How the Ashby Memory Method Dementia Intervention Program can help those in the early to mid stages to gain a new lease on life:
Lou Granger was diagnosed with dementia in his early 60s, and the disease progressed quickly. A long-time diabetic, he could no longer remember how to check his own blood sugar level.
An avid golfer, he had to give up the sport. Increasingly, he relied on his wife, Shirley, to care for him and organize his day – until Shelva Jacobs arrived, about three years ago.
Jacobs is a registered nurse with Superior Care Plus in Cincinnati, Ohio. She is certified in the Ashby Memory Method (AMM) Dementia Intervention Program: therapy based on retro-neuroplasticity.
“That’s the idea that you can train other parts of the brain to take over functions from the damaged parts through cognitive stimulation,” explains John Ashby, founder of the Alzheimer’s Innovation Institute, a small Calgary, Alta.-based company that developed the technique and trains facilitators. Although the brain doesn’t form new connections in dementia, Ashby points out, “exercising remaining cognitive abilities allows people to function better for longer.”
Within nine months of beginning therapy, Granger was golfing again with friends and maintaining his own health with a little help from his wife.
Jacobs first assessed Granger (the Granger family names have been changed) to confirm that he’d benefit from AMM. The program is only appropriate for people in the early to mid-stages of Alzheimer’s disease and dementia.
“They have to be able to actively participate,” says Ashley Shea, a nurse intake coordinator for Superior Care Plus, “and it really helps if they have an active caregiver to reinforce what we’re doing, during the week.”
Jacobs teased out Granger’s hobbies, interests, work history and significant life events, and ordered AMM work booklets tailored to his interests, namely golf and baseball. Working through the booklets’ exercises – a variety of repetitive activities, from deductive reasoning to simple math questions and matching games – helps the brain. The Institute has produced thousands of booklets based on personal hobbies, careers, historical events and celebrities, like Frank Sinatra.
If the person was a geologist, for example, the info might be centred around techniques for identifying oil and gas deposits. “If you use a one-size-fits-all approach that isn’t relevant to the person, they will find it boring,” says Ashby.
Shirley participated in the home-care sessions with Jacobs to reinforce progress. And Jacobs played putt-putt with him, to stimulate Granger’s passion for golf. She also developed a large, white orientation board, which listed the date, the day and the day’s events.
Granger typically asked Shirley, “What are we going to do today?” Now, she can point to the orientation board, a visual cue, and offer a verbal cue, “Why don’t you tell me what we’re going to do today? What’s the first step in taking your blood sugar?”
That’s crucial, says Jacobs, because caregivers want to think for and do things for their loved one. “We encourage them to step back and allow the person to be as independent as possible.”
A history of innovation
The AMM program relies on the groundbreaking work on brain-injury patients by medical doctor Mira Ashby, John Ashby’s deceased mother. In the 1970s, doctors didn’t think you could rehabilitate people with traumatic brain injuries. But when a friend’s son sustained a head injury, Dr. Ashby developed a volunteer schedule to help him relearn what he’d lost. The boy later earned a university degree.
Dr. Ashby launched a pilot program to treat brain injury that led her to open Toronto-based Ashby House (now called Community Head Injury Resource Services of Toronto) in 1978. The AMM program builds on her work, says Ashby, a Certified Professional Consultant on Aging and co-founder of Calgary home care company Signature Care.
“We try to reinforce existing neural pathways and stimulate adaptation responses to disease-related changes.”
A 2008 proof of concept study based on 50 participants showed the approach stacked up well against the commonly used Alzheimer’s drug Aricept. Given no treatment, the average person with AD drops slightly more than three points per year on their Mini Mental State Examination (MMSE) score, according to a meta-analysis of progression rates during the mid-stages of Alzheimer’s Disease. By contrast, those who benefit from the drug Aricept tend to stabilize for up to six months.
“In our study,” says Ashby, “people [given AMM] improved on their MMSE score by almost two points in the first three months, and usually a bit more for the next three months.” After that, they plateaued and remained stable for up to three or four years.
Armed with these results, Ashby estimates he’s trained 300 nurses and occupational and speech therapists who’ve worked with about a thousand patients in the United States, Australia and, to a more limited extent, Canada.
“We would love to see our program covered by medicare [in Canada], but so far it’s not.” In the U.S., AMM qualifies for Medicare coverage, says Ashby. “We’re in the process of becoming an approved training provider for the American Occupational Therapy Association.”
Ashby is also organizing a larger study on a population of as many as 250 nuns in Canada and the U.S. (chosen because of their consistent lifestyle factors), to get more clinical evidence.
The nuts and bolts
AMM is delivered by a facilitator such as a therapist or nurse. Facilitators buy a user licence: $2,500 for a corporate membership and $500 yearly renewal; $900 for an individual practitioner and $250 yearly renewal. Booklets cost $6 each.
To find a facilitator in your area go to www.alzheimersinnovation.com.
Caregivers can get training too. “We were fortunate enough to get a grant from BioAlberta Association for Life Sciences to develop the program for family, friends and volunteers,” says Ashby. “They can do the training in under an hour.” Training costs $99 per person and $6 per booklet.
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