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By Anahad O' Connor
FOR MANY, a diagnosis of Alzheimer's disease can mean life in a dreary nursing home and a treatment centred on powerful anti-psychotics to combat the onset of memory loss, dementia and other signs of a mind that is slowly unravelling.
But now, some scientists say the best way to treat Alzheimer's is with a broader approach one that emphasises regular exercise and a healthy environment. Even encouraging participation in an activity as simple as gardening, one researcher noted, can reduce depression and ease anxiety in some Alzheimer's patients.
The findings were detailed in two studies released last month. One, published in the October 15 issue of The Journal of the American Medical Association, looked at 153 Alzheimer's patients living in the Seattle area over several years. Some of the patients, who ranged in severity of the disease, were randomly assigned to an exercise programme that focussed on strength, balance and flexibility training. For about 30 minutes a day, the patients went for walks, stretched or used light hand weights for quick exercises that they could do at home. Compared with a control group that received "routine" care, the patients who exercised were in better physical shape and had lower rates of depression.
When they followed up two years later, the researchers discovered that the improvements had not dissipated; patients in the exercise group were still physically active, had more pleasant interactions with people caring for them and were less depressed.
Unlike subjects in the control group, patients who worked out regularly also showed fewer signs of physical frailty, which made them less prone to falls, fractures and hospitalisation, said Linda Teri, a professor of psychosocial and community health at the University of Washington and a lead author of the study. "These patients were much better off both physically and emotionally," Dr. Teri said. "They spent less time in bed and more time being active... Overall, they were happier."
On the other side of the country, a group of researchers, led by John Zeisel, studied how a patient's environment could influence symptoms of the disease. In a study published in the October issue of The Gerontologist, Dr. Zeisel and his colleagues looked at 427 patients living in 15 randomly selected nursing homes or assisted living residences throughout New England. They found a relationship between behavioural and emotional health and certain aspects of the patients' surroundings, like whether they could decorate their rooms with personal furniture and pictures and had access to an outdoor area or garden where they could walk and sit for hours at a time.
The more cosy or homely the environment seemed, as opposed to the traditional hospital unit with white walls and anonymous nurses, Dr. Zeisel said, the better the patients did on standard measures of aggression, social withdrawal and depression. "Things like privacy, personalised bedrooms, and common areas where residents could socialise were all associated with fewer psychotic symptoms and aggressive behaviours," said Dr. Zeisel, who runs the Hearthstone Alzheimer Care residence based in Lexington, Massachusetts. "I think when the residents are in an environment they can understand, it places less cognitive stress on them. And so they experience less anxiety or social withdrawal." In an age where people tend to define treatment for psychological conditions solely as prescription drug use, Dr. Zeisel said, the two studies together suggest that the benefits of a non-pharmacological approach should not be overlooked so quickly.
Instead, Dr. Zeisel says, the best success in treating Alzheimer's may come from using a non-pharmacological approach in combination with drugs, but not from either one alone.
At the very least, say some scientists, the new findings lend support to the notion that patients need as much physical and social stimulation as any other person. Although that seems obvious, they say, past research has shown that for years it was not unusual for many Alzeheimer's patients to be warehoused in institutions. "There was a time not too long ago when patients were left in chairs and ignored, which is the worst kind of prison," said Barry Reisberg, clinical director of the Silberstein Aging and Dementia Research Center at New York University. Though the new findings highlight a way to improve the quality of life for people living with Alzheimer's, some scientists caution that there is still no evidence to suggest that exercise and a change in environment can slow the actual progression of the disease. Some patients, said Marilyn Albert, who directs the division of cognitive neuroscience at Johns Hopkins, never develop problems with agitation and aggression at all.
Still others, including those who are severely psychologically disturbed, she says, respond much better to changes in environment than they ever would to drugs. "The message here for caregivers and families of people with the disease is that environment and exercise are pretty big factors." New York Times News Service
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