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A mentally stimulating activities program for the treatment of neuropsychiatric symptoms in Alzheimer’s disease

Angie L. Sardina, PhD, Suzanne Fitzsimmons, MSN, ARNP, GNP, Catherine M. Hoyt, BA, Linda L. Buettner, PhD


This study evaluated whether a mentally stimulating activities (MSA) program reduced neuropsychiatric symptoms and improved cognitive status and quality of life, as compared to a support group for persons in the early stage of Alzheimer’s disease (AD). This randomized controlled trial included 81 adults (aged 55+), who were randomly assigned to the MSA group (treatment) or a social support group (control). A repeated measures multivariate analysis of variance (MANOVA) identified that MSA participants significantly reduced apathy (p < 0.001) and depressive symptoms (p < 0.001), as well as improved cognitive status (p < 0.001) and quality of life (p < 0.001) as compared to the control group. A structured classroom-style MSA program may be a viable and therapeutic intervention to alleviate neuropsychiatric symptoms, and improve cognitive status and quality of life in early-stage AD.


mentally stimulating activities, support groups, apathy, Alzheimer’s disease, Depression

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Marin RS: Apathy: A neuropsychiatric syndrome. J Neuropsychiatry Clin Neurosci. 1991; 3(3): 243-254.

Zhao Q-F, Tan L, Wang H-F, et al.: The prevalence of neuropsychiatric symptoms in Alzheimer’s disease: Systematic review and meta-analysis. J Affect Disord. 2016; 190: 264-271.

Starkstein SE, Ingram L, Garau ML, et al.: On the overlap between apathy and depression in dementia. J Neurol Neurosurg Psychiatry. 2005; 76(8): 1070-1074.

Starkstein SE, Petracca G, Chemerinski E, et al.: Syndromic validity of apathy in Alzheimer’s disease. Am J Psychiatry. 2001; 158(6): 872-877.

Benoit M, Berrut G, Doussaint J, et al.: Apathy and depression in mild Alzheimer’s disease: A cross-sectional study using diagnostic criteria. J Alzheimers Dis. 2012; 31(2): 325-334.

Drijgers RL, Verhey FRJ, Leentjens AFG, et al.: Neuropsychological correlates of apathy in mild cognitive impairment and Alzheimer’s disease: The role of executive functioning. Int Psychogeriatr. 2011; 23(8): 1327-1333.

Yeager CA, Hyer L: Apathy in dementia: Relations with depression, functional competence, and quality of life. Psychol Rep. 2008; 102(3): 718-722.

Drijgers RL, Aalten P, Winogrodzka A, et al.: Pharmacological treatment of apathy in neurodegenerative diseases: A systematic review. Dement Geriatr Cogn Disord. 2009; 28(1): 13-22.

Phung KTT, Waldorff FB, Buss DV, et al.: A three-year follow-up on the efficacy of psychosocial interventions for patients with mild dementia and their caregivers: The multicentre, rater-blinded, randomised Danish Alzheimer Intervention Study (DAISY). Br Med J Open. 2013; 3(11): e003584.

Starkstein SE, Jorge R, Mizrahi R, et al.: A prospective longitudinal study of apathy in Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2006; 77(1): 8-11.

Lam LCW, Tam CWC, Chiu HFK, et al.: Depression and apathy affect functioning in community active subjects with questionable dementia and mild Alzheimer’s disease. Int J Geriatr Psychiatry. 2007; 22(5): 431-437.

Berman K, Brodaty H, Withall A, et al.: Pharmacologic treatment of apathy in dementia. Am J Geriatric Psychiatry. 2012; 20(2): 104-122.

Ferrero-Arias J, Goñi-Imízcoz M, Gonzalez-Bernal J, et al.: The efficacy of nonpharmacological treatment for dementia-related apathy. Alzheimer Dis Assoc Disord. 2011; 25(3): 213-219.

Sink KM, Holden KF, Yaffe K: Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. JAMA. 2005; 293(5): 596-608.

Muench J, Hamer AM: Adverse effects of antipsychotic medications. Am Fam Phys. 2010; 81(5): 617-622.

Koivisto AM, Hallikainen I, Välimäki T, et al.: Early psychosocial intervention does not delay institutionalization in persons with mild Alzheimer disease and has impact on neither disease progression nor caregivers? well-being: ALSOVA 3-year follow-up. Int J Geriatr Psychiatry. 2015; 31(3): 273-283.

