Until recently, Pauli Reading, now 58, used to pull on a pair of stretchy pants, unroll a mat, and do a series of asana poses in a group yoga class in Charlotte, NC. “I love it, love it, love it,” said Reading at the time. “It makes me feel so much better and stronger. I love all the friends I have in class, and it gives me a lot of energy.” But while Reading raved about the physical and social benefits of her class, her husband Tracy explained there was another reason he encouraged his wife to keep up with her yoga practice: Pauli was diagnosed four years ago with early-onset Alzheimer’s disease, and he believes the classes not only kept Pauli’s mood positive and her body strong, but they also kept her brain engaged, helping ease her memory loss and cognitive decline. “Yoga is one of the many paths that helped her,” he says. “When she was doing yoga, she was thinking about the poses and talking to the other students. She was exercising mentally and well as physically. At the very least, it didn’t hurt.”
Meanwhile in Toms River, NJ, Deanna Buccella saw something amazing happen with her mother Bonnie Ball, who was diagnosed a decade ago with Alzheimer’s, and passed away at age 88 earlier this year. In her final months, even when Bonnie couldn’t recognize her grandchildren or remember where she lived, she experienced moments of “awakening” every time a music therapist placed a set headphones over her ears, uploaded with the Christian hymns she loved from her childhood in West Virginia. “Her eyes lit up with such a sense of joy and she remembered all the lyrics and would start singing along,” says Buccella. “Afterward, she was more alert and happy, like she had just had a workout for her brain. We played music the entire time she was on hospice; we knew she heard everything. She sang until she could no longer speak.”
While alternative therapies such as yoga, meditation, and music therapy cannot reverse the inevitable cognitive decline of Alzheimer’s (the degenerative neurological disease that affects more than 5 million Americans), more and more research is showing that by engaging in these activities, people with Alzheimer’s can reduce many of their symptoms, including anxiety and depression, thereby improving their quality of life. And there is also emerging evidence that by participating in therapies that stimulate both the brain and the body, these patients may at least temporarily stimulate the memory center of their brain and perhaps even generate new brain cells.
And as Tracy Reading, Pauli’s husband says, they certainly can’t hurt.
Alzheimer's Medication Is Limited
Experts warn that these therapies should not replace medical treatment for Alzheimer’s, but the truth is, the medications we have right now are very limited. There are two classes of drugs approved by the FDA to treat memory loss and cognitive decline: cholinesterase inhibitors (sold under the names Aricept, Exelon, and Razadyne), which prevent the breakdown of acetylcholine, a brain chemical involved in learning and memory that gets depleted in Alzheimer’s; and memantine (Namenda), which regulates the activity of glutamate, a chemical involved in retrieving information. “The results vary, but in patients for whom treatment with these medications shows benefit, their symptoms typically improve temporarily, usually between 6 to 12 months,” says Elise Caccappolo, Ph.D., associate professor of neuropsychology at Columbia University College of Physicians and Surgeons. “After that, they tend to stop working, and we’re not sure why.” For the estimated 40% of Alzheimer’s patients who also experience depression, the most common treatments are antidepressants such as fluoxetine (Prozac) and paroxeine (Paxil). Additional behavioral and mood symptoms may be treated with anti-anxiety meds such as lorazepam (Ativan), and in extreme cases, when patients become hallucinatory or physically aggressive, they may be treated with antipsychotics such as clozapine (Clozaril). While these medications can be very effective, they can also have side effects, ranging from gastrointestinal problems to an increased risk of stroke and even death.
If a patient’s mood can be lifted and his or her quality of life improved without resorting to medications (which not only have side effects, but can be a financial burden), the patient may also see memory improve as a result, says Caccappolo. “When people are less active, their memory often declines at a faster rate,” she says. “If they have a yoga class to go to or interaction with a music therapist, that will get them off the couch and keep them engaged and active. And when you lift that veil of depression, that can help memory.”
Yoga to Boost Cognitive Thinking
For years, researchers have known that exercise is one of the most important factors in reducing your risk for Alzheimer’s. (A 2011 review in Mayo Clinic Proceedings found that midlife exercise significantly reduced the risk of dementia in all adults, and that people with mild cognitive impairment or dementia scored better on tests of cognition after 6 to 12 months of exercise than their sedentary peers). “Exercise has been shown to reduce the amyloid plaque in the brain that causes Alzheimer’s, to induce the birth of new nerve cells in the hippocampus [the area of the brain where memories are stored], and to help clear inflammation, so when those new cells are born they have a nice neighborhood to grow up in,” explains Rudolph Tanzi, Ph.D., Kennedy professor of neurology at Harvard Medical School/Mass. General Hospital and co-author of The Healing Self: A Revolutionary New Plan to Supercharge Your Immune System and Stay Well for Life.
