Cures for Depression & Aggression in Mild Cognitive Impairment & Dementia Patients

Depression & Aggression: Alleviating Dementia & MCI Symptoms

Evelyn Smith

M.S. In Library Science, University of North Texas (2012)

The mind is indeed a terrible thing to waste.

Recognize the Neuropsychiatric Symptoms that Correlate with Dementia

Research has substantiated that dementia correlates with late-life depression. However, the jury is still out on whether depression causes dementia, or dementia causes depression. Certainly, the loss of memory and function doesn't help the mood of older-adults who are suffering from memory loss and the ability to think and reason as well as to perform successfully the activities of daily living.

However, other neuropsychiatric symptoms of depression in order of their prevalence include aggression, anxiety, sleep disorders, irritability, appetite disorders, aberrant motor behavior, delusions, uninhibited behavior, hallucinations, and in rare instances, euphoria (Zhao, 2016, January 15, abstract). Obviously, older adults who are use to taking care of themselves are more apt to display depression, aggression, and anxiety,and lying aware worried about memory loss certain takes away a good night's sleep, but eating too little or too much (as in the case of Frontotemporal dementia), aberrant motor behavior, delusions, and uninhibited behavior might come as a surprise to family members. Even so, this post surveys recent studies that equate depression, apathy, and aggression that often accompany Mild Cognitive Impairment, Alzheimer's and other dementias as well as cost effective, primarily homeopathic ways to ameliorate them. All the same, this guide shouldn't replace a visit to a neurologist who treats Alzheimer's and other diseases that cause cognitive decline.

Cherbuin, N., Kim, S., and Anstey, K. J. (2015, December 21). Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis. BMJ Open, 5(12):e008853. doi: 10.1136/bmjopen-2015-008853. [Full text]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26692556

Searching PubMed, PsycInfo, and Cochrane databases through February 28, 2014, researchers discovered that the increased risk of dementia didn't differ significantly with the type of dementia, but late-life depression consistently correlated with a “twofold increased risk of dementia”.

Cines, S., Ferrell, M., and Steffener J., et al. (2015, December). Examining the pathways between self-awareness and well-being in Mild to Moderate Alzheimer Disease. American Journal of Geriatric Psychiatry, 23(12): 1297-306. doi: 10.1016/j.jagp.2015.05.005. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26560509.

Columbia University Medical Center and the University of Pennsylvania researchers rated how aware 104 study participants were of their memory loss in order to establish a relationship between awareness, depression, and Quality of Life. This study thus discovered a direct association between how aware dementia patients were of their memory loss and whether or not they were depressed, but it only found an indirect association between this awareness and the patients' QOL.

Herbert, J. and Lucassen, P. J. (2015, December 30). Depression as a risk factor for Alzheimer's disease: Genes, steroids, cytokines and neurogenesis--What do we need to know? Frontiers in Neuroendocrinology, 15, pii: S0091-3022. doi: 10.1016/j.yfrne.2015.12.001. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26746105

While depression predicts the onset of Alzheimer's and is a component of Alzheimer's, it may also be a trigger for Alzheimer's. Thus, intervention that successfully treat depression in older adults may prevent the onset of Alzheimer's.

Mourao, R., Mansur, G., and Malloy-Diniz, L. E., et al. (2015, December 15). Depressive symptoms increase the risk of progression to dementia in subjects with mild cognitive impairment: systematic review and meta-analysis. International Journal of Geriatric Psychiatry. doi: 10.1002/gps.4406. [Epub ahead of print], [Abstract only]. Retrieved from  http://www.ncbi.nlm.nih.gov/pubmed/26680599

A meta-analysis that evaluated and compared the risk of dementia in 10,861 patients with Mild Cognitive Impairment and depressive symptoms with MCI patients with and without depressive symptoms, showed that depression increased their risk of progressing to dementia if patients showed signs of depression.

Additionally, the Staunton-Carson study identified apathy as an often undiagnosed symptom of memory loss that medications can successfully treat.

Stanton, B. R., and Carson, A. (2016, February). Apathy: A practical guide for neurologists. Practical Neurology, 16(1), 42-7. doi: 10.1136/practneurol-2015-001232. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26502729

Apathy is an under diagnosed symptom of memory loss that can be treated with cholinesterase inhibitors, dopamine agonists, and stimulants. Furthermore, treatment for apathy improves the functioning and quality of life in older adults diagnosed with mild cognitive impairment as well as lowering the stress of their caregivers.

