•  Canada’s guide to retirement living and care

The Changing World of Alzheimer's Care

The state of affairs this Alzheimer's Awareness Month

Families dealing with an Alzheimer's diagnosis face a long, difficult road. Traditionally, their options were limited. Care their loved one received, even from professionals, was often inadequate due to a poor understanding of the disease and the brain. That's changed a lot in the past few years. And it promises to improve significantly as we learn more about the disease, as medical science makes further advances, and communication improves further.

Last year at this time, Comfort Life focused on the hope of better treatments and even the possibility of a cure. There is still progress being made in treatments and diagnoses but a cure remains distant. Caregivers' best hope for now is to learn how to manage the symptoms in the best way and to find the best care possible. 

The search for a cure continues

Last year, we reported on the hope for a cure, notably the drug Aducanumab. This drug is still currently in late-stage clinical trials run by the Massachusetts biotech company Biogen, which hopes to announce trial results in 2019 or 2020. Investors have, in fact, cooled to the prospects for the drug, but this cooling effect has been influenced by results of tests for other drugs that only seem similar.¹ LMTX is another drug that has shown early promise in "in slowing down and reducing the effects" of Alzheimer's² .

Other recently reported breakthroughs include: 

• Tracing the transneuronal spread of taus in the brain.
• A proposed new therapy that involves listening to a low humming sound. 
• The potential of gamma-secretase modulators as therapeutics for Alzheimer’s.

As reported in the Washington Post and other sources, a promising new treatment for Huntington's Disease targets its central cause, and this may also have potential as a treatment for "some forms of Alzheimer's."³ All of these treatments, though, remain in trial stages, some ways off from going to market. There is still no proven cure for Alzheimer's. 

For families dealing with the disease, it's a disappointing matter of fact, then, that the closest thing to hope rests in finding the best care. So in the immediate, caregiving mixed with home care and the eventual use of memory care and long term care remains the most humane response to the advance of the disease. With that in mind, here's a look at some important ways in which Alzheimer's care is set to take new strides forward in 2018.

Improvements in caregiving approaches

As the disease's effects are better understood, increasingly effective approaches to personal caregiving are being developed. Approaches that encourage personal interaction, combat symptoms of the disease, and facilitate a richer understanding between caregiver and patient offer small but important victories in the fight against progressive dementia.

A structured program of brain games that stimulates the brain, enables interaction, and applies errorless learning (an approach shown to be most effective for sufferers of memory loss) offers the most promise. One such program consistently gaining traction is the Ashby Memory Method (AMM), a pioneering cognitive therapy program, developed in Canada. AMM offers two tracks, one for personal caregivers (family and friends program), the other a professional certification program (certified allied professional program).

The family and friends track of AMM offers families a "professionally designed, paper-based, non-invasive program to promote connections between dementia-sufferers and caregivers, improve symptoms, and offer caregivers empowerment," says Paul Cutajar of Pivotal Aging Innovations, the Ontario distributor of the program. AMM can be combined with medication (while at the same time, it may reduce the need for medical interventions).

AMM is ideally suited to help people in the early to middle stages of Alzheimer's Disease. The program employs the brain's neuroplasticity to exercise an individual's functioning areas while others are in decline, due to the effects of the disease (i.e. the buildup of amyloid plaque). It's a "practical program [that] empowers families to be more involved in, more understanding of, and less stressed by their loved one's day-to-day lifestyle," says Cutajar.

Activities in the program stimulate all five senses. Materials, techniques and components of the program include the use of photographs and pictures to stimulate visual recognition, word exercises, tactile stimulation, logical inferences, and sensory stimulation exercises. AMM was initiated by Dr. Mira Ashby, CM, a Calgary-based specialist who later received the Order of Canada, for her work with brain injuries. 

There are other approaches to memory care, in a family caregiving setting. One other approach that has been used by caregivers for several years is the Montessori Memory Method. Based on the well-known approach to education, it applies principles of Montessori teaching to caregiving, focusing on offering sensory experiences that meet the patient where they are, using art and music activities that stimulate memory (and the brain).

