While it's widely known that there's no drug to help patients overcome cognitive defects once a disease such as Alzheimer's takes hold, new research is showing that cognitive rehabilitation therapy can teach some to compensate for such memory and thinking shortfalls.
Modeled after methods used to help people with brain injuries recover, such programs are designed to help people with mild dementia or mild cognitive impairment learn cognitive strategies that will help them function better in everyday life. Depending on the individual’s needs and challenges, weekly sessions — often combined with at-home visits — might address how to become better at remembering names and faces, or how to improve conversational abilities, competently pay bills, or manage calendars and appointments.
And newer research is backing up the idea that such training could benefit a large number of people in the earlier stages of dementia or Alzheimer's disease. A 2018 study in Belgium found that after 52 people with early-stage Alzheimer’s completed three months of once-weekly cognitive rehabilitation sessions, they were better able to perform everyday activities independently at home; the improvements persisted at the one-year follow-up.
Similarly, in a 2019 study involving 475 people with early-stage dementia, researchers in the U.K. examined whether individual goal-oriented cognitive rehabilitation could improve everyday functioning for people with mild to moderate dementia. Some of the goals they studied included doing household tasks, managing shopping, using appliances effectively and safely, managing emotions and keeping track of important information. After 10 weekly one-hour sessions over three months, plus four maintenance sessions over six months, the researchers found that the personalized program they used helped people with early-stage Alzheimer’s disease or vascular or mixed dementia function better and more independently at home.
“Our work focuses around supporting people to live as well as possible with dementia, helping them retain as much independence, functional ability and overall quality of life as possible,” explained Linda Clare, a professor of clinical psychology of aging and dementia at the University of Exeter in the U.K., who has been leading its cognitive rehabilitation program. “There’s plenty that we can do, and exactly what strategy we put in place depends on an individual’s needs.”
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As for what, exactly, this training might look like? Anthony Stringer, a professor of rehabilitation medicine and director of rehabilitation neuropsychology at the Emory University School of Medicine in Atlanta, shared how such custom-made training came together for a couple who decided to participate in Emory's cognitive rehabilitation program.
The couple, in their 70s, was having trouble remembering the details of conversations or important instructions, paying bills on time and performing other tasks at home. The husband, a retired business professional, had been diagnosed with dementia, while his wife, who didn’t work outside the home, had mild cognitive impairment. Aware of her faulty memory, she took copious notes about everything, yet she still often struggled to keep the notes organized or remember where to look for the information she needed.
“They each had strengths and weaknesses," Stringer said. "The goal was to play to their strengths so that together they could function better than either one could alone. We put them both through the training as partners; it was almost a game to them.”
After assessing their abilities and challenges, a therapist took inventory of their home, looking for safety concerns, making sure smoke detectors were installed and adding a smart-home device to turn off the stove if something was accidentally left on the burner. In addition, a distraction-free “attention space” was created where they could pay bills and read important documents. The couple practiced various strategies for remembering important numbers and learned how to use Google Maps for directions. “We try to keep it very practical, very concrete,” Stringer said. “Part of what I love about this is not just the strategies we use, but the ways we find to creatively adapt them to people’s individual needs.”
Granted, cognitive rehabilitation does have its limits. For one thing, it works best with people who have mild dementia or mild cognitive impairment rather than deficits that are farther along. For another, it won’t reverse the effects of dementia or mild cognitive impairment. Of course, the quality of the program matters, too, which is why it’s best to ask a neurologist for a referral or to look for one that’s affiliated with a reputable medical center or teaching hospital. (If a program claims it can cure dementia or completely eliminate its symptoms, those are red flags.)
“These aren’t curative programs — they’re not going to bring a loved one back to where they were a few years ago,” said Joe Verghese, division chief and professor of geriatrics at the Montefiore Health System/Albert Einstein College of Medicine in New York City, who often refers patients to cognitive rehabilitation. “But these programs will improve the behavioral disturbances that are associated with dementia and someone’s functionality in activities of daily living.” For those living with dementia, that’s an appreciable step in the right direction.