UW News

January 17, 2008

Treating the behaviors of Alzheimer’s disease

Alzheimer’s disease, a progressive and fatal brain disorder, is a thief that slowly robs the afflicted of their cognitive abilities and burdens their caregivers with overwhelming responsibilities. The disease affects more than 5 million and is the seventh-leading cause of death in the United States, according to the National Institutes of Health. No cure has yet been found for the disease.

“Alzheimer’s is the most prevalent kind of dementia in the United States,” said Dr. Linda Teri, UW professor of psychosocial and community health. “Improved technology and diagnostic methods have made us more aware of this disease. And, as our population ages and life expectancy is extended, Alzheimer’s will touch us all.” Teri is also a co-investigator of the UW Alzheimer’s Disease Research Center and the Alzheimer’s Disease Patient Registry.

First observed by Alois Alzheimer, a German physician in the early 1900s, the condition is believed to be caused by an excessive build-up of deposits of beta-amyloid and tau proteins in areas of the brain that control cognitive abilities — memory, learning, judgment, language, and behavior. Common symptoms of Alzheimer’s disease include memory loss, agitation/aggression, depression, wandering, and sleep disturbances. Caregivers often suffer from depression.

“There was a time when the symptoms of Alzheimer’s were considered an inevitable and normal part of aging,” Teri said. “Now, of course, we know that Alzheimer’s is not normal. We have a better understanding of physiological impairments of the brain as well as environmental factors that may trigger some of the symptoms of dementia. There’s a lot that can be done to mitigate the effects of the disease by managing the environment.”

Teri has invested more than 20 years of her career into identifying behavior problems associated with Alzheimer’s disease and developing nonpharmacologic treatment interventions to improve the lives of those living with Alzheimer’s disease and their caregivers.

“Teaching caregivers strategies to use with the patient on a daily basis is the focus of most nonpharmacologic treatment of dementia,” Teri said, adding that caregivers may include family members, unpaid and paid caregivers who have a role in the patient’s daily care, as well as formal health care providers. “We provide suggestions for management of several of the most common and troublesome behavior problems, including depression, agitation, aggression, wandering, and sleep disturbances.”

Teri and her colleagues have developed a systematic approach to behavioral problems associated with dementia. The program, called the Seattle Protocol, is a comprehensive behavioral training program for reducing behavioral problems in patients with dementia. The program teaches caregivers how to identify and articulate the behavioral problem, analyze circumstances or triggers surrounding the problem, set realistic goals and plans to achieve the goals, communicate with patients, encourage rewards for the patient and caregiver for small successes, and evaluate and modify plans as appropriate.

Nonpharmacologic psychosocial interventions benefit both patient and caregiver and have no adverse side effects.

“This treatment model means depression, anxiety and general behavior problems in patients with Alzheimer’s can be reduced,” Teri said. “Physical activity can be increased, and disability can be decreased. Also, institutionalization can be delayed. For family caregivers, it means both burden and depression can be reduced. And for staff caregivers, it means skill, reactivity and job satisfaction can be improved.”

Teri is optimistic about continued improvements in the emotional, physical and cognitive well-being of those with dementia. She said providing patients, families, and health care workers with easier access to resources is an important next step to improving quality of lives, but that more research dollars are needed to benefit more people.

“My fantasy is that more professionals and nonprofessionals will be trained in using nonpharmacologic approaches to Alzheimer’s disease. We need additional funding for training and research. With funding so tight, a nonpharmacologic approach is the least funded area.

“Don’t get me wrong,” Teri said. “I’m not against pharmacologic approaches — it would be great if they could develop a pill that would solve the problems of Alzheimer’s disease and make it go away. But, in the meantime, we have people suffering and we need to have the funding to do the research to develop the resources we need to help them now.”

For her pioneering work and outstanding contributions to gerontology, Teri was presented with a lifetime achievement award by the Gerontological Society of America in 2006. Last November, she gave the Lawton Award Lecture at the 60th annual meeting of the society.