Preserving cognitive function
In recent decades, brain research has led to an explosion of new knowledge. Of particular interest to a person living with dementia is the expanding knowledge of neuroplasticity and the potential for preventing or delaying the various types of dementia. A lot has been learned; for example,that ‘people with early stage dementia are capable of new learning and therefore rehabilitation interventions that aim to optimise independence may be appropriate’ (1:p56).
While there is a lack of strong quality evidence regarding their efficacy (1:p57), some allied health professionals, particularly occupational therapists and neuropsychologists, run programs for cognitive stimulation, cognitive training and cognitive rehabilitation7 which have reported benefits. These allied health disciplines have a lot to contribute in this area as further research into their programs is undertaken.
There are many opportunities for a person living with dementia to exercise their cognition outside the types of programs mentioned above. Engaging in new learning can have a positive effect. This may be as varied as learning a musical instrument or a language, enrolling in a course, singing with a choir, or joining a dance class.
Keeping mentally active connects the person living with dementia to the world, and connection to the world keeps the person living with dementia mentally active. It may be through:
- seeing family and friends, or making new friends
- staying involved with their community, club, religious group or sporting group
- joining groups for activities, outings and fun.
- have expertise in assessing the impact of cognitive function on everyday functioning
- are able to determine the amount of cognitive support required for a person to complete an activity
- identify obstacles and barriers to participation
- work with the person living with dementia and their carer to get around obstacles by developing strategies, suggesting technologies or modifying the environment
- assess suitability for cognitive stimulation therapy, cognitive training or cognitive rehabilitation programs and may provide these.
- get to know the history, passions, skills, culture and interests of the person living with dementia as engagement will occur best when there is a natural interest
- find suitable sources of mental stimulation.
Neuropsychologists and psychologists:
- assesses suitability for cognitive stimulation therapy, cognitive training or cognitive rehabilitation programs
- provide interventions based on that assessment.
- provide optimal nutrition which enables a person to take full advantage of their cognitive capacity.
A couple of years after being diagnosed with Alzheimer’s disease, Daniel joined a pilot study on cognitive stimulation therapy (CST) at a metropolitan teaching hospital. Daniel joined a group with eight others who were also living with dementia. Two trained allied health professionals ran these weekly groups.
Although he questioned the reason for attendance each week, Daniel never missed a session. He made friends with another man and they caught the bus together each week. Daniel made a great contribution to the group; he enjoyed hearing what others had to say and sharing his own strategies to assist his declining memory. Daniel saw the group as an exercise program for his brain, saying ‘it must be useful because it makes me think’. Even though he was experiencing word finding difficulty, Daniel was a particularly vocal member of the group.
As the program came to an end, the occupational therapist referred him to a community gym. After medical clearance by his GP and assessment by the exercise physiologist at the gym, Daniel started going twice weekly, and has kept going for years.
He walks to the station and catches the train to the next suburb on his own. He enjoys the gym so much he has recruited several friends to join the gym, and they go for a coffee and a sandwich after each session.
Comment from occupational therapist Natalie
CST is a non-pharmacological, multisensory intervention for people with mild to moderate dementia. It’s based on the idea that consistent stimulation of memory, attention, language and other cognitive skills can potentially be useful in slowing the rate of cognitive decline associated with dementia. This CST program consisted of a 14-week course, followed by a 24-week maintenance course. Additional benefits observed include reducing apathy, reawakening of former interests and skills, establishing routine and structure and providing an opportunity for socialisation. In addition, carers received support, education and respite.
Research has shown that keeping socially connected, having a well-balanced diet and doing exercise are important. Daniel was referred to other community programs to keep up the stimulation to his mind and body.
- Cognitive stimulation therapy is engagement in a ‘range of group activities and discussions aimed at general enhancement of cognitive and social functioning’. Cognitive training ‘typically involves guided practice on a set of standard tasks designed to reflect particular cognitive functions, such as memory, attention, language or executive function’. Cognitive rehabilitation is an ‘individualised approach to helping people with cognitive impairments in which those affected, and their families, work together with health care professionals to identify personally-relevant goals and devise strategies for addressing these. The emphasis is not on enhancing performance on cognitive tasks but on improving functioning in the everyday context’ (1:p57).
The National Dementia Helpline is an Australian Government funded initiative.