Advances for Alzheimer's, Outside the Lab

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They sit demurely in rows of plastic chairs, hands in their laps, awaiting instructions. They have been dressed carefully by their spouses and relatives in ankle-long frocks or neat cardigans, with crisply knotted ties — the overly formal style of the aged.

Organizing this unlikely choir is Chreanne Montgomery-Smith, who runs support groups for the Newbury branch of Britain's Alzheimer's Society. On cue, the 40 or so Alzheimer's and dementia patients join hands and begin singing in unison — a tentative rendition of Amazing Grace. They remember most of the words and their chorus fills the hall. Montgomery-Smith is certain that the music helps bring her patients' thoughts — ravaged by dissonance and dislocation — into harmony. (Read how secondhand smoke has been linked to dementia.)

"You can see how they become lucid when they sing," says Montgomery-Smith, who has witnessed improvements in sociability and communication during her musical meetings. "The research isn't there to support it at the moment but I'm confident these sessions will one day be shown to slow the progression of Alzheimer's. The benefit [of singing] as a hidden cognitive rehabilitation is evident. You can't keep a good idea down forever."

For now though, Montgomery-Smith has been asked by the Alzheimer's Society not to describe this activity — called Singing for the Brain — as "treatment." The scientific data doesn't even support the term "therapeutic." But there are few other dementia therapies that the evidence can validate — currently only two types of drugs have received government approval in the U.S. to slow the progression of Alzheimer's, but both offer only limited benefits — and many caregivers, desperate to better the lives of their patients, resort to such low-tech, behavior-based solutions as singing. (Read "Ginko Biloba Does Not Prevent Alzheimer's.")

Medicine has long fought two fronts in the battle against disease — in the research lab and at the bedside. The race toward a treatment for Alzheimer's has focused almost exclusively on research in psychopharmacology, immunology and gene therapy. But as patients and caregivers wait for a cure, the progressive, fatal condition continues to affect some 5 million Americans. Meanwhile, low-tech memory-enhancing devices like diaries, Post-It notes and portable cameras are used increasingly by Alzheimer's caregivers, leading some researchers to contemplate whether the consistent and comprehensive use of bedside solutions may actually slow the progression of the disease. If rudimentary tools have any chance of inhibiting the disease, health-care workers are interested. When it comes to Alzheimer's, even incremental improvements can have a profound effect: a 2004 Australian study found that delaying the onset of dementia by five years would eventually halve the number of people living with the condition.

At Cambridge University's Addenbrooke's Hospital, one pilot program has generated a lot more excitement than any new drug or gene discoveries made at the high-tech labs there. (GlaxoSmithKline and other pharmaceutical companies conduct dementia-related research at Addenbrooke's.) Led by a team of clinical psychologists who specialize in rehabilitating brain-injured patients, the program involves using SenseCam, a digital camera, developed by the nearby Microsoft Research Lab, that hangs from the neck and passively takes photographs every 30 seconds. The pictures can then be played back in sequence.

Addenbrooke's psychologists decided to try the device with their patients with memory loss. They found surprising results. While memory-impaired patients who take pictures with traditional cameras often fail to remember the photographed events or activities, those who used SenseCam, which has a wide-angle lens and takes impromptu rather than staged pictures, found their recall to be greatly enhanced. "This isn't rocket science and the device is quite simple but there's something about its spontaneous, wide-angle photographs that seem to mimic the brain's own episodic memory," says Emma Berry, a neuropsychologist working on the project. In the past few years, several studies conducted at the hospital have shown that, after reviewing the photographs for an hour every other day for two weeks, dementia patients are able to recall photographed activity months later — even without the help of the camera's playback function. (See the top 10 gadgets of 2008.)

"That's what we find so exciting. Their recall improved by up to 80%, not only when looking at the photos but months after studying the sequence. It raises the possibility of firing up parts of the brain that have become inactive because of the disease," Berry says.

Humans store memories in various regions of the brain, but neuroscientists have pinpointed one section deep within, a seahorse-shaped structure called the hippocampus, as particularly crucial to memory. Studies of patients with brain injury or disease have shown that the hippocampus is where new memories are formed and where recent ones are retrieved; like a librarian, it scans the brain's catalog of bygone information and brings appropriate material to the fore. (But a recent brain-scan study of 15 healthy adults at the University of California, San Diego, found that the hippocampus has less to do with memories from the distant past. It is vital to the recall of recent events, from a year or two ago, but when study participants were asked to recall memories five or 10 years old, scientists recorded less activity in the hippocampus and more in the cerebral cortex.)

In Alzheimer's, the hallmark plaques of the disease are known to target and clog the hippocampus and nearby regions first, which explains why the initial symptoms of the disease involve memory loss — and why early stage patients may have trouble remembering whether they ate breakfast that morning, but can still recognize friends from childhood. Though Berry does not yet have scientific evidence, she strongly believes that low-tech treatments like episodic photography can spark specific and targeted activity in the hippocampus, keeping it active for longer or even regenerating it — and perhaps allowing patients to hold on to new memories.

The Alzheimer's Society's Montgomery-Smith thinks singing sessions may work similarly, by dredging up distant memories associated with the music and stimulating memory-retrieval mechanisms in the brain. But many other Alzheimer's activists warn that putting too much hope in claims of so-called "hidden cognitive rehabilitation" will only distract from the urgent need to find a cure. "There are so many things that you can't overcome with Alzheimer's — we can't get too excited by these low-tech treatments. They can help patient care but they will never deliver a solution," says Susanne Sorensen, head of research for the Alzheimer's Society U.K. "We need more clinical trials [for vaccines and drugs]. There's no substitute." (Read "The Year in Medicine 2008: From A to Z.")

No one disagrees that more research is necessary. But even if activities such as singing or taking pictures cannot treat Alzheimer's, they may still improve patients' mood and social skills and, at least for a time, raise their quality of life. When the Alzheimer's Association, based in Chicago, surveyed 350 Americans diagnosed with dementia in 2008, many respondents said they felt abandoned by the medical community after diagnosis, and most wished for a greater range of treatment options other than just pills. "Their impression was that the doctor felt their job was done as soon as the diagnoses was made and the prescriptions written," says Shelley Bluethmann of the Alzheimer's Association.

Responding to these concerns, Bluethmann's organization has commissioned various projects in hospitals and rehabilitation centers across the U.S. that are intended to supplement pharmacological treatment — from art and music classes to the development of a board game called "Make Memory Together," designed by Gene Cohen at George Washington University. "Our vision is to work for a cure, but we also have an obligation to support the best quality of life for patients living with the disease now," Bluethmann says.

Bluethmann adds that low-tech activities offer another "hidden" benefit: helping spouses and relatives who care for Alzheimer's patients. Often, caregivers describe the distress and frustration that result from watching a disease slowly rob them of their loved ones as unbearable. They say any reprieve is a godsend. In Newbury, as the group shuffled out after two hours of singing, I asked one man whether he had enjoyed himself. "I liked it very much," he responded. His wife gasped. "He said five words," she said, placing her hand tenderly on his arm, and peering hopefully into his eyes. "He hasn't strung together five words like that in months."

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