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Counseling’s Role in Averting AD

By Jennifer Mellace

Research shows the importance of life counseling for preventing Alzheimer’s disease.

For patients suffering through the onset of Alzheimer’s disease (AD) and family members struggling to hold on to their loved ones, the knowledge that there is no cure for the disease is nearly unbearable. It also extends to physicians who recognize that dementia of the Alzheimer’s type (DAT) results in brain cell destruction that eventually stretches beyond the realm of cognitive function to impact general body systems, ultimately resulting in death.

But research by experts in the field, specifically Kathryn Douthit, PhD, chairperson and associate professor of counseling and human development at the University of Rochester, indicates that counseling by professionals may play an important role in early dementia prevention. Researchers have identified several risk factors that increase the likelihood of individuals developing AD, including depression and numerous lifestyle variables related to physical, mental, and social activities. Douthit believes counselors could potentially play a major role in delaying, if not preventing, the onset of Alzheimer’s dementia for millions of people by treating the whole person early on.
“Although the study and treatment of Alzheimer’s dementia has largely been the purview of medicine, as information about this disorder has emerged, a clear role for counseling has taken shape,” Douthit wrote in an article for the Spring 2007 issue of ADULTSPAN Journal, published by the Association for Adult Development and Aging, a division of the American Counseling Association. “Interventions across the life span that address stress, depression management, social integration, spirituality, and other targets of holistic wellness such as diet and exercise hold much promise for delaying or circumventing the cognitive disabilities associated with Alzheimer’s dementia.”
While Douthit admits that “research in the biomedical sciences has yet to elucidate a specific causal mechanism linking depression and dementia of the Alzheimer’s type,” her study cites the following:

• There is a significantly higher chance that DAT will develop in subjects who manifest symptoms of depression one to 25 years prior to the onset of AD compared with normal subjects.

• Individuals diagnosed with AD who concurrently develop depression suffer from more severe DAT symptoms than subjects who are not depressed.

• Brain imaging studies strongly suggest the hippocampus, a brain structure important in memory, emotion, and learning, shrinks during the course of untreated depression. This finding has led neuroscientists to hypothesize that the toxic effects of untreated depression on the hippocampus may play an important role in shaping DAT symptoms.

“Whatever the exact nature of the relationship, it is clear that depression exacerbates DAT symptoms in those with AD and is predictive of the disease in previously healthy subjects,” she says.

The Counselor’s Role
With a rapidly aging population, the Alzheimer’s Association predicts AD will continue to impact more lives. According to information from the association’s 2010 Alzheimer’s Disease Facts and Figures, AD deaths increased 46.1% from 2000 to 2006, while other selected causes of death decreased. Douthit points to the damaging effects of chronic stress, increased sales of antacids, sleep aids, alcoholic beverages, and other “stress-busting tonics” and says managing stress before its toxic effects take hold may play an important role in mitigating the symptoms of DAT.

“At least two conditions associated with chronic stress—depression and cardiovascular disease—appear to have a significant relationship with the devastating effects of DAT,” says Douthit. “Therefore, counselors could play a major role in preventing or mitigating these effects by attending to the destructive impact of untreated depression.”

According to the Alzheimer’s Association, more than 10% of people aged 65 and older have AD, and nearly 50% of people aged 85 and older have the disease. While there is some evidence that genes play a role in AD, the evidence for genetic involvement is much stronger for early-onset AD (prior to age 65) than late onset. Douthit’s study showed that by addressing risk factors early in typical counseling sessions (ie, promoting the importance of being socially active, maintaining meaningful relationships, positive thinking, and overall well-being), the early onset of AD can be thwarted.

“It has been found that, over time, people who found a sense of meaning in their life tend to be much healthier in cognitive thinking, and living a life of well-managed stress contributes significantly to good brain health in old age,” says Douthit. “Myers, Sweeney, and Witmer have provided the counseling profession with a multidimensional model of wellness—The Wheel of Wellness—that includes factors such as diet, exercise, social engagement, and self-efficacy, many of which have also been studied, with positive results, in relation to dementia of the Alzheimer’s type. And in his popular accounting of the Nun Study, Aging with Grace, Snowdon provided compelling anecdotal descriptions of elderly nuns who maintain these principles of wellness while escaping the symptoms of DAT. In any case, wellness and prevention, as a central aspect of counselor identity, may provide a venue for counselors to make significant contributions in the struggle against AD.”

The Wheel of Wellness, a theoretical model outlined by Myers and Sweeney in the American Counseling Association’s 2007 Professional Counseling Digest, remains a useful tool for professional counselors as a guide for both formal and informal assessment and for wellness-oriented counseling. The model embraces spirituality as the core characteristic of a well person.

In the end, Douthit stresses that physicians need to talk to their patients, letting them know it’s OK to speak to someone about organizing their lives. “Counseling that anticipates what’s to come and prevents depression with stress management and focusing not on being mentally ill, but mentally well, will help prevent AD,” she notes.

— Jennifer Mellace is a Maryland-based freelance writer whose articles have been published in various regional and national publications.