Exercise has been shown to reduce the amyloid plaque in the brain that causes Alzheimer’s.
But of all exercise programs that are available, what’s special about yoga? In addition to being a physical activity that can be practiced indoors, even seated in a chair—a benefit for those with mobility challenges—yoga has the added element of mindfulness, says Helen Lavretsky, M.D., a professor of psychiatry at UCLA. “Yoga involves awareness of your movement and breath, posture, and focused attention on a mantra, a pose, or a visualization,” she says. “If it’s done in a group setting, there is also a social element. There are many components to the exercise that involve different brain centers.”
In a series of studies, Lavretsky has shown that people with cognitive impairment see improvement in their cognition, memory, and mood after practicing yoga. In a study published last year in International Psychogeriatrics, adults with mild cognitive impairment (known as MCI, and a precursor to Alzheimer’s) participated in either a kundalini yoga class or a did standard memory exercises. After 12 weeks, both groups saw improvements in verbal and visual memory skills, but those who did yoga had greater improvements in executive function, mood, and resilience than those who did the memory exercises.
One limitation to yoga, however, is that it is a difficult practice to begin once you have slipped into the later stages of dementia—one reason it’s important to integrate these practices into your life as early as possible. “It yoga is something you did when you were younger, and you’re just getting a refresher, then it’s a good addition to your Alzheimer’s management,” says Lavretsky. “But in the advanced stages of dementia, it may be better to introduce something the patient is already familiar with, like dancing to the music of their youth.”
Meditation to Reduce Stress
If even sitting in a chair and doing a modified warrior pose seems too intimidating for your loved one with Alzheimer’s, you may want to consider meditation, which experts claim can change the brain and improve memory, sleep, and mood in as little as 12 minutes a day.
The main benefit of meditation—which has been practiced for thousands of years as a way to calm the mind and body and find inner peace—is stress relief, which is nearly as important as exercise in reducing risk for Alzheimer’s. “Both acute and chronic stress signal the brain to secrete the hormone cortisol, which is highly toxic to just about every system the body, but especially the brain,” says Dharma Singh Khalsa, M.D., medical director of the Alzheimer’s Research and Prevention Foundation, who, along with Lavretsky and other colleagues, has published numerous studies on the effects of meditation on dementia. “It causes brain-cell death in the hippocampus and can lead to earlier amyloid deposition. It can also lead to decreased blood flow, and decreased function in the synapses where the brain cells talk to each other.” Indeed, several long-term recent studies have shown that chronic stress greatly increases the risk of MCI. A 2015 study of more than 500 older adults at the Albert Einstein College of Medicine in the Bronx, NY, published in Alzheimer Disease & Associated Disorders found that adults who considered themselves “highly stressed” were 30% more likely to develop MCI as those who were not, and an earlier long-term study of 600 adults in the Rush Memory and Aging Project found that those who had a self-reported highest level of stress were 2.7 times more likely to develop Alzheimer’s than those who were not under chronic stress.
Those who reported the highest level of stress were 2.7 times more likely to develop Alzheimer’s.
Over the past 20 years, Khalsa has studied the effects of a particular type of meditation called Kirtan Kriya on cognitive decline. The practice involves intoning four syllables—saa, taa, maa, naa—while tapping the fingers together in sequence—thumb to index, middle, ring and pinkie—for 12 minutes once a day. His research has shown that those who practice Kirtan Kriya see an increase in cerebral blood flow, especially in the hippocampus, a decrease in memory loss, plus a decrease in anxiety and an improved feeling of well-being. In a paper published in 2017 in the Journal of Alzheimer’s Disease, adults with subjective cognitive decline (an early predictor of Alzheimer’s) who practiced Kritan Kriya for at least three months had significant improvements in memory function and cognitive performance. “As long as the person can still sit in a chair and listen to a CD to follow this practice, they can benefit from it,” says Dr. Khalsa (go here more info).