Spaces designed for dementia sufferers

New memory care communities incorporate a compassionate-minded, thoroughly progressive approach "from the ground up." A leader in this field is Andrea van der King, a Toronto interior designer who creates spaces with the needs of dementia sufferers top of mind. Her company, van der King Design Group, Inc., is at work on several projects across the province of Ontario.

In her designs, van der King focuses on creating spaces that:

• appear residential, disguising clinical elements.
• ensure cultural diversity while also speaking to local communities.
• provide opportunities for residents to use skills and intelligence, keeping their minds active, with daily activities to maintain independence and confidence.
• use design elements for orientation, along with clear signage that minimizes residents' memory load.

Residences with interior spaces designed by van der King use natural daylight and appropriate acoustics that improve both privacy and social engagement. Her designs embrace biophilic design principles, where "natural materials, natural light, vegetation and other experiences of the natural world are built into a modern environment," she says. We profiled van der King's work in more depth, in last summer's look at "Design for Memory Care."

Beyond design, retirement communities also adopt recent technologies that can help aid and abet the safety of Alzheimer's patients. A number of communities associated with Comfort Life use real time location systems (RTLS) to surreptitiously monitor the movements of dementia sufferers, with their safety foremost in mind.

With the consent of families, dementia sufferers are fitted with badges or pendants equipped with GPS transponders. Software run by care staff in the community tracks the location of care residents, and alerts staff if someone is wandering too far afield. It's much less an impingement on privacy (as some might object), than it is a smart use of technology to actually allow Alzheimer's sufferers much more freedom of movement. 

Professional care for Alzheimer's sufferers

Care offered in memory care communities also incorporates a variety of cognitive exercise programs that stimulate memory and cognition in Alzheimer's sufferers. The Ashby Memory Method also has a certified allied professional program, as mentioned above.

Other programs offered by communities include the following:

• The Java Music Club, which facilitates peer support, learning and memory retention. Like AMM, this was developed in Canada and has been adapted by over 600 facilities in North America.
• It's Never 2 Late employs touch-screen interactions that give each dementia sufferer his or her customized program that includes games and activities that exercise the mind, stored personal memories in the form of photos and videos, the option to share stories with others, and more.
• Living in My Today, available through Schlegel Villages retirement residences, supports those living with dementia, learning what their inner life is like and renewing the commitment to care every new day. 
• MemoryPlus™ from Delmanor focuses on recognizing the full life story of the dementia sufferer, of which Alzheimer's is only a small part.

All memory care communities at Comfort Life offer exceptional care in environments focused on security, staffed by people increasingly better-trained to offer sensitive, compassionate care. For example, many staff in memory care homes understand the behaviour of dementia sufferers as responsive behaviours. This is a softer way of framing negative behaviours associated with dementia, behaviour such as repetition of the same question, wandering, angry outbursts, and others. Staff are trained to see things from the perspective of the dementia patient, who is only behaving as a response to external things.

Similarly, training in the Gentle Persuasive Approach (GPA) is a core requirement for staff at many memory care residences. The GPA training program helps caregivers anticipate behaviours related to Alzheimer’s Disease or Related Disorders (ADRD), and to gently deflect typical reactions in favour of more patient responses. You can learn more in our deeper look at professional treatment of Alzheimer's.

Alzheimer's research at an inflection point

A number of observers believe that the field of Alzheimer’s research is at an inflection point similar to the one that sparked a renaissance in cancer research about a decade ago.  “We are where oncology was 10 or 12 years ago, when most tumours were thought to be intractable and could only be treated with chemotherapy or radiation,” says Steve Holcombe, quoted in the Financial Times (see footnote below). Cancer therapies made breakthroughs on many fronts when it was understood that it was not a single disease, but in fact a collection of conditions, each with varying genetic traits. 

With our growing understanding of the genetic bases of Alzheimer's Disease, propagated by several drug therapies (as noted above) that show promise in treating symptoms, diminishing the growth of amyloid plaque, and even reducing it, we live in an era where there is hope for an end to this disease. That era is not here, yet, but it may be close. 

~ Jim Huinink

Notes

¹ As reported in the Financial Times, but also elsewhere. 

² See report in pressaandjournal.co.uk.

³ "‘Phenomenal’ trial results may lead to a treatment for Huntington's disease." Washington Post. Dec 12, 2017.