Alzheimer’s Disease: Treatments for Patients

Abstract

The pharmacological and non- pharmacological treatments are both able to manage the vast progression of Alzheimer’s and maintain behavioral symptoms. The difference between the two treatments is the after effects. The pharmacological treatments may cause serious adverse effects and the non- pharmacological treatments are safe to the patient and is as effective as the medications for Alzheimer’s without the adverse effects. The pharmacological treatment does affect the cognitive function, but the medications have caused a decrease in quality of life because of the cost and the side effects. The non-pharmacological treatment have been proven to increase cognitive function and quality of life, and improve levels of depression. The symptom that is common with the Alzheimer’s disease is depression and many patients struggle with this symptom. The use of reminiscence therapy, music intervention, and social interaction between peers, has been shown to improve the quality of life in an Alzheimer’s patient and the strategy for music intervention has shown the same results. The music intervention allows the patients to remember past events that are triggered by music that is connected to the emotion. The reminiscence group therapy allows patients to share the experience with peers and gain support from peers. Education is key to helping patients as well as nurses. The nurse should educate the patient on the different treatments other than pharmacologic treatments, and let the patients know what therapies and techniques are available to the patients.

Introduction

 Alzheimer’s disease is a memory loss disease. The first sign of Alzheimer’s disease is when a patient or client has a difficult time recalling a recent event. People with Alzheimer’s may not remember their loved ones, how to dress, or use the bathroom (WebMD, 2019). People with Alzheimer’s disease are usually 65 years old or older, although the disease is not a part of aging (WebMD, 2019). Symptoms of Alzheimer’s disease include trouble focusing, difficulty with daily activities, confusion or frustration, mood swings, and disorientation or getting lost (WebMD, 2019).

 To be diagnosed with Alzheimer’s disease, there is a series of tests that needs to be done which includes a physical and neurological exam, mental status, and brain imaging (WebMD, 2019). As of now, there is no known cure for Alzheimer’s disease, but there are treatments that may help delay the symptoms of the disease (WebMD, 2019). There are two types of drugs that are used to treat cognitive symptoms: cholinesterase inhibitors and memantine (WebMD, 2019).

 Pharmacological treatments are not the only treatment that can help maintain mental function and behavioral symptoms, or slow the symptoms of Alzheimer’s. There are studies that have been done to treat Alzheimer’s disease without medication. Some non-pharmacological interventions include coconut oil enriched Mediterranean diet, reminiscence therapy, social environment and activities, and music therapy with reminiscence therapy and reality orientation (De la Rubia Ortí et al., 2018; Inventor et al., 2018; Lök, Bademli, & Selçuk-Tosun, 2019; Onieva-Zafra et al., 2018; Staedtler & Nunez, 2015). The non- pharmacologic treatments showed that the treatment was safe and effective for Alzheimer’s disease patients. Patients may either choose pharmacologic or non-pharmacologic treatments. In the article by Inventor et al.,(2018) showed that patients who used psychotropic medication were associated with fewer episodes of positive behaviors and those who were more active and were in social environments with other individuals were associated with positive behaviors. Reminiscence group therapy had shown a positive impact on Alzheimer’s disease patients. Reminiscence group therapy is a group environment that states positive experiences, making individuals feel stronger, valuable, and self-confident (Lök et al., 2019). Lök, Bademli, and Selçuk-Tosun (2019) state in the article that reminiscence therapy improved mental functions, levels of depression, and standard of life of Alzheimer’s patients. Music intervention with reminiscence therapy and reality orientation has shown to be an effective treatment for Alzheimer’s disease (Onieva-Zafra, Hernández-Garcia, Gonzalez-del-Valle, Parra-Fernández, & Fernandez-Martinez, 2018). This intervention should be used in clinical settings for people with Alzheimer’s.

