May 12, 2017
Portable computer tablets, such as iPads and other electronic devices, may be a safe and effective way to help ease the agitation of Alzheimer’s disease and other forms of dementia, researchers report. Using tablet-based apps that allow users to flip through photos of puppies, for example, or to complete crossword or Sudoku puzzles, those with dementia showed fewer behavioral problems and less agitation.
“Tablet use as a non-pharmacologic intervention for agitation in older adults, including those with severe dementia, appears to be feasible, safe, and of potential utility,” said Dr. Ipsit Vahia, the study leader and the medical director of Geriatric Psychiatry Outpatient Services at McLean Hospital in Belmont, Mass. “Our preliminary results are a first step in developing much-needed empirical data for clinicians and caregivers on how to use technology such as tablets as tools to enhance care and also for app developers working to serve the technologic needs of this population.”
The findings are important because behavioral problems like agitation and aggression are a major source of distress for patients and caregivers, and are often the reason why people with Alzheimer’s are moved from the home into a nursing home. Current drugs to ease the memory and thinking problems of Alzheimer’s, such as Aricept, are no more effective than a placebo in easing symptoms like agitation, studies have shown.
To treat behavioral problems, doctors often prescribe potent antipsychotic drugs, but they can have severe side effects, including an increased risk of heart attacks and strokes, and can accelerate memory decline. They may also cause sedation and are often not effective in reducing agitation. Better, and safer, treatments are needed for such behaviors, which affect more than 90 percent of people with Alzheimer’s.
Non-drug treatments are recommended as the first line of treatment for behavioral perturbationsfrom Alzheimer’s. There is no substitute for good supportive care and knowledgeable, compassionate caregivers. Having Alzheimer’s patients spend at least 60 minutes a week in activities that they enjoy, for example, has been shown to have calming benefits. Music therapy, art therapy and pet therapy may also help to ease stress and anxiety, although none of these approaches is a cure.
Tablet devices offer unique advantages because they are portable and can be easily customized for the individual patients for example. “The biggest advantage is versatility,” said Dr. Vahia. “We know that art therapy can work, music therapy can work. The tablet, however, gives you the option of switching from one app to another easily, modifying the therapy seamlessly to suit the individual. You don’t need to invest in new equipment or infrastructure.”
For the study, published in The American Journal of Geriatric Psychiatry, Dr. Vahia and his colleagues loaded a menu of 70 computer apps onto tablet devices. The apps were available on iTunes and varied greatly in their complexity. Some showed photos of baby animals; others featured word and number games.
The researchers then studied the tablet use in 32 people with Alzheimer’s and other forms of dementia who were patients at McLean Hospital, which is affiliated with Harvard Medical School. Some had only mild symptoms and were in the early stages of Alzheimer’s; others had more advanced and severe disease.
They found that tablet use was safe for every patient, regardless of the severity of their dementia. With proper supervision and training, almost all the patients engaged with the devices. The tablets also significantly reduced symptoms of agitation, particularly among those with milder forms of dementia, although all the patients showed benefits.
Dr. Vahia described how one patient, for example, who only spoke Romanian, was very withdrawn and irritable, and medications were ineffective in controlling his symptoms.
“We started showing him Romanian video clips on YouTube, and his behavior changed dramatically and instantaneously,” said Dr. Vahia. “His mood improved. He became more interactive. He and his medical support team also started using a translation app so that staff could ask him simple questions in Romanian, facilitating increased interaction. These significant improvements are a clear testament of the tablet’s potential as a clinical tool.”
Hospital staff at McLean are now using the devices more widely among patients. The research group is planning to expand their study to larger numbers of patients, and will seek to better understand how patients with dementia engage with and respond to apps.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D. Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.
Source: Ipsit V. Vahia, M.D.; Rujvi Kamat, Ph.D.; Cheng Vang, M.S.; et al: “Use of Tablet Devices in the Management of Agitation Among Inpatients with Dementia: An Open Label Study” The American Journal of Geriatric Psychiatry, January 2017.