Supportive Group Experience for Patients With Early‐stage Alzheimer's Disease

To the Editor: Dementia is a neurodegenerative syndrome of acquired progressive intellectual impairment that presents one of the greatest challenges to the health care system.1,2 Standardizing diagnostic techniques and expanding access to services has been the mobilizing factor of public health concern. Despite the increased focus on diagnosis, research, and clinical drug studies for dementing illnesses, clinicians have paid limited direct attention to either the psychological consequences of the progressively deteriorating level of function in this patient population or its profound impact on their daily activities, role identity, and quality of life.3 Individuals with early stage Alzheimer's face solitary challenges peculiar to their level of impairment. Progressive deterioration in role function has an insidious effect on the individual's self-esteem. Individuals often possess relatively intact insight and appreciation of experience, and, as such, are not shielded from the transitional stages of denial, anger, and depression.4 These individuals frequently feel segregated from their former friends and social activities, leading to feelings of rejection, boredom, and worthlessness. Patients and their caregivers often voice concern over the lack of appropriate resources to assist them in coping with these consuming changes. To date, efforts to understand and treat the psychological impact of neurodegenerative processes have been conspicuously absent. Historically, older adults have been considered inappropriate candidates for psychotherapeutic interventions.5 The current psychotherapeutic models, until recently, neglected Alzheimer's disease patients. A search of the literature revealed few references of individual therapy or support groups for early stage Alzheimer's disease patients.6–8 Support groups have proven to be a major and invaluable ingredient in the treatment of unimpaired patients and caregivers, as well as for caregivers of individuals with cognitive impairment.3,9–12 The reasons for forming an early-stage dementia support group include: (1) to provide a therapeutic intervention for a subset of Alzheimer's patients who, by virtue of the early stage of their losses and relatively intact insight, are particularly vulnerable to states of depression, frustration, and crisis; (2) to identify specific issues unique to this population; (3) to evaluate the influence of a psychotherapeutic group experience on patients’ self-esteem, coping skills, and sense of well-being; and (4) to develop practical recommendations from which a model for early-stage Alzheimer's support groups may follow. This specialized support group could provide a forum for a subset of dementia patients recently diagnosed with early-stage Alzheimer's disease. Participants would be at similar points on the coping-collapse continuum13 as determined by standard cognitive/mood scales for the subject and caregiver interview. Common and sensitive group themes might involve individual level of comfort versus discomfort with the diagnosis, how they now perceive themselves, and how others, particularly family members, reacted to their condition; feelings of guilt, anxiety, and hopelessness for a future without executive control; increasing reliance on caregivers for assistance in decision making; and inevitable role reversals occurring with spouses, children, and contemporaries. Life style adjustments would occur for social activities, interpersonal relations, transportation, and employment. Patients and caregivers might make these changes with a sense of urgency and haste as they now carried a diagnosis that was for them unwanted, inescapable, and threatening. These combined factors might serve to explicate the participants’ vulnerabilities and bleak future. Conceivably, early participation by Alzheimer's individuals in a support group might lead to a better understanding and acceptance of the inevitable changes in function, role, and identity. A psychotherapeutic group intervention may have unrecognized potential for alleviating suffering and improving the quality of life for this patient population and their families.