Is the Neurologist Expression "Diagnose and Adiós" the Right Approach?
The Alzheimer’s Hub of Hope has four sections: Heroes, Highlights, Headlines and Helpers/Caregivers. This post is aligned to the headlines section.
I was disappointed in my August 21 post “Can Yoga Help Prevent Alzheimer's?” since I felt like I was missing something. I thought there had to be more studies covering the relationship between Yoga and Alzheimer’s. So I went back to the drawing board and began my search anew. I found many yoga studies related to bone health, menopause, cancer treatment and dementia but came up with nothing new specific to Alzheimer’s; however, I did stumble upon the Mayo Clinic’s HABIT (Healthy Action to Benefit Independence & Thinking®) program which included Yoga as one of its five practices.
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HABIT Healthy Action to Benefit Independence & Thinking®
The Mayo Clinic created a 50 hour program using five interventions for individuals with mild cognitive impairment (MCI) which is not so mild and is often a precursor to Alzheimer’s. The interventions are:
Memory support: Calendar training for memory compensation.
Cognitive exercise: Computerized brain games for concentration and thinking speed.
Yoga: Chair-based physical activity and relaxation skills.
Wellness education: Group classes that present scientific evidence around nutrition, sleep, future planning, emotional health, and how to make healthy changes.
Support groups: Therapist-led emotional support with separate groups for participants and care partners.
HABIT teaches the MCI sufferer to learn the best skills for maintaining independence in spite of memory problems, improving self-esteem, and coping with the emotions that arise for the person in their family with the uncertainty that comes with a diagnosis of MCI.
During HABIT, the sufferer will work with a multi-disciplinary team made up of neuropsychologists, social workers, occupational therapists, cognitive therapists, and certified yoga instructors. The program uses methods backed by science to help people with MCI incorporate new brain health habits into their life. These habits, when supported by a partner, can compensate for certain memory deficits and promote optimal wellness for mind and body.
Compensation based cognitive rehabilitation is the backbone of the HABIT program and incorporates techniques used with patients with memory loss due to other (non-dementia) causes, traumatic brain injury or stroke, for example. This could be as simple as forming the habit of writing things down in a comprehensive organized fashion.
Essentially HABIT uses techniques commonly used for cognitively impaired individuals due to brain injury or some other assault and applies them to MCI sufferers. It is logical that techniques that help with independence, memory and coping problems caused by by one type of injury may also helpful with those same problems caused by MCI.
HABIT also uses cognitive exercises that can help keep thinking skills healthy such as computerized programs with cognitive exercises that might help with concentration and thinking speed. Chair yoga is used to provide physical exercise, meditation and relaxation. Wellness education includes nutrition, sleep and other life style information.
The eight minute video below provides a good overview of the program.
Is the HABIT Program Effective?
I searched and searched but couldn’t find any studies on the effectiveness of the HABIT program. I did find a detailed study focusing on the effectiveness of each of the five interventions of the program in relationship to each other here. A summary of this study is found here and highlighted below.
Researchers found no significant difference in effectiveness among the interventions for the study’s endpoint: improved quality of life. However, in two secondary measures, wellness education had a greater impact on mood, and yoga had a greater impact on memory-related activities of daily living.
And….
At a 12-month follow-up, wellness education had the greatest impact on quality of life. Yoga and calendar training were also valuable for mood outcomes, and a support group positively affected participants’ ability to achieve goals.
Here’s an article with more details on Yoga’s effectiveness at the 12-month follow-up.
The study’s co-author Pamela Dean, an assistant professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and clinical neuropsychologist at the VA Puget Sound states:
“The take-home message is that a multi-component intervention benefits patients in a variety of outcomes,” “It’s not any one thing. The study is really saying that people with MCI who are untreated may experience worsening functioning.”
How is this Relevant to Diagnose and Adiós?
Reading books and listening to Alzheimer’s related podcasts and interviews, I frequently hear the phrase “Diagnose and Adiós” when discussing Alzheimer’s sufferers. This essentially means a doctor can diagnose the disease but can’t do anything to help the patient. I experienced this myself with my mother-in-law. She was diagnosed and when we asked “what can be done for her” we were told by the doctor that he could prescribe “Aricept” but he hasn’t seen any of his patients helped by it but it doesn’t hurt to try. Essentially he said “go away” I can’t help. He was a super nice guy but totally useless. And he was correct, Aricept was totally ineffective.
Kudos to the Mayo Clinic’s HABIT approach for being proactive. It is doing something even though it may not be a silver bullet. It’s a way of fighting the disease. It may slow it down or at least compensate for Alzheimer’s related deficiencies for a period of time. I much prefer “Diagnose and Attack” vs. “Diagnose and Adiós”.
Thanks Bob.