Becky McCall

March 13, 2012

March 13, 2012 (London, United Kingdom) — There is more evidence to support the use of what is being called "learning therapy" in patients with Alzheimer's disease (AD). Preliminary results of a new study suggest learning therapy provides an effective method for improving cognitive function in patients with AD and vascular dementia.

Ryuta Kawashima, MD, from the Smart Ageing International Research Center, IDAC, Tohoku University, Sendai, Japan, previously published a report on this approach from a study conducted in Japan. Those promising results have now been replicated in a US-based trial, preliminary results of which were presented here at the Alzheimer’s Disease International (ADI) 27th International Conference.

"We can say from this RCT [Randomized Control Trial] that the learning therapy intervention has beneficial effects and improves quality of life for people suffering from dementia," Dr. Kawashima told Medscape Medical News.

Learning Therapy

Dr. Kawashima developed learning therapy as a cognitive intervention for patients with dementia to train their working memory through reading aloud and arithmetic.

Working memory tends to decline during late adulthood, but when fully functional, it provides temporal storage and retrieval of information, which directs an individual's behavior, Dr. Kawashima said. "When people undergo intensive, adaptive working memory training, they can expect to expand their working memory, which enhances their ability to reason quickly and to think abstractly," he said.

In the learning therapy program, all patients do a combination of storytelling and arithmetic. Dr Kawashima and his colleagues have developed 4000 different materials for the purpose. Before the start of the intervention, programs are individualized to suit the patient’s cognitive needs. "This gives the patient the best chance of engaging and performing the task without difficulty," Dr. Kawashima noted. Patients participated in learning therapy for 15 minutes per day for 3 to 5 days per week.

The effect of this approach in Japanese patients with AD was first investigated in a previous trial published in 2005. In this study, the Mini-Mental State Examination (MMSE) score in the intervention group (n=16) increased marginally over 6 months from 19.9 to 20 points while the MMSE score in the control group (n=16) declined by approximately 1.8 points on the scale (19.6 to 17.8).

In the intervention group, the Frontal Assessment Battery at Bedside (FAB) score at 6 months increased from approximately 7.0 to 8.5, while the control group scores declined from 6.8 to 6.2.

Dr. Kawashima said, "We followed the Japanese patients for 5 years and in 1 case for 10 years. This patient retained her cognitive function for 10 years, which is a miracle."

In September 2011, Dr. Kawashima conducted a similar study in US patients because he wanted to investigate whether learning therapy would work equally well in a different cultural setting. Approximately 30 patients with AD or vascular dementia were included in each of the intervention and control groups. The mean age of these patients was 65 to 70 years in contrast to 80 years in the previous Japanese study.

Citing a pending publication, Dr. Kawashima said he could not provide detailed results from the US study, but indicated that their findings closely resembled those seen in the previous Japanese trial. "In both cases we found exactly the same results," said Dr. Kawashima.

In the new study, the MMSE and FAB scores showed improvement in the intervention group and a decline in the control group after a 6-month period of therapy.

Patients who received learning therapy showed an increase in the MMSE score from approximately 15.8 to 18.2, and an increase from approximately 6.6 to 7.7 in the FAB score after 6 months. Patients in the control group demonstrated a decline in MMSE scores from 16.4 to 13.9 while FAB scores remained constant for 6 months.

In addition to improvements in the neuropsychological scores, patients also experienced a transfer effect, essentially a positive influence on nontrained cognitive functions. "We believe that intensive, adaptive working memory training can improve general prefrontal cognitive function encompassing general intelligence and creativity," commented Dr. Kawashima.

Finally, in both studies, beneficial changes were seen among the staff in care homes running the learning therapy programs. Carers reported an increase in deeper communication and understanding with learners, especially in terms of recognizing the patients' potential to still learn.

"Staff also reported that they felt greater respect for the elderly in their care and experienced a heightened sense of pride in their work," Dr. Kawashima pointed out. "If staff do change their attitudes towards the patients then the improvements spiral upwards. If carers do not feel benefits too, then the situation spirals downwards."

Daily Engagement

Nori Graham, MD, emeritus consultant in Old Age Psychiatry, London, United Kingdom, former chairman of the Alzheimer’s Society UK, and former chairman of ADI moderated the session. She remarked that she found the whole concept excellent because it engaged the person with dementia with whomever they were living with or their carer.

"This is far preferable to effectively leaving that person alone," she told Medscape Medical News. "Everyone with dementia can be involved in some way throughout the day but having something very specific to do is very morale boosting for the patient."

Dr. Graham added that it appeared to be a relatively simple training to carry out and therefore could be used widely. "The biggest problem in most care homes is that very little goes on," she said. "There are too few staff and those that exist are not sufficiently aware that doing these activities with patients will stimulate them. Drugs are used very readily because often, too few staff are available to do anything else. It might be interesting for family members in their own homes to use learning therapy, which is where most people with dementia live."

Also commenting on the work as presented at the conference, Aimee Spector, PhD, from University College London, said that she felt it was a work in progress.

"Despite being impressive, the trial has fairly small numbers; trials with larger numbers are needed," she said. "However, I like the idea of getting people to actually do something and actively engage the brain rather just talk about the past. It also led to broader changes in the patients’ lives."

Dr. Kawashima and Dr. Graham have disclosed no relevant financial relationships. Dr. Spector conducts private Cognitive Stimulation Therapy sessions.

Alzheimer’s Disease International (ADI) 27th International Conference : Abstract PL11. Presented March 9, 2012.

J Gerontol A Biol Sci Med Sci. 2005;60(3):380-384. Abstract

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