Objective: The preservation of cognitive function in patients with mild cognitive impairment and dementia has recently received greater attention. However, there is not enough research data on combined medication treatments and non-pharmacological interventions. The aim of our study was to evaluate the level of cognitive function in medically ill patients with mild to moderate dementia after 1-year of integrative treatment.
Design: Patients with mild to moderate dementia were assessed by a battery of neuropsychiatric tests before and after 6 and 12 months of treatment. This presentation is part of the ongoing study.
Materials and Methods: Data will be presented regarding 56 medically ill patients (mean age = 76.16), including 32 males and 24 females with complaints of memory decline and depression. Educational level ranged from 4 to 16 years (mean = 10.78, SD = 4.1). Their diagnoses were probable Alzheimer’s dementia, mixed dementia and vascular dementia (MMSE mean = 25.5, mild to moderate stage). For treatment of depression we used 1 of 3 medications: Sertraline, Citalopram or Venlafaxine XR alone or in combination with Bupropion XR. For dementia 1 of 3 cholinesterase inhibitors (Donepezil, Rivastigmine or Galantamine) was used. The patients were taking their regular medications for medical problems, including Aspirin or Plavix, as well as vitamin E, folic acid, omega-3 and Coenzyme Q-10. They were encouraged to maintain healthy diets, to modify their lifestyle and to perform mild physical exercises.
Results: The improvement in all cognitive (attention, memory, and executive function) domains was found after a 6 month treatment and remained at this level by the end of 12 months. These tests included MMSE (p < 0.05), Reaction Time (from 590 to 455 ms, p <. 003), 5-minute Memory Recall (Word Learning Memory Test - WLMT)) and 60-minute Delay Memory (Ruff Light Trail Learning Test - RULIT), Repetition and Construction (Neuro Behavior Status Exam - Cognistat), and Ruff Figural Fluency Test (Unique Design, p < 0.01). Attention and Naming (Cognistat) and Word Fluency Category tests (p < 0.001) showed even more improvement by the end of 12 months compared to the first 6 months . At the same time, Word Fluency Letter Test and immediate recall on WLMT and RULIT did not show significant changes during treatment period.
Conclusion: This study combined medication treatment with non-pharmacological interventions. The presenting data demonstrated that even medically ill patients with dementia are still capable of activating different neural networks in the brain over long periods of time (12 months).
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