Alzheimer’s Treatment Options: Early and Non-Drug Interventions

A diagnosis of Alzheimer’s disease can be very difficult for patients and their loved ones. At the moment, there is no cure for this condition, but there are various drug and non-drug interventions available to help patients as the disease progresses. Understanding the multiple options available allows patients and caregivers to decide the best solutions for them. 

During the early stages, interventions are designed to slow down the progression of symptoms and allow the patient to maintain independence for longer. As symptoms worsen and patients need more care, the aim of the treatments changes and focuses more on preserving the patient’s quality of life and dignity. Options during later stages are more limited and aim to keep the patient as comfortable as possible.

In this article, we’ll review different interventions that can be used during the early and late stages, including what you can do at home and the specialized treatment we offer at our dementia clinic, Neural Effects. 

Neural Effects provides structured and evidence-based interventions to enhance cognitive and social functioning in individuals with dementia. We are located in Provo, Utah, and serve anyone in Salt Lake City or the Utah Valley area. We are in-network for most types of medical insurance. Schedule your evaluation today.

Early Interventions 

Alzheimer’s disease typically progresses in three stages of dementia: early, moderate, and late. Normally, patients in the early stages of Alzheimer’s disease continue to function independently and don’t need the help of a carer. They can still drive, work, and engage in social activities. Most symptoms are not visible at this stage, but loved ones may start to notice some signs of dementia, including: 

• Memory loss: One of the earliest signs of Alzheimer’s disease is memory loss, especially recent information. Patients may also forget important dates or events and increasingly need to use memory aids, such as to-do lists and reminders on mobile phones. 

• Changes in cognitive skills: Some patients struggle to focus on a particular task or take longer to do things than they did before. They may also find some daily activities challenging, such as paying bills or keeping track of medication. 

• Difficulty with familiar tasks: Patients with Alzheimer’s disease may have trouble driving to a familiar location or forget the rules of a favorite game.

• Confusion with time: Patients quickly lose track of time, including changing seasons during the year. They may also have trouble understanding when something will happen in the future.

• Difficulties with spatial awareness: Patients with Alzheimer’s disease often experience vision changes, which may lead to problems judging distances and poor depth perception. 

• Problems with communication: It’s common for patients to experience difficulties following conversations. They may struggle to find the right word or repeat themselves. 

• Misplacing objects: Patients may put things in unusual places and then struggle to retrace their steps to find them again. 

• Poor judgment: Patients with dementia may struggle to make decisions. They may have poor judgment when dealing with money or pay less attention to personal hygiene. 

• Avoid social activities: Given their symptoms, it’s common for patients to withdraw from hobbies, social activities, or other engagements. 

• Personality changes: Patients can become confused, suspicious, depressed, fearful, or anxious. They may become easily upset when out of their comfort zone or in unfamiliar places. 

There are several pharmacological and non-pharmacological interventions to address these symptoms and treat patients during these early stages. Overall, dementia care at this stage aims to slow down the progression of cognitive, physical, and emotional symptoms, allowing patients to continue performing their usual daily activities and live independently for longer. 

Pharmacological Early Interventions

For patients with early Alzheimer’s, doctors and other healthcare professionals often prescribe cholinesterase inhibitors, including donepezil, rivastigmine, or galantamine. In simple terms, these drugs prevent the breakdown of a chemical in the brain called acetylcholine, which is important for memory, judgment, thinking, and other cognitive skills. While these prescription drugs don’t stop the damage triggered by Alzheimer’s disease, they help control cognitive and behavioral symptoms for a while. In practical terms, patients experience improvements in memory, thinking, language, judgment, and decision-making. 

Another early intervention involves using medication to reduce the protein plaques that build up in the brain of patients with Alzheimer’s disease. These are called amyloid-beta directed monoclonal antibodies. In this category, Aducanumab (Aduhelm) was recently approved by the FDA to treat patients with mild cognitive impairment (MCI) and early Alzheimer’s disease. However, there was some controversy following its approval, and many doctors refused to prescribe the drug to their patients. Now, manufacturer Biogen has announced that Aducanumab is going to be discontinued. Patients receiving the drug as part of a clinical trial will continue to have access to it until May 2024, and patients who have been prescribed it will continue to receive it until November 2024. 

A second drug — called Lecanemab (Leqembi) — was also recently approved by the FDA to treat patients with MCI and early Alzheimer’s disease. Studies showed that this drug can slow down the rate of cognitive decline and reduce the levels of amyloid in the brain, but, at the moment, insurance companies only cover this medication in special situations.