Finally, recently published research has underlined the importance of recognizing the neuropsychiatric symptoms of Alzheimer's disease, so that family members of individuals with symptoms of cognitive impairment and dementia seek treatment for their loved ones earlier.

Zhao, Q. F., Tan, L., and Wang, H. F., et al. (2016, January 15). The prevalence of neuropsychiatric symptoms in Alzheimer's disease: Systematic review and meta-analysis. Journal of Affective Disorders, 190:264-71. doi: 10.1016/j.jad.2015.09.069. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26540080

After surveying studies published from 1964 to September 30, 2014 from the PubMed and Embase databases as well as reference lists and conference abstracts, researchers identified 12 neuropsychiatric symptoms common to Alzheimer's, which they listed in the order of their frequency: 1) apathy (49 percent), 2) depression (42 percent), 3) aggression (40 percent), 4) anxiety (39 percent), 5) sleep disorder (39 percent), 6) irritability (36 percent), 7) appetite disorder (34 percent), 8) aberrant motor behavior (32 percent), 9) delusion (31 percent), 10) uninhibited behavior (17 percent), 11) hallucination (16 percent). and 12) euphoria (7 percent).

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Ways to Delay, Relieve, & Possibly Prevent Depression & Anxiety in MCI & Alzheimer's

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So if a family member with a failing memory and a declining ability to fend for him or herself is apathetic, depressed, and agitated, what are some of the ways that caregivers can lift their mood and ameliorate some of these symptoms, thus delaying his or her slide into loss of self?

 Meditation Reduces Stress & 

Improves Memory

Khalsa, D. S. (2015). Stress, meditation, and Alzheimer's disease prevention: Where the evidence stands. Journal of Alzheimer's Disease: JAD, 48(1), 1-12. doi: 10.3233/JAD-142766. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26445019

Khalsa highlights Kirtan Kriya as a easy time-and cost-effective meditative technique for improving memory in those diagnosed with Mild Cognitive Impairment. Khalsa claims this meditation technique that takes only twelve minutes per day not only improves sleep and decreases depression and anxiety, but it also regulates inflammatory genes, adjusts immune genes, improves insulin and glucose regulatory genes and increases telomerase by 43 percent—not to mention improving psycho-spiritual well being.

See also:

Practice the 12-minute yoga meditation exercise. (2015). Alzheimer's Research and Prevention Foundation. Retrieved from http://www.alzheimersprevention.org/research/12-minute-memory-exercise

Kirtan Kriya, a 12-minute, non-religious meditative exercise, reduces stress and increasing memory. In Sanskrit, kirtan translates as “song”,and kriya refers to a specific set of movements; in this case, the movement of the fingers (Practice, 2015, para. 1-2). Thus, those practicing this form of yoga should repeat the mantra “Saa, taa, naa, maa” while seated in an upright position with the spine straight and the hands closed, singing in a natural voice for two minutes, then whispering the syllables for two minutes, and finally saying them silently for four minutes before reversing the process. While singing saa, touch the index finger in both hands to the thumb; on taa, touch the middle finger in both hands to the thumb; on saying naa, touch the middle finger in both hands to the thumb, and on maa, place the little finger on both hands on the thumb (Practice, 2015, para. 7-8).

Lavretsky, Helen. (2013, November 15). Kirtan Kriya meditation: 12-minute brain boost for stressed-out people. Bottom Line Health. Retrieved from http://bottomlinehealth.com/kirtan-kriya-meditation-12-minute-brain-boost-for-stressed-out-people/

After two eight week repetitions of either listening to soothing instrumental music with the eyes closed or practicing Kirtan Kriya meditation, 65 percent of the caregivers of patients with mild to moderate Alzheimer's alleviated their own symptoms of depression compared with only 31 percent of those listening to calming instrumental music while 52 percent of the caregivers improved their mental health, but only 19 percent of those listening to music did so. Moreover, while meditation increased telomerse activity in 43 percent of those practicing Kirtan Kriva, listening to music only lengthened telomeres in four percent of those listening to music (Lavretsky, 2013, November 15, para 8-15).

Numerous YouTube videos also illustrate the practice of Kirtan Kriva.

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Art, Dance, & Music Ease Depression

Sing-a-longs ease depression and improve quality of life.

Music and dancing also decrease depression as well as increase cognitive function in older adults diagnosed with depression, Alzheimer's, and Mild Cognitive Impairment.

