Archives for April 2012

Failure-proof Alzheimer’s Activities

It is important to have failure proof Alzheimer’s activities every day for your loved one if his or her level of cognitive ability allows participation. The objective is to offer simple activities, which help reinforce the patient’s self-esteem while relieving boredom and frustration. This, for the caregiver, involves being alert to the preserved abilities of the patient and helping develop and use the skills he or she still has. The more involved Alzheimer’s patients remain with the world around them, the more resourceful they will become at finding ways to keep their world from slipping away.

Emphasize Assets rather than Deficits

The failure proof Alzheimer’s activities described here may be used by anyone who comes in contact with the Alzheimer’s patient: the family caregiver, the companion, the nurse’s aide or the occasional visitor. They are described as failure- free activities because they are adapted to suit the needs and capacity of the person with memory loss, and are to be used in a way that will enable the person to succeed.

Used appropriately, failure proof Alzheimer’s activities provide moment-to-moment satisfaction and raise self -esteem. They help nurture the person by removing focus from disability onto preserved abilities. By allowing the patient to have a meaningful role, whether washing the dishes, dusting, or singing along to old tunes on the radio, the patient’s self-confidence is built up.

Caregivers can help slow the consequences of the disease by allowing the patient to perform at her fullest potential. This involves recognizing whatever skills and interests are retained and helping the patient to capitalize on these. The emphasis is on assets rather than deficits. Chores and simple activities can be sensitively set at a level, which does not place the person in a position of failure.

These activities work best with Alzheimer’s Patients

Only time and experience will show which of the Alzheimer’s activities are the most suitable for your loved one. A trial-and-error approach, with adjustments based on observations, is essential. The majority of surveys throughout adult day-care centers show that the most successful activities with victims of memory loss were those which:

  • Take advantage of old skills
  • Offer social interaction (sing-alongs, pets, visits from children.)
  • Allow considerable physical activity (physical exercise, active games, walks and outings)
  • Support cognitive functions (reality orientation, reminiscence, and listening to music)

The following specific failure proof Alzheimer’s activities have been identified as being most successful (those which participants seem to enjoy most):

  • Sing-alongs
  • Active games
  • Physical exercise
  • Outings
  • Walks
  • Listening to music
  • Reminiscence
  • Reality orientation
  • Visits from children
  • Visits from pets

Studies have shown the above Alzheimer’s activities were more successful than quiet games such as bingo, and activities that require fine motor and language skills such as crafts and discussions.

Have a Big Activity Calendar

Begin your activity program by having a big monthly calendar with daily Alzheimer’s activities written in. Many people with Alzheimer’s are unaware of the date and hour. A large calendar can be part of reality orientation by discussing today’s date, activities, the weather and changing seasons, or mention of upcoming holidays.

Caregivers can determine which Alzheimer’s activities participants respond to with the most enthusiasm and then make these a regular part of the schedule. Keep sessions flexible enough so that participants can engage at their own level of functioning. Most of all, keep interaction stress free. All activities should promote feelings of good will, self worth and independence.

Exercise is a welcome addition to the daily routine, providing both mental and physical stimulation. Dancing can also be a fun exercise. Play the same familiar music each time for dancing. If weather permits, go walking once or twice each day in the neighborhood or park.

If some participants are confined to a wheelchair, try playing catch with a beach ball or bright colored balloon. Balloon toss is a simple activity that can quickly turn into a spirited volleyball game with the patient tapping the balloon across the table from one side to the other.

Familiar games such as bowling, golf, ring toss, and horseshoes are easily adapted to the home setting. Indoor versions are available at toy stores and are generally made from safe substances such as plastic or rubber. Even participants who are functioning at a fairly limited level will try these games and enjoy them.

You can also conduct a reminiscence session or schedule celebrations, such as birthday or holiday parties.

Puzzles – Have a variety of puzzles on hand and adapt them to the level of functioning. Puzzles keep participants quietly and independently involved for short periods of time.

Cooking activities – can include making soups, cookies, and cakes, as well as preparing things that don’t need to be baked, such as salads and instant puddings.