Non-Pharmacological Early Interventions

An increasing number of non-pharmacological therapies are also available for patients with early dementia. 

Cognitive Stimulation Therapy

One of the most important interventions at this stage is cognitive stimulation therapy (CST). We’ve written in more detail about this therapy (which we use at Neural Effects), but briefly, patients engage in various activities for memory care, including discussions, word games, and puzzles to stimulate cognitive skills. CST’s learning style is implicit, which means participants absorb information in an incidental way and are not aware that they are learning something new. Multiple studies show that CST is one of the most effective non-pharmacological interventions for patients with early dementia.  

Further reading: Memory therapy for patients with dementia

Reminiscence Therapy

CST incorporates some aspects from other types of therapies, including reminiscence therapy and reality orientation therapy. Both these therapies can also be used in isolation for patients with early dementia. Reminiscence therapy involves discussing past activities and events using a variety of props, including photos, videos, and other objects that have a special meaning for the patient. This therapy can improve well-being and promote social interactions and behavior.  

Reality Orientation Therapy

Reality orientation therapy helps the person understand the present using games, puzzles, and visual prompts, such as calendars and flip charts. The aim is to give the patient a greater understanding of their surroundings and an improved sense of control and self-esteem.

Speech and Language Therapy

To protect cognitive skills, patients may also need speech and language therapy. This therapy addresses communication and language symptoms, such as difficulty with attention and focus, voice and speech problems, and difficulty reading. Using speech therapy, patients experience improvements in understanding spoken and written language and find it easier to express their thoughts and ideas. 

Physical Therapy

In addition to cognitive issues, patients with Alzheimer’s disease may also experience physical symptoms, such as balance and mobility issues. For these patients, the best option is physical therapy. This therapy increases muscle strength and fitness, lowers the risk of falls, reduces fatigue, and improves sleep. Regular exercise improves quality of life and mood and stimulates social interactions.

Further reading:

• Physical therapy exercises for dementia
• How physical therapy helps patients with dementia

Occupational Therapy

Patients with Alzheimer’s disease may also benefit from occupational therapy. Therapists work with patients to maximize their independence by suggesting ways to help with daily activities (including using mobility aids and other equipment) and helping to establish a daily routine that patients can follow. 

Further reading: Occupational therapy for patients with dementia

Talk Therapy

Finally, to address emotional symptoms, such as anxiety and depression, patients can attend talk therapy. Talk therapy — such as cognitive behavioral therapy (CBT) and counseling — involves sessions with a counselor, a psychologist, or a psychiatrist. During these sessions, patients talk about their feelings and worries, including how they feel about their diagnosis. Several studies show that talk therapy can reduce symptoms of depression and anxiety, but it’s most suited for patients during the early stages of the disease. Patients in the later stages have cognitive problems and may not be able to engage in this type of therapy.

Validation Therapy

Patients with early and moderate Alzheimer’s may also benefit from validation therapy. This form of therapy aims to validate the patient’s feelings and emotions as a way to alleviate stress, improve quality of life, and reduce the incidences of behavioral issues. Results are mixed about the effectiveness of this therapy; and some studies found a positive impact, while others found no significant benefits. 

Recreational Activities (e.g. Music and Art Therapy)

Finally, patients with early Alzheimer’s can also engage in various recreational activities, such as playing a musical instrument, being creative with arts and crafts, or playing with a pet. These activities challenge the brain as patients learn new skills, stimulate social interactions, and give patients opportunities for self-expression. 

For example, several studies have reported benefits from music therapy, including increased well-being, better social interactions, and lower incidence of disruptive behaviors. Typically, this therapy involves singing, playing a musical instrument, or just listening to songs. Crucially, music therapy encourages verbal and non-verbal expression, and patients can engage without any previous knowledge of music. 

Many patients also enjoy being creative during art therapy. Patients can learn to sculpt, paint, draw, make cards, create jewelry, or participate in community art projects. Art therapy can reduce agitation, boost mood, and give patients a sense of accomplishment and purpose. Studies show that creativity boosts cognitive function, enhances communication, and promotes social interaction for dementia patients.

Another option for patients with dementia is animal-assisted therapy. Using animals in patients with dementia reduces stress, lowers blood pressure, and limits disruptive behaviors, such as agitation and aggression. During the early stages, patients can take the dogs out for a walk, which also stimulates physical activity. 

Combination of Physical and Cognitive Therapies

Multiple therapies for dementia can be administered one at a time. In particular, studies have shown that patients benefit from completing cognitive therapy immediately after physical exercise. 

