Article by Mary Sano, Ph.D and Margaret Sewell, Ph.D.
Non-pharmalogic therapy (NPT) is a term that encompasses a wide variety of non-drug interventions for Alzheimer’s disease (AD) patients and their caregivers. Many NPT’s are intended to complement the use of standard dementia medications.
Like pharmacological therapies, NPTs for Alzheimer’s disease can focus on behavioral or cognitive outcomes as well as economic or quality of life effects. NPT may be conducted in the community or in residences and nursing homes. NPTs often use person-centered approaches that focus on understanding the patient’s experience of dementia and dementia-related symptoms. NPTs may also be aimed at caregivers and include caregiver education, skills training, counseling, respite care, and social support. While these may reduce caregiver burden, many also improve outcomes for the patient. A comprehensive list is beyond the scope of this article, but commonly described therapies include behavioral therapy, art and music therapy, spaced-retrieval training (where patients are trained to remember simple tasks over longer periods of time), cognitive stimulation and training, reality orientation therapy, pet therapy, and physical exercise programs.
Determining if NPTs work is confusing and made more difficult by the limited amount of well conducted research. Compared to medication therapies, there is less research for NPTs. A review of AD/MCI studies listed on the website ClinicalTrials.gov indicated only 24 of 256 studies were specifically non-pharmacologic. Probably less research funding is possible for the lack of high quality randomized controlled trials of NPTs. Many NPT studies have significant limitations including: small sample sizes, positive findings that have not been replicated, small magnitudes of change that do not generalize to daily life, and results that do not last over time. These limitations make it difficult to interpret the results.
Even among well-conducted studies that assess substantial or sustained memory improvement, results are disappointing. In a review of the effectiveness of NPTs in AD, Resiberg et al described research on behavioral interventions, cognitive stimulation, music and art programs and physical exercise.