Management of cognitive decline in Alzheimer's disease using a non-pharmacological intervention program: A case report

Abstract

Introduction: In China, the over 60 population is estimated to grow from 12% in 2010 to 33% of the overall population by 2050. The escalation in the aging population is projected to result in an Alzheimer's disease prevalence of 27.7 million people in China by 2050 causing substantial health and economic burden. While there are some published studies on multicomponent, non-pharmacological interventions for people with dementia, we have found no published community-based approach to care that encompasses personalized selection of non-pharmacological interventions, active social participation, and dementia education.

Patient concerns: An elderly female living at home alone in urban Beijing presented with significant short-term memory impairment, episodes of confusion, difficulty with language skills, and episodes of wandering. She had become reclusive and disengaged from her previous social networks, and no longer attended any community activities or events. The patient had no significant past medical or psychiatric history.

Diagnosis: The patient was diagnosed with Alzheimer's disease by a local physician based on clinical features of impaired communication, disorientation, confusion, poor judgement, behavioral changes, and difficulty speaking. Depression was considered a differential diagnosis but is also both a risk factor and symptom of dementia.

Interventions: A novel, community-based, multicomponent social care program for dementia was used to facilitate implementation of non-pharmacological interventions, gradual socialization and provide supportive carer and community education. Non-pharmacological interventions included a combination of validation therapy, music therapy, art therapy, reminiscence therapy, talking therapy, reality orientation, cognitive training, smell therapy, food therapy, sensory stimulation, garden therapy, and physiotherapy.

Outcomes: Improvements in the patient's Geriatric Depression Scale and Mini Mental State Examination scores were noted in association with increased social participation in the community.

Conclusion: The community-based, multicomponent dementia social care program described in this case report has enabled a socially isolated patient with Alzheimer's disease to reduce her social isolation with an associated improvement in her mood and prevention of cognitive decline. Educating the community was an essential part of re-integrating the patient into the social setting. Reducing social isolation and increasing community engagement were essential to maintaining the patient's independence in her own home.

Figure 1

A graph of the patient's Geriatric Depression Scale Scores March 2018 to March 2019. Geriatric Depression Score-15: 0 to 5 normal; more than 5 indicates depression.^[30,31] (February 2019: no assessment due to Chinese holidays).

Figure 2

A graph of the patient's Mini Mental State Examination Scores March 2018 to March 2019. MMSE is scores out of 30 indicating levels of cognitive impairment severity as follows: 0 to 9 severe; 10 to 18 moderate; 19 to 23 mild.^[–26] (February 2019: no assessment due to Chinese holidays).