At least some patients with early Alzheimer’s disease can be taught to recall important information and perform daily tasks at a higher level, according to an article in the July-August issue of the American Journal of Geriatric Psychiatry.

In the current study, American researchers led by David A. Loewenstein, PhD, found mildly impaired Alzheimer patients who participated in three to four months of cognitive rehabilitation had a 170 percent average improvement in ability to recall faces and names and a 71 percent improvement in ability to provide proper change for a purchase. The participants also could respond to and process information more rapidly and were better oriented to time and place than a similar group of patients who did not receive targeted intervention. The improvements were still evident three months after the cognitive training ended.

The current report follows a recent study that found older people with early-stage Alzheimer’s disease retained functioning levels of implicit memory similar to young adults and older adults without the disease. Implicit memory is relatively unconscious and automatic: Information from the past "pops into mind" without a deliberate effort to remember. This unconscious, implicit memory is important for common skills and activities such as speaking a language or riding a bicycle. In many cases, people implicitly remember how to perform these activities, without being able to deliberately remember when or where they learned them. The previous study was conducted by Cindy Lustig, PhD, and Randy Buckner, PhD, and appeared in the June 10th issue of Neuron.

"Taken together, these studies introduce the exciting notion that older people who are in the early stages of Alzheimer’s disease can be taught techniques to help stay engaged in everyday life," said Neil Buckholtz, Ph.D., of the National Institutes of Health. "These findings show it is possible to pinpoint what memory capabilities are preserved in early Alzheimer’s and suggest ways to target those memory functions and make the most of them."

Previous studies have shown that cognitive rehabilitation can effectively improve memory and other cognitive functions in people who have had strokes or traumatic brain injuries. Some of these techniques also have helped improve memory in some people with Alzheimer’s disease. However, the current research is believed to be the first to combine several specific cognitive memory techniques into a single rehabilitation program for people mildly impaired with Alzheimer’s disease.

In the current study, researchers randomly assigned 44 people into two groups. All
participants were taking a cholinesterase inhibitor. The 25 people in the cognitive rehabilitation group participated in two 45-minute sessions weekly for a total of 24 sessions. During these sessions, they learned face-name recognition techniques, such as associating a prominent facial feature with a name. So a smiling man
named Sam might be recalled as "Smiling Sam." To enhance time and place orientation, the participants were given memory notebooks and encouraged to record appointments, medication schedules, and contact information for relatives, friends, and doctors in them. The participants were asked to review this central information repository twice daily throughout the study.

They also were taught effective ways to make change for a purchase and asked to use a calculator to balance a checkbook after paying three bills. In addition, they learned to click a mouse button in response to yellow boxes as they randomly appeared on a computer screen to improve attention span and cognitive processing speed. Finally, the rehabilitation group was asked to manipulate objects, such as a key, as though they were using them, a technique that can jumpstart memory in some people. In addition, patients and their caregivers were encouraged to practice all techniques at home.

The 19 participants in a mental stimulation group played computer games that required memory, concentration, and problem-solving skills. In addition, participants in this group were asked to discuss various topics, such as describing the neighborhood in which they grew up. They also were asked to do crossword puzzles, word scrambles, and other "homework" assignments.

At the end of the study, rehabilitation participants showed significantly improved ability to associate faces and names, had faster mental processing speeds, were better oriented to time and place, and were better able to make correct change for purchases than those in the mental stimulation group. However, neither group showed memory improvement for manipulating objects or balancing a checkbook.

"Our study shows that people with early Alzheimer’s disease can learn. This learning can be greatly enhanced if you teach them certain techniques that target particular areas of the brain," Loewenstein said. "More importantly, by combining specific cognitive rehabilitation strategies, we can help people with Alzheimer’s disease remain engaged in daily activities and retain a connection to their family and friends and the world as a whole for a longer period of time."