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As of 2015 over 47 million people worldwide are diagnosed with Alzheimer’s disease (AD). The incidence of AD increases with age, and affects males and females equally. Current pharmacologic treatment includes two classes of drugs. The purpose of this study was to determine if a multimodal approach (i.e. diet, exercise, cognitive stimulation) towards the prevention and treatment of AD would be more beneficial than pharmacologic therapy alone. Research methods included reviewing peer reviewed journal articles published within the past five years obtained from PubMed, Dynamed, Cochrane, CINAHL, and Clinical Key. Ehret and Chamberlin (2015) found donepezil (Aricept) increased MMSE scores (95% CI, 1.3 to 2.5; P< 0.001); whereas memantine (Namenda) increased MMSE scores (95% CI, 0.6 to 1.8; P< 0.001). Combination therapy of donepezil and memantine revealed no significant improvement of MMSE scores (95% CI, -0.1 to 1.6; P= 0.07). The MIND diet and FINGER studies evaluated multimodal approaches to preventing and treating AD. Morris et al. (2015) found that participants who adhered to the MIND diet significantly reduced the rate of developing AD over an average of 4.5 years by 53% (HR= 0.47; 95% CI: 0.29, 0.76; P= 0.002) compared to those who were the least adherent to the diet. The FINGER study compared four factors between an intervention and control group. Ngandu et al. (2015) found NTB scores revealed a mean difference between groups of 0.022 (95% CI; 0.002 to 0.042; P = 0.030) per year with the intervention group scoring 25% higher at 24 months. The intervention group revealed differences in executive functioning (P = 0.039) 83% higher, and processing speed (P = 0.029) 150% higher than the control group. Memory scores analysis revealed a mean difference in memory decline between the intervention and control groups 1.31 (95% CI; 1.01 to 1.71; P = 0.036) after 24 months. Drug therapy alone provides nominal and short term improvement in cognitive functioning. A multimodal approach can improve or maintain cognitive functioning in those who are at risk for or who already have AD. Primary care providers should consider a multimodal approach to treating patients who have AD or early cognitive decline. Utilizing a multidisciplinary healthcare team by employing the expertise of other health professionals who are trained in working with older adults may be beneficial in the treatment of individuals who are at risk for, or who have AD.
Physician Assistant Studies
Master of Physician Assistant Studies (MPAS)
Alzheimer Disease -- prevention & control; Combined Modality Therapy; Comparative Study
Nervous System Diseases
Smith, Jason B., "A Multimodal Approach to Preventing and Treating Alzheimer’s Disease" (2016). Physician Assistant Scholarly Project Posters. 87.