Leung P, Orrell M, Orgeta V: Social support group interventions in people with dementia and mild cognitive impairment: A systematic review of the literature. Int J Geriatr Psychiatry. 2015; 30(1): 1-9.

Wilson RS, Segawa E, Boyle PA, et al.: Influence of late-life cognitive activity on cognitive health. Neurology. 2012; 78(15): 1123-1129.

Niu Y-X, Tan J-P, Guan J-Q, et al.: Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer’s disease: A randomized controlled trial. Clin Rehabil. 2010; 10(3): 178-184.

Hultsch DF, Hertzog C, Small BJ, et al.: Use it or lose it: Engaged lifestyle as a buffer of cognitive decline in aging? Psychol Aging. 1999; 14(2): 245.

Burgener SC, Yang Y, Gilbert R, et al.: The effects of a multimodal intervention on outcomes of persons with early-stage dementia. Am J Alzheimers Dis Other Demen. 2008; 23(4): 382-394.

Kelly ME, Loughrey D, Lawlor BA, et al.: The impact of cognitive training and mental stimulation on cognitive and everyday functioning of healthy older adults: A systematic review and meta-analysis. Ageing Res Rev. 2014; 15: 28-43.

Buettner LL, Fitzsimmons S, Atav S, et al.: Cognitive stimulation for apathy in probable early-stage Alzheimer’s. J Aging Res. 2011; 2011: 1-6.

Gould RL, Arroyo B, Brown RG, et al.: Brain mechanisms of successful compensation during learning in Alzheimer disease. Neurology. 2006; 67(6): 1011-1017.

Rapoport SI: Functional brain imaging in the resting state and during activation in Alzheimer’s disease: Implications for disease mechanisms involving oxidative phosphorylation. Ann N Y Acad Sci. 1999; 893(1): 138-153.

Algase DL, Beck C, Kolanowski A, et al.: Need-driven dementia-compromised behavior: An alternative view of disruptive behavior. Am J Alzheimer’s Dis. 1996; 11(6): 10-19.

American Psychiatric Association: Diagnostic and statistical manual of mental disorders DSM-IV-TR (4 ed., text revision). Washington, DC: American Psychiatric Association; 2000.

Folstein MF, Folstein SE, McHugh PR: Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3): 189-198.

Luzny J, Holmerova I, Petr W, et al.: Dementia still diagnosed too late--Data from the Czech Republic. Iran J Public Health. 2014; 43(10): 1436-1443.

Marin RS, Biedrzycki RC, Firinciogullari S: Reliability and validity of the Apathy Evaluation Scale. Psychiatry Res. 1991; 38(2): 143-162.

Kroencke K, Spitzer RL, Williams JBW: The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9): 606-613.

Kroencke K, Spitzer RL, Williams JBW: The PHQ-9. J Gen Intern Med. 2001; 16(9): 606-613.

Folstein MF, Robins LN, Helzer JE: The mini-mental state examination. Arch Gen Psychiatry. 1983; 40(7): 812-812.

Ready RE, Ott BR, Grace J, et al.: The Cornell-Brown scale for quality of life in dementia. Alzheimer’s Dis Assoc Disorders. 2002; 16(2): 109-115.

Fitzsimmons S: Brain fitness: An instructor’s manual of 154 exercises for persons with low to high cognitive function. State College, PA: Venture Publishing; 2008.

Vance DE, Webb NM, Marceaux JC, et al.: Mental stimulation, neural plasticity, and aging: Directions for nursing research and practice. J Neurosci Nurs. 2008; 40(4): 241-249.

Fukushima RLM, do Carmo EG, Pedroso RV, et al.: Effects of cognitive stimulation on neuropsychiatric symptoms in elderly with Alzheimer’s disease: A systematic review. Dement Neuropsychol. 2016; 10(3): 178-184.

Ball K, Edwards JD, Ross LA: The impact of speed of processing training on cognitive and everyday functions. J Gerontol Ser B: Psychol Sci Social Sci. 2007; 62B(Special Issue 1): 19-31.

Edwards JD, Wadley VG, Vance DE, et al.: The impact of speed of processing training on cognitive and everyday performance. Aging Mental Health. 2005; 9(3): 262-271.

Rebok GW, Ball K, Guey LT, et al.: Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc. 2014; 62(1): 16-24.

Aguirre E, Woods RT, Spector A, et al.: Cognitive stimulation for dementia: A systematic review of the evidence of effectiveness from randomised controlled trials. Ageing Res Rev. 2013; 12(1): 253-262.

Woods B, Aguirre E, Spector AE, et al.: Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev. 2012; 2: CD005562.



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