By Jessica LaGrossa

Four million Americans were diagnosed with Alzheimer's disease in 1998.

The Alzheimer's Treatment and Memory Training Centers of America (ATMTC), headquartered in Brooklyn, NY, has estimated that there is a five-year span between initial symptoms of dementia and admission to a nursing home.

A diagnosis of mild cognitive impairment, the early warning sign of dementia, could grant patients the opportunity to seek preventive treatment that could give them at least five more years of normal functioning time.

Recognizing the need for preventive care, the ATMTC has devised a treatment plan to serve the growing population of Alzheimer's patients.

Partnership

The ATMTC forms partnerships with existing practitioners who wish to expand their practices into the area of Alzheimer's and memory loss. In this contractual alliance, the practitioner provides space in an existing facility, while the ATMTC provides the treatment models, which include computer programs for treatment and tests for assessment; manuals containing the research supporting treatment and evaluation; marketing; and the procedure for referral.

The Wartburg Adult Care Community in Mt. Vernon, NY, recently formed a partnership with the ATMTC in order to better serve the needs of its patients. "We have a diagnostic and treatment center on our campus that provides medical and specialty services to older adults, many of whom have some form of cognitive deficit or memory loss," explained Aaron Kessler, administrator of outpatient care at Wartburg. "We felt that the services [the ATMTC] were offering fit very nicely with some of the demands and needs of our patients."

The program shares an administrative staff with the Wartburg staff, providing assistance with scheduling and transportation of the patients; the clinical side is staffed by clinical psychologists and neuro clinical psychologists through the ATMTC.

Evaluation

Peter Magaro, PhD, cognitive psychologist and director of the ATMTC, told ADVANCE that while everyone could benefit a little from preventive memory training, the question is who needs it the most. "As a person ages, we find that there is a decrease in memory function if there isn't a lot of intellectual activity going on in their life," he explained. "That deficit could be from isolation, depression or from various extraneous activities that are not directly related to the mental condition, such as diet, fatigue, etc."

Memory loss is usually the first thing people notice, said Dr. Magaro, and therefore a complete evaluation is important in order to determine the cause of the memory loss.

The ATMTC evaluation includes cognitive and neuropsychological testing that takes anywhere from two to four hours to administer and that focuses on delayed memory, working memory and memory storage. Then patients undergo neurological testing such as CT scans.

"In some evaluations we find early signs of delayed memory loss, which shows up before any neurological signs," said Dr. Magaro. "That is what we [focus] on for someone to be a candidate for memory training."

Memory Training

"There has always been a number of diagnostic memory and cognitive training batteries out there," explained Dr. Magaro. "And therapists have always had ways to work with a person on memory, from card games to flash cards and so forth."

But in the past five to 10 years, computer programs have developed systematic training procedures, which is what the ATMTC uses today. "They aren't very different than what used to be done by hand, except that is more systemized—you get clearer numbers, and we know if it is getting worse," said Dr. Magaro.

Once a client has undergone evaluation and has been diagnosed with mild cognitive impairment, a memory program is prescribed to suit the individual. The client then visits the center once a week to work with a psychologist at the computer to go through an individualized program.

The program consists of cognitive tasks such as the game Concentration, where tiles cover hidden pictures that must be matched together. "We can systematically start with eight tiles and move up to 12, 16, 24, etc.," explained Dr. Magaro. "We can keep maximizing the task."

Clients also are given homework assignments, Dr. Magaro said. Getting the client to do a cognitive activity appropriate to his condition for an hour a day, every day, is the biggest challenge of training. "And not only to do it every day, but to do it for an entire year, maybe even two," he added.

Clients are evaluated for progress every 13th session. Dr. Magaro told ADVANCE that most clients tend to achieve the upkeep of their current memory, and some even succeed at increasing their memory.

Dr. Magaro doesn't attribute it completely to the training program but also gives credit to the self-confidence that clients gain in doing the program.

Kessler agreed. "Positive self-esteem and outlook has had ramifications far beyond memory for the population we are working with here [at Wartburg], which is why we feel this [partnership] is such a good marriage between us and the programs we provide," he told ADVANCE.

According to Dr. Magaro, the ATMTC's training program is truly reflective of the wellness concept. "You are always preventing; you are always doing the healthy thing," he explained. "It actually makes our job much easier."

Kessler pointed out that the training program is an alternative for patients that doesn't involve taking yet another pill. "Patients learn that there are behavioral things they can do for themselves, or activities they can be involved in, that can help them feel better over time without additional medication."

Jessica LaGrossa is on staff at ADVANCE and can be reached at jlagrossa@merion.com