“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.