Lavretsky points out that there are numerous types of meditation, and each has a different benefit, depending on what part of the brain is engaged. In a 2013 study at Beth Israel Deaconess Medical Center in Boston, researchers used MRI scans to find that a group of 8 adults with MCI who participated in Mindfulness-Based Stress Reduction (MBSR) had significantly improved functional connectivity in the brain. And while they did see expected atrophy in the hippocampus, the rate of atrophy was less than those who did not do the stress-reducing meditation.
Harvard’s Dr. Tanzi has also found positive neurological results from short periods of meditating. He explains that in one small study he did last year, published in the journal Nature Translational Psychiatry, he was able to detect remarkable changes in healthy women who meditated for just one week. “After a week of learning meditation and doing it several times per day, there were changes in the genes involved with how brain clears out Alzheimer’s-associated amyloid from the brain out of the body,” he explains. He adds that in the meditation group, there was a 20-40% increase in telomerase activity, a protein that protects cells from aging.
Caccappolo cautions that these studies are small and there is no evidence the brain can recover tissue lost through the ravages of Alzheimer’s, but she still encourages her patients to try any stress-relief method that works for them. “Stress can make anything worse, especially memory,” she points out. “The best thing about meditation is that it doesn’t cost anything, and if it can help relieve any symptoms, I encourage patients to try it.”
Music to Lift the Mood
While yoga and meditation do take some cognitive effort on the part of the patient, meaning they are most effective with those who are in the earlier stages of Alzheimer’s, music therapy can have remarkable effects even on those who are in the latest stages of the disease. For a peek at how this works, check out the 2014 documentary Alive Inside. As Deanna Buccella found out, music can perk up the attention and stir memories of people who have been lost in the fog of dementia for years.
The first way music therapy works is through stimulating memories and emotions: Just think about how you can hear a Beatles or Bee Gees song or and immediately be transported to the moment in your childhood when you first listened to it. Caccappolo points out that personally meaningful music activates regions of the brain that are usually the last to be affected by Alzheimer’s, so while someone with Alzheimer’s dementia may not be able to remember what year it is, where the kitchen is, or how to hold a pencil, they may recall all the lyrics and melody to their favorite Frank Sinatra tune. “The emotional associations with that music from your past releases chemicals in their brain to boost mood,” points out music therapist Concetta A. Tomaino, executive director of the Institute for Music and Neurologic Function, which she co-founded with the legendary neuroscientist Dr. Oliver Sacks.
The emotional associations with that music from your past releases chemicals in their brain to boost mood.
But music therapy works on a deeper level than just nostalgia. The act of singing along to that Frank Sinatra tune engages different parts of the brain: “There are several levels at which music is effective,” says Tomaino. “We know the act of playing music or singing forces the frontal cortex to be engaged, and that part of the brain is crucial for short-term memory, so engaging in active music-making actually reinforces short-term memory and long-term memory storage.” A 2014 Finnish study confirms this theory, showing that the hippocampus becomes activated when listening to musical phrases.
In a 2014 review in the Journal of Psychiatric and Mental Health Nursing, researchers found that music therapy reduces anxiety, depression and agitated behavior in people with dementia and improves the quality of their other therapeutic interventions with their caretakers.
Music can have other positive effects on those with dementia. A 2010 study at Boston University School of Medicine found that patients with Alzheimer's are better able to remember new information when it is provided in the context of music. “I often make up a little melody to help patients remember their children’s names or their address,” says Tomaino, who points out that TV commercials do the same thing, using jingles to help viewers remember their 800 numbers. Music also works to “prime” the brain, an effect that Deanna Buccella noticed with her mother. “The act of singing words actually primes the verbal areas in their brain to be more active, and word retrieval improves after they sing,” says Tomaino. “It’s almost like you have to turn on those neuronal networks into action.” Music can even help those with balance and movement difficulties get around easier, explains Tomaino. “The rhythm of music can improve a person’s motivation to move and also improves coordination of movement,” she says. “Listening to music while you’re walking can improve balance, posture, and gait coordination on a neuronal level.”
But most importantly, listening to music—like going to a yoga class, or spending a few minutes in calm meditation—can bring a sense of peace and joy back to people who may spend the day in a state of confusion and depression.
“There is no magic bullet that can prevent Alzheimer’s, though the closest thing is regular exercise, which can lower the risk and delay decline,” says Eric B. Larson , M.D.,vice president of research and health care innovation for Kaiser Foundation Health Plan of Washington. “For things like yoga and music, the evidence has been soft. But when people ask, should I try it? I tell them, it’s not going to hurt you, and the drugs can be harmful to some people. It makes a lot of sense.”
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