Medicare Stops Cognitive Therapy for Patients with Alzheimer’s Disease

06/04/2012 (press release: brucebrotter) // Forest Hills, New York, USA // Bruce Brotter, PhD, info@memorytrainingcenters.com

SHARPBRAINS has published an article that is essential reading for all providers, patients and family members who are concerned with the availability of effective interventions to treat Alzheimer’s disease. MEMORY TRAINING CENTERS OF AMERICA agrees with the concerns raised in this article, and warns that more ‘bad news’ is coming.

In his article, “From Anti-Alzheimer’s ‘Magic Bullets’ to True Brain Health,” Dr. Peter Whitehouse writes that if one followed the headlines surrounding the National Alzheimer’s Plan (NAPA), “you’d probably conclude that the likely solution to maintain lifelong brain health is simple: simply wait until 2025 for a ‘magic bullet’ to be discovered, to cure (or end or prevent) Alzheimer’s disease and aging associated cognitive decline. These kinds of beliefs, often reinforced by doctors and advertising, may explain the billions spent today by pharma companies on discovering new compounds….” (SharpBrains, May 31, 2012)

Dr. Whitehouse continues that the ‘magic bullet’ approach does not reflect “existing clinical evidence or emerging neuroscientific thinking, nor does it address the lifelong needs and demands of our citizens.” Dr. Whitehouse challenges us, instead, to “imagine the implications of being able to maximize cognitive performance and delay cognitive decline, and in so doing, that we build on what we already know.”

Much of what we know today results from the comprehensive 2010 NIH ‘State of the Science Review,’ which provides evidence for the benefits of nonpharmacological interventions. A most significant finding was that cognitive training appears to be protective against cognitive decline, whereas pharmaceutical/‘magic pill’ interventions had no such effect.

Dr. Whitehouse continues: “It simply makes no sense to put all our eggs in the biomedical basket…. Sure, more research is better than less, and we hope that the new funded trials will result in useful drugs. But neither policy-makers nor citizens should wait until then to foster and make lifestyle decisions than can maximize cognitive performance across the lifespan.”

We could not agree more with the concerns raised by Dr. Whitehouse. The NIH report tells us there is so much that can be helpful to healthy older adults as well as individuals suffering from MCI and early stage AD. And yet, NAPA (latest version 5/15/12) does not once mention cognitive therapy or training as an effective intervention, or even mention funding for further study. Even in the face of the NIH report and countless others (not listed in NAPA bibliography), the protective and restorative effects of cognitive training are not discussed.

Is it possible, as Dr. Whitehouse suggests, that the funding from pharmaceutical companies and the search for the “magic bullet” has resulted in neglect of what is already known and available in our “arsenal” to help patients struggling with the early effects of Alzheimer’s disease? We think it is, and that a true disservice is being done to patients and families who are in desperate need of help NOW.

We certainly believe that biomedical research should continue, and it is of course our fervent hope that ongoing research will lead to new and improved treatments for patients with chronic neurologic diseases such as Alzheimer’s, including the possibility of a “magic bullet — cure”. However, we must also make every effort to keep the public well-informed regarding effective non-pharmaceutical intervention.

We know that in clinical practice, biomedical and psychological or rehabilitative interventions are not mutually exclusive. In fact, in the field of cognitive rehab, a March, 2012 review by Cotelli, et al., makes the case for combining biomedical and cognitive rehab interventions in relation to Alzheimer’s patients: “The studies described above have shown that non-pharmacological intervention can enhance the effect of ChEI treatment.” (Cotelli, 2012)

So we know from the NIH review and others that cognitive training is an effective treatment for cognitive decline and early stage AD. We also know from the NIH review that the benefits of pharmaceutical approaches showed no such effect. And we now know that adding cognitive training to pharmaceutical intervention “enhances” the effect of medication alone. Still, NAPA does not speak of the practice or funding of cognitive intervention.

And there is more bad news coming. Despite the NIH report, and despite recommendations by organizational advocates for the Alzheimer’s patient (AA, AFA, & others) regarding the need for early detection and effective interventions, one of Medicare’s largest Carriers — NGS — has removed cognitive rehabilitation as treatment for memory loss, when cognitive impairment results from neurological disease. This ruling most directly impacts upon the early Alzheimer’s (pre-clinical) patient.

In 2007, NGS reviewed the available research, and changed their policy to allow Alzheimer’s patients to receive cognitive rehabilitation, including memory training. However, in 2009/2010, when NGS was reorganized, that decision was reversed – at the very time that NIH informed us that cognitive training was the factor most highly associated with a decreased risk of cognitive decline. Is it possible that NGS was unaware of the latest research? Is it possible that this pivotal finding was known but ignored?

The Memory Training Centers of America has requested that NGS resume coverage for patients suffering from Alzheimer’s disease (as well as other chronic, neurodegenerative diseases) allowing such patients to receive one of the only interventions that at this time is known to be helpful. May 23, 2012, NGS rejected this request. NGS will not allow cognitive rehab to be applied to memory loss and other cognitive impairments resulting from neurological diseases such as early Alzheimer’s. These patients will only be allowed ineffective medication. We are appealing that decision.

One has to wonder what could possibly be the motivation of Medicare to stop a medically necessary treatment that can relieve or delay the major symptoms of this devastating disease, in the face of the research, and in the absence of a “magic bullet,” and with NAPA’s stated goal of finding that bullet by the year 2025. What are we to tell our patients TODAY, who we know we can help, but from whom Medicare is now withholding treatment?

Bruce Brotter, PhD, Clinical Director, Memory Training Centers of America, bbrotter.mtca@gmail.com