This combination works because physical exercise triggers a phenomenon called the post-exercise cognitive boost (PECB). This involves the release of an important chemical called brain-derived neurotrophic factor (BDNF). BDNF makes the brain more receptive to change, allowing patients to benefit more from therapy shortly after exercise.

This is the approach we take in treating early-stage Alzheimer’s patients at our clinic, Neural Effects. At the bottom of this article, we’ll provide more details on how our program works. To jump straight to that section, click here.

Early Interventions at Home

Lifestyle choices have a strong impact on how patients feel. Studies show that staying physically and mentally active, as well as following a balanced diet, are some of the most effective interventions to slow down the progression of the disease. 

Getting Exercise

Engaging in regular exercise improves fitness and strength and helps patients cope better with their cognitive problems. It can be any type of exercise, from going for a walk, attending an aerobic or yoga class for seniors, or simply doing a bit of gardening. Our advice is to be active for at least 30 minutes every day, five days a week. This can be broken down into multiple sessions throughout the day, each lasting a minimum of 10 minutes. 

Staying Mentally Active

Alongside regular physical activity, patients should strive to stay mentally active to slow down the progression of symptoms. It’s essential to pick an activity that is not too easy or too difficult because that is likely to frustrate the patient. It also needs to be something that the patient can enjoy. Anything that can help patients think quickly, recall information, or make decisions can improve cognitive function. Examples include playing board games, learning to play a musical instrument, or engaging in arts & crafts activities.

Eating a Healthy Diet

Another intervention at home that can help slow down symptoms is following a healthy diet. Patients should avoid a poor diet as this may increase behavioral symptoms and cause weight loss. One example of a balanced diet suitable for patients with dementia is the MIND diet, which combines a traditional Mediterranean diet and the DASH diet (designed to lower high blood pressure). Studies show this diet can slow down brain aging by the equivalent of 7.5 years. This diet includes eating vegetables, fruits, nuts, whole grains, low-fat dairy products, and lean protein foods while avoiding salty, sugary, and fatty processed foods.  

Socializing

In addition, patients with early Alzheimer’s need to maintain an active social life. Avoiding contact with others accelerates the progression of the disease and increases the chances of developing anxiety and depression. Patients can join an art club, volunteer for a local charity, or go out with friends. Patients with mobility issues can still keep in touch with friends and family with a regular chat on the phone. 

Establishing a Sleep Routine

When it comes to interventions at home, one of the ways to help patients with Alzheimer’s disease is to establish a good sleep pattern. Many patients experience sleep difficulties at night and drowsiness during the day. Some patients experience a phenomenon called sundowning, where they feel lost and confused in the evening. Patients should follow a strict routine of going to bed and getting up at the same time every day. It may help to engage in some relaxing activity in the evening, such as reading a book in a quiet space or listening to calming music. It’s also helpful to avoid using mobile phones before going to bed. 

Late Interventions

As the disease progresses, patients need more intensive supervision and appropriate care options. Patients with late-stage Alzheimer’s struggle to communicate and are completely dependent on others for eldercare. This type of intense in-home care can be challenging for loved ones and family caregivers, especially when it reaches end-of-life care. 

During this stage, symptoms of dementia include:

• Increased confusion

• Increased memory loss, such as forgetting events or personal history

• Difficulty recognizing family and friends

• Withdrawal from social activities

• Inability to learn new things

• Difficulty with communication

• Difficulty thinking and other cognitive skills

• Poor attention span

• Difficulty coping with new situations

• Changes in sleeping patterns

• Difficulty carrying out familiar tasks, such as getting dressed or setting the table

• Hallucinations, delusions, and paranoia

• Impulsive behavior, such as undressing in inappropriate places or using abusive language

• Inappropriate emotional outbursts

• Restlessness, agitation, and wandering, especially in the late afternoon or evening (this is called sundowning)

• Repetitive movements and muscle twitches

• Inability to communicate

• Poor awareness of their surroundings 

• Weight loss with little interest in eating

• Seizures

• General health decline, including dental, skin, and foot problems 

• Poor mental health

• Difficulty swallowing

• Loss of bowel and bladder control

At this stage, the main aim of late interventions is to support the patient and keep them comfortable and pain-free. Patients may still be able to participate in some activities, but these need to be adjusted to their abilities. This can be done in the patient’s own home or in a dementia care or senior living facility. 

Pharmacological Late Interventions 

As we described earlier, patients with early Alzheimer’s disease are often prescribed acetylcholine inhibitors. However, as the disease progresses, the brain produces less acetylcholine, and over time, acetylcholine inhibitors lose their effectiveness. 

