Cognitive therapies for dementia
Encyclopedia
Cognitive therapies for dementia are starting to gain some momemtum. Improved clinical assessment in early stages of Alzheimer's disease
and other forms of dementia
, increased cognitive stimulation of the elderly, and the prescription of drugs to slow cognitive decline have resulted in increased detection in the early stages. Although the opinions of the medical community are still apprehensive to support cognitive therapies in dementia patients, recent international studies have started to create optimism.
attempt to identify and reduce the antecedents and consequences of problem behaviors. This approach has not shown success in the overall functioning of patients,
but can help to reduced some specific problem behaviors, such as incontinence
. There is still a lack of high quality data on the effectiveness of these techniques in other behavior problems such as wandering.
, validation therapy
, supportive psychotherapy
, sensory integration or snoezelen
, and simulated presence therapy
. Supportive psychotherapy has received little or no formal scientific study, but some clinicians find it useful in helping mildly impaired patients adjust to their illness.
Reminiscence therapy (RT) involves the discussion of past experiences individually or in group, many times with the aid of photographs, household items, music and sound recordings, or other familiar items from the past. Although there are few quality studies on the effectiveness of RT it may be beneficial for cognition
and mood
.
Simulated presence therapy (SPT) is based on attachment theories
and is normally carried out playing a recording with voices of the closests relatives of the patient. There is preliminary evidence indicating that SPT may reduce anxiety
and challenging behaviors
.
Finally, validation therapy is based on acceptance of the reality and personal truth of another's experience, while sensory integration is based on exercises aimed to stimulate sense
s. There is little evidence to support the usefulness of these therapies.
is the restoration of cognitive deficit
s. Reality orientation consists in the presentation of information about time, place or person in order to ease the understanding of the person about its surroundings and his place in them. On the other hand cognitive retraining tries to improve impaired capacities by exercitation of mental abilities. Both have shown some efficacy improving cognitive capacities, although in some works these effects were transient and negative effects, such as frustration, have also been reported. Most of the programs inside this approach are fully or partially computerized and others are fully paper based such as the Cognitive Retention Therapy
method.
, music
and pet
therapies, exercise
, and any other kind of recreational activities
for patients. Stimulation has modest support for improving behavior, mood, and, to a lesser extent, function. Nevertheless, as important as these effects are, the main support for the use of stimulation therapies is the improvement in the patient daily life routine they suppose.
Objective was to determine the level of quality of the studies and the effectiveness of the results.
Main theories of the studies explored were as follows.
Results were dependent on reality orientation and were largely insignificant.
Results were inconclusive and insignificant.
Results were insignificant.
Results varied but were very positive in improving aspects of neuropsychiatric symptoms immediately and for many months after. Also improved mood, and delayed institutionalization.
Results may have been a product of environment but concluded an improvement to behavior and depression.
Most were inconclusive. Positive results were achieved using ‘life review, sensory stimulation’ and other personalized techniques.
Results showed a possible reduction in agitation and improvement with orientation, with no other real benefits.
Results showed individual education was more effective then groups in being useful to treat neuropsychiatric symptoms.
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...
and other forms of dementia
Dementia
Dementia is a serious loss of cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging...
, increased cognitive stimulation of the elderly, and the prescription of drugs to slow cognitive decline have resulted in increased detection in the early stages. Although the opinions of the medical community are still apprehensive to support cognitive therapies in dementia patients, recent international studies have started to create optimism.
Classification and efficacy of the different therapies
Interventions are used as an adjunct to pharmaceutical treatment and can be classified within behavior, emotion, cognition or stimulation oriented approaches. Research on efficacy is reduced.Behavioral interventions
Behavioral interventionsBehavior modification
Behavior modification is the use of empirically demonstrated behavior change techniques to increase or decrease the frequency of behaviors, such as altering an individual's behaviors and reactions to stimuli through positive and negative reinforcement of adaptive behavior and/or the reduction of...
attempt to identify and reduce the antecedents and consequences of problem behaviors. This approach has not shown success in the overall functioning of patients,
but can help to reduced some specific problem behaviors, such as incontinence
Urinary incontinence
Urinary incontinence is any involuntary leakage of urine. It is a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners...
