Institut Hospital del Mar d'Investigacions Mèdiques IMIM - Institut Hospital del Mar d'Investigacions Mèdiques


10/09/2010 - Press release

International study shows that "Non-pharmacological Therapies" are just as effective as drugs for Alzheimer's disease.

World presentation of the study in Madrid, New York, Munich, Hong Kong and London

A worldwide network of 22 scientists, among them Jordi Peña, a researcher at the Research Group in Behavioral Neurology and Dementia at IMIM and neurologist at the Hospital del Mar, has just published a large study that for the first time provides clear evidence on the effectiveness of Non-pharmacological Therapies in Alzheimer’s disease. Governments are now ethically obliged to develop infrastructures and financial mechanisms to make these efficacious treatments readily available. While a cure for Alzheimer’s is not yet in sight, and available drugs have only very modest results, scientifically developed and tested Non-pharmacological Therapies can already significantly improve lives of patients and hard-pressed caregivers.

36 million people around the world suffer from Alzheimer’s. The effects of available drugs are generally very small. A drug that can cure or prevent the disease is not yet in sight.

Looking for alternative approaches, 22 top international scientists embarked on a 5 year project to determine exactly which Non-pharmacological therapies could significantly improve the lives of patients and caregivers. The team screened 1.313 scientific studies on the topic. The previous work of thousands of other scientists allowed the group to classify the entire field according to the type of intervention employed (cognitive stimulation, interventions with music, behaviour interventions, multi-component interventions for the patient or multi-component interventions for the caregiver, recreation therapy, etc).

The team discovered that Non-pharmacological Therapies have a wide spectrum of potential benefits: they can improve cognition (e.g. memory and thinking), behaviour, mood (e.g.: depression), physical wellbeing, activities of daily living, quality of life, improve caregiver psychological well-being and reduce caregiver burden, avoid or postpone nursing home placement or reduce costs of care. Some Therapies improve several domains simultaneously, while others produce benefits in a specific domain.

This study has now definitively confirmed what previous, but not so exhaustive, research has pointed out: by applying the rigorous criteria of the Oxford Centre of Evidence Based Medicine one Non-pharmacological Therapy turned out to have the highest possible level of supporting evidence (grade A): the inexpensive “Multi-component Interventions for the Caregiver” improve psychological well-being of the caregiver, and prevent or delay costly care home placement. No pharmacological treatment can, to date, show such an outstanding cost/benefit ratio. There are indications that this intervention can be replicated anywhere in the world.

“Multi-component Interventions for the Caregiver” are based on a comprehensive assessment of the caregiver, the patient, the family and the social environment. An individualized programme is then designed to help both the caregiver and the patient. Components this intervention may include are training and education, use of resources (day care, support groups, respite services, etc.), organizing additional family support, etc. First results of these programmes start appearing from the 6th month but are maintained or increased further in time.

There is also strong evidence that “Multi-component Interventions for the Patient” (i.e. interventions including cognitive stimulation, physical exercise and other components in different proportions) improve daily functioning, cognitive capacity and mood (reduced depression), whilst reducing behavioural symptoms that can severely distress caregivers. These interventions are relatively easy to implement in day care units or care homes. “Multi-component Interventions for the Patient” have a great potential to produce well-being: most patients enjoy participating. Besides enjoyment the interventions create widespread therapeutic and prophylactic effects, underpinning overall better quality of life. No drug has been able to show so wide an effect, together with the considerable added benefit of virtually no side effects. These benefits are independent of the patient taking any of the currently available anti-Alzheimer’s drugs. In fact, these Non-Pharmacological Therapies may be even more effective when combined with these drugs (Donepezil, Rivastigmine, Galantamine or Memantine).

What is surprising, is that although these therapies overall achieve better effects than drugs, so little has been invested in the past in researching them. Launching a drug may cost between 1 and 1.8 billion US$. Most tested Alzheimer drugs have ended in huge losses to the pharmaceutical industry. The UK has led the way in investing in research on Non-pharmacological therapies, with several large studies costing over a million pounds each currently underway, but the investment is still small in comparative terms.

The clear message is that these therapies are effective, cheap to develop and cheap to research: in the UK they are already recognised in official guidelines, such as those published by NICE*, as being best practice; the time has now come for governments to invest in further developing the infrastructures (e.g.: by improving partnerships between health and social care providers and the voluntary sector, where caregiver treatments can readily be offered) to make the two aforementioned therapies, and others as they are developed, universally available.

*NICE-SCIE. (2006). Dementia: supporting people with dementia and their carers in health and social care: Clinical Guideline 42. London: National Institute for Health and Clinical Excellence.

Press release written by Ruben Muñiz, Dr. Javier Olazarán, Dr. Teodoro del Ser, Dr. Henry Brodaty and Bob Woods on behalf of the International Non Pharmacological Therapies Project in cooperation with Alzheimer’s Disease International.

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