Doctors may change to a glutamate regulator called memantine (Namenda) when this happens. Briefly, nerve cells in patients with advanced Alzheimer’s release excessive amounts of a chemical called glutamate, which affects how these cells communicate with each other. 

Memantine protects surviving brain cells against the effects of excessive glutamate. This drug can help patients maintain the ability to carry out certain daily tasks a little longer than they would without the medication. For example, memantine can help patients maintain their ability to use the bathroom independently for a few more months. In addition to patients with Alzheimer’s disease, these meds can also help patients with Lewy body dementia, vascular dementia, and mixed dementia. Memantine is currently available by itself or combined with donepezil. Both are used to treat dementia symptoms in patients with moderate to severe dementia.  

In addition, patients with late Alzheimer’s may need a variety of other prescription drugs to control symptoms triggered by the disease, including:

• Depression and anxiety
• Difficulty sleeping at night
• Agitation
• Hallucinations
• Wandering
• Aggression

These patients may be prescribed a variety of meds, such as:

• Anti-anxiety drugs, including benzodiazepines, can be used to treat agitation and other behavioral symptoms. However, they can cause sleepiness, dizziness, and confusion, and most doctors recommend using these drugs only as a last resort and for short periods.

• Sleeping pills can be used to help patients sleep better at night. Patients should not rely on these drugs regularly as they make patients more confused and more likely to fall.

• Anticonvulsants can be used to treat severe agitation and aggression. However, these drugs should only be used on a short-term basis, as side effects include sleepiness, dizziness, mood swings, and confusion.

• Antipsychotics are only used in extreme cases when all other options have failed. These drugs can treat hallucinations, delusions, and paranoia, but side effects can be serious and even fatal. 

Non-Pharmacological Late Interventions

Patients with late Alzheimer’s can still engage in many of the therapies described earlier, but activities need to be adjusted to the patient’s abilities. 

For example:

• Instead of talking about past events and looking at old photos and videos during reminiscence therapy, patients can still enjoy listening to old songs and hearing about old family stories. 

• During speech therapy, patients focus on swallowing problems, which are a common symptom for patients in the later stages of the disease. 

• During music therapy, therapists can use different songs to engage with patients. For example, they can use a song with a fast tempo to encourage patients to participate in physical activities or use something slower to soothe and calm down patients when they’re stressed and agitated.

• Even if a person experiences serious mobility issues, they may still be able to do seated exercises during physical therapy. These exercises are aimed at maintaining muscle strength and balance and are easier and less strenuous than exercises in a standing position.

Multisensory Stimulation Therapy

One specific type of therapy that may help patients with late Alzheimers is called multisensory stimulation therapy. During these sessions, patients are exposed to different scents, sounds, and textures to evoke positive emotions and memories. Sessions can cover a variety of activities, including eating the patient’s favorite cake, brushing their hair, or sitting outside and smelling the flowers. The aim is to make patients feel safe and relaxed, as well as to improve their mood and quality of life. 

Doll Therapy

Patients with late Alzheimer’s may also enjoy doll therapy. Patients play with a doll (or some other toy) and remember events from their childhood. Studies show that this approach improves the patient’s mood and communication skills, promotes social interactions, and reduces the incidence of delirium episodes. Playing with dolls also reduces the need for antipsychotic drugs, prevents wandering, and improves quality of life. 

Aromatherapy

Finally, aromatherapy is quickly growing in popularity among patients with dementia. Essential oils can be administered through inhalation, bathing, massage, and topical application in a cream, which means that they can be used in different situations. For example, inhalation can help calm down agitated patients, while massage is better to help patients who enjoy being touched. Studies show positive effects using aromatherapy, including patients feeling less agitated and sleeping better.

Late Interventions at Home

Inevitably, as the disease advances, the needs of patients living with Alzheimer’s change significantly. During the later stages, interventions at home should focus on preserving the aging parent’s quality of life and dignity. 

Although a patient with late-stage Alzheimer’s typically loses the ability to communicate and express their needs, it’s important to recognize that the core of the person is still there. Loved ones can still strive to connect throughout the late stage of the disease.

Establishing a Daily Routine

Establishing a daily routine can help patients stay focused and oriented. Patients know what to expect when it’s time to eat, go out, or prepare to sleep. Loved ones must understand what triggers changes in behavior and adapt the daily routine as needed. For example, if patients are more alert and cooperative in the morning, caregivers must adjust their routine to make the most of this period.