. There is still a lack of high quality data on the effectiveness of these techniques in other behavior problems such as wandering.
Emotion-oriented interventions
Emotion-oriented interventions include reminiscence therapyReminiscence therapy
Reminiscence therapy is used to counsel and support older people, and is an intervention technique with brain-injured patients. This form of therapeutic intervention respects the life and experiences of the individual with the aim to help the patient maintain good mental health.Often utilised in...
, validation therapy
Validation therapy
Validation therapy was developed by Naomi Feil for older people with cognitive impairments and dementia. Feil's own approach classifies individuals with cognitive impairment as having one of four stages in a continuum of dementia...
, supportive psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
, sensory integration or snoezelen
Snoezelen
Snoezelen or controlled multisensory Environment relates to the interdependence of both the space and the "client-centered" approach of the practitioner...
, and simulated presence therapy
Simulated presence therapy
Simulated presence therapy is an emotion-oriented non pharmacological intervention for people with dementia. It is based in psychological attachment theories and is normally carried out playing a recording with voices of the closests relatives of the patient. There are preliminary evidences...
. Supportive psychotherapy has received little or no formal scientific study, but some clinicians find it useful in helping mildly impaired patients adjust to their illness.
Reminiscence therapy (RT) involves the discussion of past experiences individually or in group, many times with the aid of photographs, household items, music and sound recordings, or other familiar items from the past. Although there are few quality studies on the effectiveness of RT it may be beneficial for cognition
Cognition
In science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...
and mood
Mood (psychology)
A mood is a relatively long lasting emotional state. Moods differ from emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event....
.
Simulated presence therapy (SPT) is based on attachment theories
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...
and is normally carried out playing a recording with voices of the closests relatives of the patient. There is preliminary evidence indicating that SPT may reduce anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
and challenging behaviors
Challenging behaviour
Challenging behaviour is defined as "culturally abnormal behaviour of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to the use of ordinary community...
.
Finally, validation therapy is based on acceptance of the reality and personal truth of another's experience, while sensory integration is based on exercises aimed to stimulate sense
Sense
Senses are physiological capacities of organisms that provide inputs for perception. The senses and their operation, classification, and theory are overlapping topics studied by a variety of fields, most notably neuroscience, cognitive psychology , and philosophy of perception...
s. There is little evidence to support the usefulness of these therapies.
Cognition-oriented treatments
The aim of cognition-oriented treatments, which include reality orientation and cognitive retrainingRehabilitation (neuropsychology)
Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that has been diminished by disease or traumatic injury....
is the restoration of cognitive deficit
Cognitive deficit
Cognitive deficit, also known as cognitive impairment is an inclusive term to describe any characteristic that acts as a barrier to cognitive performance...
s. Reality orientation consists in the presentation of information about time, place or person in order to ease the understanding of the person about its surroundings and his place in them. On the other hand cognitive retraining tries to improve impaired capacities by exercitation of mental abilities. Both have shown some efficacy improving cognitive capacities, although in some works these effects were transient and negative effects, such as frustration, have also been reported. Most of the programs inside this approach are fully or partially computerized and others are fully paper based such as the Cognitive Retention Therapy
Cognitive Retention Therapy
Cognitive Retention Therapy also known as the Ashby Memory Method is a Cognitive therapy for dementia, based on the research of Dr. Mira Ashby. It is adapted from her programs for brain injury rehabilitation, for which she won the Order of Canada in 1984. CRT is a specifically tailored program to...
method.
Stimulation-oriented treatments
Stimulation-oriented treatments include artArt therapy
Because of its dual origins in art and psychotherapy, art therapy definitions vary. They commonly either lean more toward the ART art-making process as therapeutic in and of itself, "art as therapy," or focus on the psychotherapeutic transference process between the therapist and the client who...