Kim, S. H., Kim, M., and Ahn, Y. B., et al. (2011, December 1). Effect of dance exercise on cognitive function with metabolic syndrome: A pilot study. Journal of Sports Science, and Medicine, 10(4), 671-8. [Free article]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24149557

Since metabolic syndrome is associated with an increase risk of cognitive decline, this Korean study examined the effects of dance exercise in older patients with metabolic syndrome in 38 elderly metabolic syndrome patients, 26 of whom performed dance exercise twice a week; and then, researchers compared their results with the 12 members of the control group. Compared with the control group, the dance exercise group “significantly improved” their verbal fluency, word list delayed recall, word recognition, and over all cognitive function score. However, no significant differences occurred in their body mass index, blood pressure, waist circumference, fasting plasma glucose, and triglyceride and HDL cholesterol levels over the six-month period. Thus, researchers concluded that dance exercise may reduce the risk for cognitive disorders in older adults with diagnosed with metabolic syndrome.

Ray, K., and Mittelan, M. S. (2015, October). Music therapy: A non-pharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia. Dementia (London). Pii: 1471301215613779. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26519453

After researchers evaluated 132 nursing home patients with moderate to severe depression for depressive symptoms, agitation, and monitoring, two assessments further evaluated their behavior both two weeks before and two weeks after an intervention—two weeks of music therapy. After two weeks of music therapy, symptoms of depression and agitated “significantly reduced” although no change in wandering behavior occurred. The results thus suggested that music therapy in long-term setting might reduce symptoms of depression and agitation.

Ridder, H. M., Stige, B., and Qvale, L. G., et al. (2013). Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging and Mental Health, 17(6), 667-78. doi: 10.1080/13607863.2013.790926. [Free text]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23621805

A crossover trail of 42 nursing home patients assessed the benefits of music therapy in a randomized trial that analyzed the effects of six-weeks of individual music therapy versus six weeks of standardized care, evaluating agitation levels, quality of life, and the need for psychotropic medication. Agitation and disruptive behavior significantly decreased during music therapy as did the need for psychotropic meds while demand for mood-altering drugs increased when patients. These positive results led researchers to call for a larger sampling size to further tests the positive effects of music therapy.

See also:

Art and music therapy for Alzheimer's disease. (2016). Alzheimer's Disease Health Center. Web MD. http://www.webmd.com/alzheimers/guide/alzheimers-therapies-music-art-more

Music therapy soothes agitation, triggers long-term memory, engages the mind, and sometimes improves appetite (Art & music, 2016, para. 3).

Try golden oldies, karaoke, and sing-a-longs to bring back old memories; use toe-tapping, up-tempo dance music to stimulate mental and physical activity, and use easy listening music and lullabies to relieve anxiety (Art & music, 2016, para. 4).

Rely on facial cues to determine whether or not the Alzheimer's patient likes a particular type of music or individual song (Art & music, 2016, para. 5).

Art therapy helps Alzheimer's patients to communicate when they are at a loss for words. Try asking the patient to paint or draw their memories, encourage free-form abstract paintings, and refrain from criticism (Art & music, 2016, para. 6).

Additional therapies commonly used with Alzheimer's patients include massage, pet therapy [if the patient like dogs], or helping mild to moderate Alzheimer's patients to participate in previous hobbies like gardening or cooking (Art & music, 2016, para. 7).

Clair, Alicia Ann, and Tomaino, Concetta M. (2015). Education and Care. Music. Alzheimer's Foundation of America. Retrieved from http://www.alzfdn.org/EducationandCare/musictherapy.html

Since rhythmic and well-rehearsed responses don't require much thought, but instead rely primarily on auditory cues, even late-stage dementia patients respond favorably to music (Clair, 2015, para. 3).

Previous experiences with a song or melody is most likely to elicit a response. Therefore, music that was popular during the dementia patient's young adult years from 18 to 25 is most likely to bring about a positive response during the early to mid-stages of dementia. However, as Alzheimer's progresses into its later stages, music from childhood also stimulates favorable responses (Clair, 2015, para. 5, 8, & 10).

Quick tempos stimulate while ballads and lullabies sedate (Clair, 2015, para. 11-12).

Musical activities, such as singing, playing rhythm band instruments, like tambourines, rain forest drums, and castanets, dancing, and exercising to music, diffuse aggression even in late-stage dementia. For best results, schedule music therapy just before the time disruptive behavior is most likely to occur (Clair, 2015, para. 14 & 16).

