Acupuncture and Alzheimer’s Disease
Alzheimer’s disease presents a formidable challenge to health care providers and family caregivers. According to the Alzheimer’s Association, about 4 million people in the US have been diagnosed with Alzheimer’s disease. Expected increases in the next 50 years will bring that number to 14 million. 1 in 10 persons over 65 and nearly half of those over 85 have Alzheimer’s disease.
As of 1993, about 19 million Americans had a family
member with Alzheimer’s, and another 37 million knew someone with the disease.
Most Alzheimer’s patients are cared for at home for many years by family
members at their own expense. Typically long term care is not covered by
private health insurance or medicare. Family caregivers become frustrated
and exhausted from the burdens of caring for their loved ones 24 hours/day.
There is an enormous need for therapies that can help these patients and
Research at Wellesley College
Subjects in the study were 11 elderly patients, average age 76 years, diagnosed with mild to moderate Alzheimer’s Disease or Vascular Dementia. They were treated with a course of acupuncture 2-3 times per week for 3 months. In addition to the acupuncture, they continued using any medications already prescribed. The patients were carefully evaluated 3 times in the course of the study to assess mental status, mood, and ability to function in activities of daily living. Assessments were completed by the research team neurologist, psychologist, and acupuncturist, as well as by family caregivers and the subject. A number of standardized tests were used to measure pre- and post-treatment anxiety, depression, and cognitive functioning.
Researchers concluded that acupuncture is very helpful for reducing anxiety and depression associated with Alzheimer’s. Changes in mood were substantiated by multiple measures and were both statistically and clinically significant. The patients also benefited from increased energy and relief of pain from other age related conditions. It is not clear that acupuncture helped improve memory or intellectual function. But it is very encouraging that cognitive functioning appeared to remain stable over the months of the study. Several subjects whose mood improved the most also improved cognitively. Normally progressive cognitive losses are characteristic of the disease.
"Acupuncture appears to be very helpful in relieving anxiety, improving mood, increasing energy, improving some aspects of well-being, and decreasing mood related behaviors."
There were no negative side effects of acupuncture treatment. Most subjects expressed some level of enjoyment or satisfaction with the treatment, and none dropped out of the study. The high level of patient satisfaction and compliance indicate acupuncture treatment is quite feasible for patients with dementia.
Patients in the study also seemed to benefit from the relationship with the acupuncturist. During each session, acupuncturists normally provide sympathetic listening and conversation for about 30 minutes. For these patients, relieving the sense of social isolation and providing increased mental stimulation can be important interventions.
Additional research is needed to explore the benefits of acupuncture for persons with Alzheimer’s and other dementias. Dr. Emerson Lombardo is continuing to work on a randomized controlled trial of acupuncture care.
Emerson Lombardo N, et al, Acupuncture to treat anxiety and depression in people with Alzheimer’s disease and with vascular dementia: a pilot feasibility and effectiveness trial. Presented at World Alzheimer’s Conference, Washington DC, July 9-18, 2000 and at Wellesley College Center for Research on Women, Wellesley, Massachusetts, June 7, 2000.
For more information about Dr. Emerson Lombardo’s work, please contact:
Laura Palmer Edwards, External Relations
Wellesley Center for Research on Women
106 Central Street
Wellesley, MA 02481
To read short articles about this study, visit these sites:
www.ivanhoe.com December 2000 issue
www.acupuncturetoday.com November 2000 issue
Research from The University of Hong Kong
A relatively simple acupuncture protocol was administered to 8 patients with mild to moderate Alzheimer’s Dementia. The subjects were treated for a month in cycles of 7 treatment days followed by 3 days of rest.
The research team concluded that acupuncture provided "significant therapeutic effects" in reducing symptoms of Alzheimer’s. Test procedures measured improvement in memory, attention, and verbal and motor skills such as ability to name an object, follow verbal and written commands, and write a sentence.
Kao H, Acupuncture enhancement in clinical symptoms and cognitive-motor abilities of the Alzheimer’s disease patients. Presented at World Alzheimer’s Conference, Washington DC, July 9-18, 2000.
