Barcelona Alzheimer Treatment & Research Center

non-pharmacological therapies

non-pharmacological therapies

Alzheimer’s disease (AD) is the most frequent form of dementia, representing over 50% of cases. In recent years, its prevalence has risen exponentially. Unfortunately, no cure has as yet been found. Existing pharmacological treatments, such as acetylcholinesterase inhibitors, only allow the progression of symptoms to be delayed up to a maximum of a year. Currently, only the combination of pharmacological and non-pharmacological treatments can extend the period of higher quality of life.

In this context, non-pharmacological therapies are appearing as a potential treatment for people with dementia, focusing on slowing or delaying cognitive and functional decline and minimising the overburdening of carers. Non-pharmacological therapies offer a wide range of activities that provide cognitive stimulation in a social context. Institutions dedicated to the treatment of people with dementia usually use different cognitive stimulation techniques, such as reality orientation, reminiscence, validation and cognitive rehabilitation computer programmes.

Recent studies have demonstrated that the combination of pharmacological and non-pharmacological treatments can produce beneficial effects in AD patients because neuroplasticity allows the modification of their performance through cognitive training.

Cognitive stimulation sessions usually last one hour, with two or three sessions per week.

However, Fundació ACE has created a much more extensive programme, covering 8 hours a day, Monday to Friday. This is the Integrated Psychostimulation Programme (PPI), created by Fundació ACE’s founders, Lluís Tárraga and Mercè Boada. It was designed to improve, preserve and promote the independence of patients with mild to moderate dementia in their activities of daily living and to reduce the overburdening of carers.

Since 1991, Fundació ACE has been using PPI as an integrated treatment for patients with dementia, principally Alzheimer’s-type dementia, and to date more than 1,400 users have benefited from the programme.

PPI is defined as a therapeutic strategy founded on the presence of brain neuroplasticity and based on cognitive neuropsychology, behavioural modification therapy and the individual’s biopsychosocial state. It aims to improve and/or slow the clinical/evolutive process of the person with dementia in the short to medium term. The term “Programme” is used because overall guidelines for intervention are established in each case, as a function of the person’s clinical state and premorbid personality traits, previous personal and family history, and neuropsychological assessment.

The raison d’être of the term “psychostimulation” is in the use of therapeutic interventions which are implicitly or explicitly pursued by neuropsychology through the stimulation and rehabilitation of cognitive functions. Finally, the qualifier “Integrated” is justified by the attention that is offered to the patient and to their family. It is integrated, both in its deficits and its excesses, integrating into the ecosystem, family and social environment, understanding that all disease has biological, social and cultural roots.

The findings of a recent study by our team show that people with Alzheimer’s-type dementia who were subject to non-pharmacological treatment with PPI, in addition to pharmacological treatment, remained cognitively stable for longer than 6 months. No significant changes were seen until 9 or 12 months of follow-up; these were less than the annual deterioration previously reported in this type of patients.

Neither were functional or psychiatric changes found during the year of treatment. Therefore, these findings suggest that PPI may be an effective treatment to maintain the cognitive, functional and psychological levels of patients with mild to moderate dementia.