Adapting Activities of Daily Living

In addition, loved ones may need to adapt activities of daily living (ADLs). ADLs include all basic personal care tasks, such as bathing, dressing, and eating. Most people can do these independently, but they become increasingly difficult for patients with late Alzheimer’s. Some adaptations for dementia support include:

• Bathing: For many late Alzheimer’s patients, bathing is a frightening and confusing experience. Patients often forget when they have a shower, or they refuse to get wet. Caregivers should ensure they have everything they need in the bathroom, including bath products, towels, and assistive devices. Crucially, patients should never be left alone in the bathtub or shower to avoid falls or other injuries.

• Dressing: Getting dressed is not complicated, but patients with Alzheimer’s may not recognize when clothes need washing or struggle to find appropriate clothes for the weather. Caregivers can help patients by giving them a limited choice of outfits and buying comfortable clothes that are easy to get on and off. 

• Using the bathroom: It’s common for patients with Alzheimer’s to experience difficulties going to the toilet, including poor bladder and bowel control. This can be upsetting and embarrassing for senior patients. Caregivers need to see a doctor, as incontinence may indicate urinary tract infections (UTIs). Also, encourage patients to go to the toilet regularly, which helps avoid accidents. 

• Eating: Some patients struggle to eat, while others only want to eat certain items and don’t follow a balanced diet. In addition, being able to eat requires coordinated movements, which may be difficult for some patients. It’s important to make mealtime adjustments to make sure patients maintain a healthy weight. This may include serving small meals several times during the day and offering appealing foods that vary in taste, texture, and color. Patients with difficulties using cutlery may prefer finger foods, such as sandwiches, chicken nuggets, and fruit. 

Encourage Social Interaction

Finally, even if patients struggle to communicate, they still enjoy spending time with their loved ones. Caregivers and family members need to encourage social interactions and ensure they continue to talk with their relatives with dementia, even if they can’t always reply, ask questions or keep repeating themselves. 

A study showed that just one hour a week of personalized and tailored social interactions in a dementia care facility can improve the quality of life of patients with moderate and severe dementia.

Alzheimer’s Treatment at Neural Effects

At Neural Effects, our treatment can also be considered an early intervention, as it uses a combination of cognitive stimulation therapy (CST) and aerobic exercise to delay the progression of symptoms. Patients with moderate to late Alzheimer’s may struggle to engage during the sessions and receive little to no benefit. 

Before treatment starts, patients complete our dementia evaluation. This includes a neuropsychological exam (also called a neurocognitive evaluation) to find out exactly how Alzheimer’s has affected the brain, as well as a physical, cognitive, and emotional assessment. This exam takes about 2–2.5 hours to complete. 

Even if patients already have a dementia diagnosis, we feel it’s still beneficial for them to complete this exam. It provides useful information to help our therapists make important decisions regarding their treatment. 

All information gathered is then used to create a cognitive care plan (CCP). Every patient gets a personalized care plan, even if they decide not to continue treatment with us. The CCP includes the following health information:

• Diagnosis
• Results from the assessment
• Risk factors for progression and discussion of how the disease is likely to progress
• Lifestyle changes that may help the patient
• Suggestions for family involvement
• Recommended treatment options

Once this exam is completed, patients can start their therapy sessions. Our treatment plan includes two one-hour sessions per week for seven weeks, for a total of 14 sessions.

Each session starts with 10–15 minutes of aerobic exercise, usually done on a stationary bike or treadmill. The patient’s safety is paramount to us, and our therapists are trained to adapt the exercises in intensity and duration to ensure patients don’t get injured. We use physical exercise as a way to stimulate the flow of blood in the brain and trigger the release of the chemical we mentioned earlier, brain-derived neurotrophic factor (BDNF). This is a crucial step as BDNF makes the brain more receptive to therapy and helps patients learn better. 

After exercise, patients engage in various cognitive games and activities to stimulate thinking and memory, including discussing past and present events, word games, puzzles, music, and practical activities. The sessions are run by two facilitators working with a small group of up to six patients. These facilitators guide the discussions and encourage patients to socialize with each other. 

Family support is very important for patients with dementia. We invite loved ones and caregivers to attend the first session and learn more about CST. This way, they can support the patient at home and repeat some of the games used during our sessions. Our therapists also meet with family members to discuss information about lifestyle changes that may help the patient and share resources, including suggestions for support groups in their area for both patients and their caregivers.

Neural Effects uses the latest evidence-based techniques to diagnose and help patients with dementia. We are located in Provo, Utah, and serve anyone in Salt Lake City or the Utah Valley area. We are in-network for most types of medical insurance. Schedule your evaluation today.