Failure becomes an all-too-familiar experience, even in little things with the Alzheimer’s patient. Well-planned failure proof Alzheimer’s activities can mean the possibility of eliminating frustration, helplessness, depression and possibly delaying the progression of the disease. Keep it simple and fun.

Citation

By AGIS Staff, AGIS Network

http://www.agis.com/Document/4495/failure-proof-alzheimers-activities.aspx

©2008 AGIS Network

 

Benefits of Long-term Use of Donepezil and Memantine for Moderate-to-Severe Alzheimer’s Disease

N Engl J Med 2012; 366:893-903 March 8, 2012

Donepezil and Memantine for Moderate-to-Severe Alzheimer’s Disease

Robert Howard, M.D., Rupert McShane, F.R.C.Psych., James Lindesay, D.M., Craig Ritchie, M.D., Ph.D., Ashley Baldwin, M.R.C.Psych., Robert Barber, M.D., Alistair Burns, F.R.C.Psych., Tom Dening, F.R.C.Psych., David Findlay, M.B., Ch.B., Clive Holmes, Ph.D., Alan Hughes, M.B., Ch.B., Robin Jacoby, D.M., Rob Jones, M.B., Ch.B., Roy Jones, M.B., Ian McKeith, F.Med.Sc., Ajay Macharouthu, M.R.C.Psych., John O’Brien, D.M., Peter Passmore, M.D., Bart Sheehan, M.D., Edmund Juszczak, M.Sc., Cornelius Katona, M.D., Robert Hills, D.Phil., Martin Knapp, Ph.D., Clive Ballard, M.D., Richard Brown, Ph.D., Sube Banerjee, M.D., Caroline Onions, P.G.Dip., Mary Griffin, R.G.N., Jessica Adams, B.Sc., Richard Gray, M.Sc., Tony Johnson, Ph.D., Peter Bentham, M.B., Ch.B., and Patrick Phillips, Ph.D.

Abstract

Background

Clinical trials have shown the benefits of cholinesterase inhibitors for the treatment of mild-to-moderate Alzheimer’s disease. It is not known whether treatment benefits continue after the progression to moderate-to-severe disease.

Methods

We assigned 295 community-dwelling patients who had been treated with donepezil for at least 3 months and who had moderate or severe Alzheimer’s disease (a score of 5 to 13 on the Standardized Mini–Mental State Examination [SMMSE, on which scores range from 0 to 30, with higher scores indicating better cognitive function]) to continue donepezil, discontinue donepezil, discontinue donepezil and start memantine, or continue donepezil and start memantine.

Patients received the study treatment for 52 weeks. The coprimary outcomes were scores on the SMMSE and on the Bristol Activities of Daily Living Scale (BADLS, on which scores range from 0 to 60, with higher scores indicating greater impairment). The minimum clinically important differences were 1.4 points on the SMMSE and 3.5 points on the BADLS.

Results

Patients assigned to continue donepezil, as compared with those assigned to discontinue donepezil, had a score on the SMMSE that was higher by an average of 1.9 points (95% confidence interval [CI], 1.3 to 2.5) and a score on the BADLS that was lower (indicating less impairment) by 3.0 points (95% CI, 1.8 to 4.3) (P<0.001 for both comparisons).

Patients assigned to receive memantine, as compared with those assigned to receive memantine placebo, had a score on the SMMSE that was an average of 1.2 points higher (95% CI, 0.6 to 1.8; P<0.001) and a score on the BADLS that was 1.5 points lower (95% CI, 0.3 to 2.8; P=0.02). The efficacy of donepezil and of memantine did not differ significantly in the presence or absence of the other. There were no significant benefits of the combination of donepezil and memantine over donepezil alone.

Conclusions

In patients with moderate or severe Alzheimer’s disease, continued treatment with donepezil was associated with cognitive benefits that exceeded the minimum clinically important difference and with significant functional benefits over the course of 12 months.

Citation

http://www.nejm.org/doi/full/10.1056/NEJMoa1106668

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