, music
Music therapy
Music therapy is an allied health profession and one of the expressive therapies, consisting of an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their...
and pet
Animal-Assisted Therapy
Animal-assisted therapy is a relatively new field of study, although the human-animal bond has existed for thousands of years. AAT is a type of therapy that involves animals as a form of treatment. The goal of AAT is to improve a patient’s social, emotional, or cognitive functioning...
therapies, exercise
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
, and any other kind of recreational activities
Recreational therapy
Recreational therapy, also referred to as recreation therapy and therapeutic recreation, is a treatment service that provides treatments and recreation activities to individuals with illnesses or disabling conditions to improve or maintain physical, mental and emotional well-being and help reduce...
for patients. Stimulation has modest support for improving behavior, mood, and, to a lesser extent, function. Nevertheless, as important as these effects are, the main support for the use of stimulation therapies is the improvement in the patient daily life routine they suppose.
Summary of a Systematic Review of Psychological Approaches to the Management of Neuropsychiatric Symptoms of Dementia found in the American Journal of Psychiatry
Out of 1632 total studies reviewed roughly 10% of them were included in the review.Objective was to determine the level of quality of the studies and the effectiveness of the results.
Main theories of the studies explored were as follows.
- Reminiscence TherapyReminiscence therapyReminiscence therapy is used to counsel and support older people, and is an intervention technique with brain-injured patients. This form of therapeutic intervention respects the life and experiences of the individual with the aim to help the patient maintain good mental health.Often utilised in...
- using household materials, family pictures and old newspapers to stimulate memories and hopefully have the participant share their experiences.
Results were dependent on reality orientation and were largely insignificant.
- Validation Therapy - Based on personal uniqueness, promotes validating feelings of unfinished conflicts.
Results were inconclusive and insignificant.
- Reality Orientation Therapy - Uses reminders about information such as day, time and location.
Results were insignificant.
- Cognitive Stimulation TherapyCognitive Retention TherapyCognitive Retention Therapy also known as the Ashby Memory Method is a Cognitive therapy for dementia, based on the research of Dr. Mira Ashby. It is adapted from her programs for brain injury rehabilitation, for which she won the Order of Canada in 1984. CRT is a specifically tailored program to...
- Uses information processing.
Results varied but were very positive in improving aspects of neuropsychiatric symptoms immediately and for many months after. Also improved mood, and delayed institutionalization.
- Other dementia-specific therapies - “individualized special instruction” and “self-maintenance therapy”
Results may have been a product of environment but concluded an improvement to behavior and depression.
- Non-dementia-specific therapies - Included many different varieties of treatments.
Most were inconclusive. Positive results were achieved using ‘life review, sensory stimulation’ and other personalized techniques.
- Music TherapyMusic therapyMusic therapy is an allied health profession and one of the expressive therapies, consisting of an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their...
- Helps reduce agitation and improve behavior during sessions and immediately after, however no long term benefits. - Snoezelen therapySnoezelenSnoezelen or controlled multisensory Environment relates to the interdependence of both the space and the "client-centered" approach of the practitioner...
- Possible improvement in disruptive behavior during sessions, effects are only apparent for a short time after. - Other sensory stimulation - Calming effects during sessions, no long term usefulness.
- Simulated presence therapy - Possible reduction in agitation, no other real benefits.
- Therapeutic activity programs - Results varied but overall were inconsistent and inconclusive with no real benefits.
- Montessori activitiesMontessori methodMontessori education is an educational approach developed by Italian physician and educator Maria Montessori. Montessori education is practiced in an estimated 20,000 schools worldwide, serving children from birth to eighteen years old.-Overview:...
- No changes realized. - Physical exercise - No changes realized.
- Social interaction - Possible improvement in neuropsychiatric symptoms in some participants.
- Decreased sensory stimulation - No real benefits.
- Environmental Manipulation - Changing the visual environment, adding or removing mirrors, signposting, unlocking doors and other environmental manipulations such as group living.
Results showed a possible reduction in agitation and improvement with orientation, with no other real benefits.
- Other studies focused on psychoeducation of Staff and family members ability to manage behavioral problems.
Results showed individual education was more effective then groups in being useful to treat neuropsychiatric symptoms.
Conclusions
The article concluded:-
- "Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research (only nine level-1 studies were identified). More high-quality investigation is needed."