Synthesis of Research

Both non-pharmacological and pharmacological treatments are used to manage and maintain behavior symptoms. Dionne-Vahalik (2018) states that antipsychotic medications are prescribed in nursing facilities, but the use of the medication is considered inappropriate for controlling dementia behaviors. Pharmacological strategies use antipsychotic agents, these agents have not been effective and have serious adverse effects, including parkinsonism, and death (Inventor et al., 2018). Non- pharmacological strategies, such as activities (solitary care related, family/friend visits, large group activities, and small group activities) and social environments, have no adverse effect (Inventor et al., 2018). Non-pharmacologic treatments are recommended to treat behavioral symptoms. The study in the article by Inventor et al. (2018), examines the proximal factors (non-pharmacologic and pharmacologic treatments). Positive behaviors included smiling, cooperation with care, participation in activities, accepting assistance when needed, and engaging in conversation (Inventor et al., 2018). Negative behaviors included grimacing, verbal or physical aggression, noncooperation with care related activity (Inventor et al., 2018). The results showed that patients that used non-pharmacological treatment showed positive behavior such as cooperating, engaging, and accepting help when needed (Inventor et al., 2018). Those who took the psychotropic medications had more negative behavior (Inventor et al., 2018). Inventor et al. (2018) states engaging patients in activities can promote positive behavior, studies have shown that psychotropic medication decrease episodes of positive behaviors.

Depression has been a common symptom among dementia patients (Lök et al., 2019). Depression was also associated with worsening cognitive decline in Alzheimer’s disease (Lök et al., 2019). Patients that used reminiscence therapy have shown an improvement in psychosocial well being, reduced depression and depressive symptoms, and an increase in self- esteem (Lök., 2019).  Another non-pharmacological treatment for Alzheimer’s disease is diet; the coconut oil enriched Mediterranean diet obtains direct source of cellular energy in ketone bodies, which means coconut oil could be the new pharmacological treatment for Alzheimer’s patients (De la Rubia Ortí et al., 2018). There was a difference between the use of reminiscence therapy and Mediterranean diet, but the results were similar. The results for reminiscence therapy showed there was an increase in cognitive function, this was achieved by the use of memory recall exercise (Lök et al., 2019). The results for coconut oil enriched Mediterranean diet showed that the Mediterranean diet improved cognitive function in men and women with mild or moderate stage of Alzheimer’s (De la Rubia Ortí et al., 2018).  In the end, the results also showed a decrease in signs of depression with Alzheimer’s patients who used reminiscence therapy (Lök et al., 2019). During the research of the coconut oil enriched Mediterranean diet the patients showed improved episodic memory (De la Rubia Ortí et al., 2018). The results showed that women with mild to moderate state of Alzheimer’s had positive effects with using coconut oil (De la Rubia Ortí et al., 2018). At the end, De la Rubia Ortí et al. (2018) discovered that the coconut oil enriched Mediterranean diet improved cognitive function with Alzheimer’s, with female patients with mild to moderate state of the disease. Reminiscence therapy has been highly effective with patients with Alzheimer’s and those struggling with depression. Reminiscence therapy allows Alzheimer’s patients to remember past events, have social support from peers, sharing similar pasts, and increase in self-confidence (Lök et al., 2019). These techniques allowed the patient to have improved quality of life (Lök et al., 2019).

 Reminiscence therapy has been shown to have positive effects on Alzheimer’s patients, but with the use of music therapy and reality orientation together it has affected Alzheimer’s disease in a significant way. With the use of music intervention, this allows patients to go back to a time that was familiar to them and have a feeling of connection with a memory of their past (Onieva-Zafra et al., 2018). The result of, Onieva-Zafra et al. (2018) study showed confirmation that they’re positive effects for depressed patients with mild Alzheimer’s using music therapy and reminiscence therapy together with reality orientation techniques. The treatment helped manage depressive symptoms and help patients remember past experiences and emotion that came with those memories (Onieva-Zafra et al., 2018). Lök et al. (2019) study also showed signs of improved psychosocial well being, and a reduction of depression and symptoms of depression using reminiscence therapy alone. The use of music intervention with reminiscence therapy and reality orientation allows patients to remember memories that they have forgotten (Onieva-Zafra et al., 2018). Nurses should use this treatment in clinical settings, the treatment has improved quality of life and increased cognitive function (Onieva-Zafra et al., 2018).

