Non-pharmacological interventions and neuroplasticity in early stage Alzheimer's disease

Abstract

Non-pharmacological interventions have the potential to reduce cognitive decline and to improve psychosocial aspects in mild cognitive impairment and Alzheimer's dementia, and the absence of side effects makes them a favorable option also for preventive strategies. We provide an overview on recent studies involving cognitive training and reminiscence, stimulating and challenging experiences such as visual art and music, physical activities, and electromagnetic stimulation. We review findings on neuroplasticity in the aging brain and their relevance for cognitive improvement in patients with neurodegenerative diseases. We discuss cognitive reserve and possible mechanisms that drive neuroplasticity and new learning. Finally, we identify promising avenues for future intervention strategies and research, such as combinations of cognitive and pharmaceutical interventions, and individual strategies adapted to the disease stage and tailored to the needs, predispositions and preferences of patients.

Keywords::

• Alzheimer's disease
• dementia
• mild cognitive impairment
• neuroplasticity
• non-pharmacological intervention

Financial & competing interests disclosure

K Herholz is a consultant to GE Healthcare and ELAN. K Herholz has received a research grant from Avid Radiopharmaceuticals. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Various types of non-pharmacological interventions are effective in improving cognitive and psychosocial aspects of neurodegenerativ e diseases.

• • While early stage mild cognitive impairment seem to benefit most from targeted cognitive training (e.g., memory training), Alzheimer's disease patients benefit from stimulating interventions (including arts and music) with social interaction and involvement of caregivers, especially with regard to psychosocial aspects and management of the disease.

• • Neuroplasticity in healthy elderly individuals has been demonstrated in functional and structural imaging studies, but neural correlates of training in patients are yet unknown.

• • Cognitively and physically challenging activities provide the most efficient stimuli to induce neuroplastic changes, and complex activities like making music, juggling and dancing provide promising avenues for effective intervention.

• • Strategies combining complex cognitive training with physical activity, electrophysiological stimulation or pharmacological treatment might be the most promising avenue for slowing neurodegeneration. They should be investigated in future studies, ideally with monitoring of functional and structural brain plasticity by brain imaging.