Listening to music can also elicit emotional responses and mutual affection between dementia patients and their caregivers (Clair, 2015, para. 15-17).

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 A How to Guide for Re-introducing Music & Dance to

Mild Cognitive Impairment  & Dementia Patients

Nursing home residents benefit from exercising to music.

Mild Cognitive Impairment and Early Stage Dementia:

Go out dancing or dance around the house with the MCI or dementia patient;

Play music from the MCI or dementia patient's past;

Experiment to decide what type of music works best;

Encourage former musicians to continue to play a musical instrument as long as possible;

Compile the patient's music history [assembling CD's that bring back memories].

(Clair, 2015, para. 18)

Early to Middle Alzheimer's:

Play music that allows Alzheimer's patients to improve their walking gait;

Play background music to enhance the mood of Alzheimer's patients;

Play relaxing instrumental music to reduce sun downing (night-time wandering) and other night problems.

(Clair, 2015, para. 19)

Late-stage Alzheimer's:

Continue to play the music that worked well in the earlier stages of Alzheimer's;

Lead sing-a-longs with Alzheimer's patients;

Play soothing music especially before bedtime;

Assist patients  as they exercise to music;

Help patients participate in drumming and rhythmic-based activities.

(Clair, 2015, para 21)

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Sarkamo, T., Laitinen, S., and Kuri, M., et al. (2015, October 19). Clinical and demographic factors associated with the cognitive and emotional efficacy of regular musical activities in dementia. Journal of Alzheimer's Disease: JAD, 49(3) 76781. doi: 10.3233/JAD-150453. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26519435

In a randomized-controlled trial, 89 dementia patients and caregiver partners received 10-week intervention training in either singing or listening to music or standardized care after the dementia patients received extensive neuropsychological testing and were assessed to determine their mood and quality of life. Although variables like dementia etiology and severity, age, care situation, and musical background effected the effectiveness of music therapy, singing improved especially beneficial in improving the working memory of patients with mild dementia as well as in maintaining executive function and orientation in younger dementia patients while listening to music supported cognition, working memory and quality of life especially in those dementia patients diagnosed with moderate dementia not caused by Alzheimer's disease. Both singing and listening to music alleviated depression especially in those individuals diagnosed with mild dementia.

Nesher. (2010, March 3). Dance therapy for Alzheimer's patients. Alzheimer's diseases, causes, symptoms, treatment. Blogger. Retrieved from http://alzheimers-review.blogspot.com/2010/03/dance-therapy-for-alzheimers-patients.html

Dance therapy improves physical and psychological well-being either through participating in structured dances, such as ballroom or folk dancing with a partner, or improvisation that links thoughts to movement. Sessions should last about an hour to reduce the symptoms of Alzheimer's from hindering the dancer's progress (Nesher, 2010, March 3, para. 3).

Social dancing with a partner develops procedural and long-term memory as well as concentration while free-style dancing that encourages participants to focus on creative expression enhances mood and relationships (Nesher, 2010, March 3, para. 4-5).

The accompanying music improves autobiographic memory and reduces agitation, anxiety, and delusions as well as other behavioral symptoms of dementia. Meanwhile, exercise slows the progress of Alzheimer's cognitive symptoms while increasing the concentration of insulin-like growth factors and reducing serum homocystene levels (Nesher, 2010, March 3, para. 7-8).

However, dance therapy is effective only after a period of regular sessions. Moreover, while dementia patients might have a higher risk of falling during dancing, such exercise might also reduce their risk of falling by improving stability as well as existing chronic health problems that might result in falls (Nesher, 2010, March 3, para. 20).

Dancing might also act as a preventive factor, warding off Alzheimer's and other dementia by accelerating cognitive reserve, reducing brain atrophy, invigorating the brain's ability to grow and change, and increasing brain perfusion (Nesher, 2010, March 3, para. 21).

Serlin, Ilene, (2013,November 2). Dancing away dementia. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/make-your-life-blessing/201311/dancing-away-dementia

Frequent free-style dancing reduces the risk of dementia by 76 percent—twice as much as reading does.

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Effective Sensory, Psychological, & Behavioral Interventions: Leisure Activities & Hobbies

Playing games can help alleviate depression and delay or prevent dementia.

