Nonpharmacological Treatment of Alzheimer Disease

Objective: To review the key nonpharmacological treatment approaches to the cognitive and functional symptoms of Alzheimer disease (AD). Methods: We searched and critically analyzed the most recent relevant literature pertaining to the nonpharmacological treatment of AD. Results: There is evidence from a modest number of well-conducted randomized controlled trials (RCTs) that various nonpharmacological approaches, including cognitive training, cognitive rehabilitation, and cognitive stimulation therapy (CST), confer modest but significant benefits in the treatment of cognitive symptoms in people with AD, and that there may be additive benefits in combination with cholinesterase inhibitor therapy. Cognitive rehabilitation also appears to result in functional benefits in AD. The modest number of RCTs focusing on cognitive training in AD is consistent with the results of larger cognitive training trials in healthy older people. However, there is no convincing evidence of any benefits associated with brain training games. Conclusion: An emerging evidence base indicates that different approaches to cognitive training and cognitive stimulation in people with AD confer modest but significant benefits. The best evidence base is for CST, although this approach is labour-intensive, and requires further evaluation of cost-effectiveness. There is currently no evidence that brain training games provide any significant benefit to people with AD. Can J Psychiatry. 201156(10):589-595.