Implications

 These articles have proven that non- pharmacologic treatments are as effective as pharmacologic treatments (Staedtler & Nunez, 2015). The use of non- pharmacologic strategies is safe and effective, also it is cost efficient (Staedtler & Nunez, 2015). Nurses should be educated in these treatments in order to teach patients with Alzheimer’s disease. Educating nurses about the positive behaviors that Alzheimer’s patient show when engaging in care related activities such as toileting, grooming, and hygiene care. Supporting patients to engage in activities may improve memory (Inventor et al, 2018). Nurses should also educate patients on medications they are taking and what the adverse effects are for the psychotropic medications or the antipsychotic agents. Nursing facility staff should be educated on the appropriate use of antipsychotic medication (Dionne-Vahalik, 2018). These adverse effects can harm or cause death to the patient, there are more suitable non-pharmacological treatments that have no adverse effects on an Alzheimer’s patients (Staedtler & Nunez, 2018). The non-pharmacological strategy should allow patients to reduce the amount of stress by the environment and social integrations whether with family or friends (Inventor et al., 2018). The results of this non- pharmacologic strategy showed that there was a positive behavior change and it showed that patients were able to cooperate and engage in conversation. Nurses should give this knowledge to patients and families to let them know there are other methods of care for Alzheimer’s disease. Education is key when taking care of a patient and teaching patients about these treatments.

Reflection

 The process of the paper has been long, but it has taught me to be more organized with my thought process when writing a literature review on five different articles. The whole process of this paper was confusing because there are parts of when I needed to just focus on the main subject and not go off topic. I was glad that the outline was made because if I did not have that I would have really been lost with my thought process. This paper was a long process that took a lot of time and thought.

 Overall, I was glad that we got the chance to learn how to write a literature review. Even if the process was a bit frustrating at times, I think I was able to learn something about literature reviews. I feel like I can take this process that I learned and use it in the future, every paper does take time and that is what I learned when writing this one. The last thing I learned was that educating a patient may help them. I also learned lots about treatment plans for Alzheimer’s disease, and I can now educate anybody on different treatment plans that do not include medication.

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References

• De la Rubia Ortí, J. E., García-Pardo, M. P., Drehmer, E., Sancho Cantus, D., Julián Rochina, M., Aguilar, M. A., Hu Yang, I. (2018). Improvement of main cognitive functions in patients with alzheimer’s disease after treatment with coconut oil enriched mediterranean diet: A Pilot Study. Journal of Alzheimer’s Disease, 65(2), 577–587. https://doi.org/10.3233/JAD-180184
• Dionne-Vahalik, M. (2018). Use of antipsychotic medications in individuals with alzheimer’s disease in nursing facilities. Use Of Antipsychotic Medications In Individuals With Alzheimer’s Disease in Nursing Facilities, 1. Retrieved from https://resource.ahu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=cin20&AN=131800521&site=ehost-live&scope=site
• Inventor, B. R., Farran, C. J., Paun, O., Cothran, F., Rajan, K., Swantek, S. S., & McCann, J. J. (2018). Longitudinal effects of activities, social environment, and psychotropic medication use on behavioral symptoms of individuals with alzheimer’s disease in nursing homes. Journal of Psychosocial Nursing & Mental Health Services, 56(11), 18–26. https://doi.org/10.3928/02793695-20180503-04
• Jennings, E. (2015). The importance of diet and nutrition in severe mental health problems. Journal of Community Nursing, 29(5), 68–73. Retrieved from https://resource.ahu.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=cin20&AN=110709634&site=ehost-live&scope=site
• Lök, N., Bademli, K., & Selçuk-Tosun, A. (2019). The effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer patients: Randomized controlled trial. International Journal of Geriatric Psychiatry, 34(1), 47–53. https://doi.org/10.1002/gps.4980
• Onieva-Zafra, M. D., Hernández-Garcia, L., Gonzalez-del-Valle, M. T., Parra-Fernández, M. L., & Fernandez-Martinez, E. (2018). Music intervention with reminiscence therapy and reality orientation for elderly people with alzheimer disease living in a nursing home: A Pilot Study. Holistic Nursing Practice, 32(1), 43–50. https://doi.org/10.1097/HNP.0000000000000247
• Staedtler, A. V., & Nunez, D. (2015). Nonpharmacological Therapy for the management of neuropsychiatric symptoms of alzheimer’s disease: Linking Evidence to Practice. Worldviews on Evidence-Based Nursing, 12(2), 108–115. https://doi.org/10.1111/wvn.12086
• WebMD. (2019). Alzheimer’s Disease Information: Facts, Causes, Definition, and More. Retrieved from https://www.webmd.com/alzheimers/guide/understanding-alzheimers-disease-basics