To read a short article about this study, visit this site:
www.acupuncturetoday.com November 2000 issue
Background on Alzheimer’s Disease
More than 7 out of 10 people with Alzheimer’s live at home and are cared for primarily by family members. Patients live from 8-20 years after the onset of symptoms, with most of the burden of care - emotional, physical, and financial, carried by family members. Among nursing home residents, half have Alzheimer’s or other dementias.
Alzheimer’s disease costs the US about $100 billion per year. The cost of long term care is typically borne by the family since it is not covered by medicare or private health insurance. The annual costs to US businesses exceed $33 million, $26 million in lost productivity of caregivers and $7 million for health care services and long term care.
For more information about Alzheimer’s disease and resources for care, please visit the site of the Alzheimer’s Association, ww.alz.org.
Alzheimer’s disease is characterized by gradual onset of forgetfulness followed by chronic, progressive deterioration of cognitive function with personality and mood changes. The disease is always fatal; it is the 4th leading cause of death in the US after heart disease, cancer, and stroke. It is not part of normal aging.
In the early stages, patients forget words and substitute or invent words inappropriately. Realizing that something is wrong and unable to stop it, patients become embarrassed and anxious. More than half become depressed. Over a period of several years, there is progressive disorientation and confusion. Patients get lost while driving even in familiar places and no longer know the date or even the season. They may be adept at concealing cognitive losses, covering their confusion with social graces. In a restaurant, they may order what you’re having and thank the waiter politely, while having forgotten what menu choices are and even what they like to eat. Increasingly poor judgement poses dangers around traffic, stoves and other kitchen appliances, and the family checkbook. They may wander aimlessly or pace interminably. There is progressive difficulty with dressing, grooming, and other activities of daily living, leading to increasing dependence on caregivers and social withdrawal. Communication gradually becomes more impaired so that they cannot express themselves or understand conversations or instructions from others. The later stages pose enormous challenges for caregivers. Patients may wander late at night when others are sleeping, an activity called sundowning, which disrupts and frightens the whole family. Eventually they can no longer identify common objects like a knife and fork, or remember how to use them. In response to an increasingly mystifying world, there are inevitable flare ups of agitation and combativeness. The final stage is an image of what none of us wants for ourselves, total dependence on the care of others. The patient no longer recognizes themselves or others and cannot communicate at all. Confined to bed, they must be fed, washed, and repositioned. Loss of muscle control leads to difficulty swallowing even pureed foods or water, and incontinence of stools and urine.
Changes in the brain
The progressive loss of cognitive function in Alzheimer’s disease is associated with the death of nerve cells in the brain. The internal structures of nerve cells become severely twisted and tangled. Sections of the brain associated with memory are clogged with debris from destroyed cells. There is evidence of genetic changes that predispose some families to Alzheimer’s. Researchers are also exploring whether Alzheimer’s may be related to history of head trauma earlier in life, gender, and educational levels or types of previous cognitive stimulation. Pharmaceutical companies are in the process of developing a number of new medications.
Special care units
Family caregivers can take great comfort in how much has been learned about providing residential care for Alzheimer’s patients that preserves their dignity and quality of life. Providing first for their safety, special residences offer a protected environment in which patients can wander freely without the need for physical and chemical restraints. Patients are helped to maintain the ability to function in activities of daily living as long as possible. Nursing interventions provide care that supports and comforts the patient and orients them to reality as much as possible. Caregivers are skilled at distracting or redirecting confused patients for their comfort and safety. Specially trained staff members may be able to provide therapeutic interventions including reminiscence and validation therapy that help patients participate in a process of life review. For those who are still able to remember and reflect, such a process reinforces a sense of identity and self worth, before memories and identity are lost forever.
Please check the web site of the Alzheimer’s Association for resources, www.alz.org.
Care for the caregiver
Acupuncture has as much to offer caregivers as the Alzheimer’s patients themselves. Caregivers often become frustrated and exhausted from the burdens of caring for loved ones 24 hours/day. Respite care programs offer some support in the form of temporary care for the patient while the caregiver goes to work or takes a break. Acupuncture offers an ideal intervention as part of respite care, providing a deep state of relaxation, peacefulness, and a heightened sense of wellbeing.
Bayley, John, Elegy for Iris, New York: Picador (St. Martin’s Press), 2000.
Pierce Charles P., Hard to Forget: An Alzheimer’s Story, New York: Random House, 2000.