Livingston, G., Kelly, L., and Lewis-Holmes, E., et al. (2014, June). A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technology Assessment (Winchester, England), 18(39), 1-226, vi-vi. doi: 10.3310/hta18390. [Free text]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24947468

A British meta analysis turned up 160 relevant studies out of 1,916 papers screened in a search for cost-effective, long-term ways to relieve dementia patients' agitation and depression. Of these ways to ameliorate depression and aggression, better person-centered care, improved communication skills, and modified Dementia Care Mapping [where caregivers make effective changes in an individual's environment after observing how he or she spends his or her day] were the most effective means in reducing agitation immediately as well as for six-months afterward. Leisure activities and music therapy as well as sensory intervention also reduced mean levels of agitation. However, therapeutic touch, individualized activities, aroma therapy, and light therapy didn't effectively relieve depression or lessen aggression. Moreover, the few studies documenting activities of daily living and quality of life also produced no improvement.

Verghese, J., Liton, R. B., and Kratz, M. J. (2003, June). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348 (25), 2508-16). [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12815136

In a cohort of 469 community-welling, cognitively healthy older adults, aged 75 and older, researchers survey their frequency of participation in leisure activities and their risk of developing dementia over 5.1 years and found that regularly taking part in leisure activities and hobbies, including reading, board games, playing a musical instrument, and dancing, all reduced the risk of dementia.

Lee, J., Lee B., and Park, Y., et al. (2015, October 27).  Effects of combined fine motor skill and cognitive therapy to cognition, degree of dementia, depression, and activities of daily living in the elderly with Alzheimer's disease. Journal of Physical Therapy Science, 10: 3151-4. doi: 10.1589/jpts.27.3151. [Free text]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26644663

After 26 patients were divided into an experimental group that received therapy in fine motor skills and cognitive therapy and a control group who only received general medical care, the experimental group improved their cognitive skills, showed decreased signs of dementia and depression, and enhanced their activities necessary for daily living when compared with the control group patients who only received medical care.

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A Mediterranean Diet Featuring Omega-3 Fatty Acid Fish Improves Mood & Memory

More than ever, the elderly are what they eat!

Scarmeas, N., Stern, Y. , and Mayeux, R. (2006, December ). Mediterranean diet, Alzheimer disease, and vascular mediation. JAMA Neurology, 63 (12). [Full text]. Retrieved from http://archneur.jamanetwork.com/article.aspx?articleid=792992

Adherence to a Mediterranean diet was the primary predictor of whether or not older adults were diagnosed with Alzheimer's in a New York community-based study that compared 194 patients diagnosed with Alzheimer's versus 1,790 non-demented patients after adjusting for age, gender, ethnicity, years of formal education, apolipopprotein E genotype, caloric intake, smoking, medical comorbidity, and Body Mass Index factors.

Song, C., Shieh, C. H., and Wu, Y. S., et al. (2016, January 4). The role of omega-3 polyunsaturated fatty acids eicosapentaenoic and docosahexaenoic acids in the treatment of major depression and Alzheimer's disease: Acting separately or synergistically? Progress in Lipid Research. 15, pii: S0163-7827doi: 10.1016/j.plipres.2015.12.003. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26763196

Omega-3 polyunsaturated fatty acids (n-3-PUFAs) improve or prevent some neurodegenertive diseases in both experimental and clinical studies by modulating neuroimmune and apoplectic pathways, changing membrane function and/or competing with n-6 PUFAs, even though their exact role remains unclear.

See also:

Boutziouka, V., Polychronopoulos, E., and Zelmbekis, A. (2009 September). Long-term fish intake is associated with less severe depressive symptoms among elderly men and women: The Medis (MEDiterranean Islands Elderly) epidemiological study. Journal of Aging and Health, 21(6), 864-8. doi: 10.1177/0898264309340693. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19587361

From 2005 to 2007, Greek researchers studied 1,190 Greek and Cyprus men and women over age 65 and found that those who increased their weekly fish intake by one portion were 0.58 percent less likely to suffer from depression. [Given their locale, most probably they already ate several servings of fish per week].

Psaltopoulou T., Sergentanis T. N, Panagiotakos, D. B. (2013 October).  Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis.  Annals of Neurology, 74(4), 580-91. doi: 10.1002/ana.23944. [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23720230

After analyzing 22 studies estimating the relative risk for the association between adhering to a Mediterranean diet and stroke, depression, cognitive impairment, and depression, researchers concluded that strict adherence to a Mediterranean Diet consistently equated with a reduced risk of stroke, depression, and cognitive impairment while a moderate adherence to such a diet reduced the incidence of depression and dementia.