Cognitive remediation and reminiscence therapy

Scientists are still fighting to find a cure for dementia. Frustratingly, a way to reverse the brain damage caused remains elusive; however, there are ways of improving function and wellbeing. Specialised therapeutic techniques have been developed, which may help unlock memories, improve function and boost wellbeing in people living with dementia.

The names of the therapies are long and can seem confusing; however, the approach is simply to use the brain’s untapped potential. When it comes to the mind, experts believe that we need to ‘use it or lose it.’ Keeping the brain active and firing can help maintain cognitive function as we age. In studies, brain-activating rehabilitation treatments helped people with dementia both maintain and improve their ability to perform the activities of daily life. A clinical trial published in the journal Dementia and Cognitive Decline finding that:

‘Rehabilitation for dementia, such as reminiscence therapy, reality orientation, cognitive rehabilitation, and physical activity, has an important role in delaying disease progression and functional decline.’

What is cognitive remediation therapy?

Cognitive remediation is a form of rehabilitation. Trained therapists support the individual to go through a number of exercises that work to improve attention, memory, communication, and function. They can help make it easier for people with early dementia to manage daily activities, with the aim of improving independence and quality of life.

Occupational therapists or physiotherapists carry out the treatment, often in the comfort of the person with dementia’s own home. The sessions are tailored to their abilities and needs, building on their existing strengths and setting the goals they personally want to achieve. The Alzheimer’s Society says:

‘Cognitive rehabilitation could be a valuable part of the care, and home support offered to people who have been diagnosed with dementia.’

The aims will depend on the specific challenges that the individual is facing. The therapist and the individual will choose targets and work together to meet these goals. It’s important to be realistic when setting goals, as failure can be depressing and demotivating. Depending on the level of function and the stage of dementia, targets could include brushing teeth, using a mobile phone, setting the microwave or getting money out of the cash machine.

Cognitive reminiscence research

The Alzheimer’s Society researched this form of therapy intending to increase access and availability of treatment for people living with dementia. An extensive study looking at the effects of goal-oriented cognitive rehabilitation for people with early dementia was published early in March 2019, with very promising results. The authors said:

‘Cognitive rehabilitation is clinically effective in enabling people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy session.’

What is reminiscence therapy?

Reminiscence therapy is a process of encouraging recollection and memory. Forgetfulness is a key feature of dementia; however, in the earlier stages of the disease, it usually affects short-term memory more than reminiscences from the past. Often an individual can remember childhood events, particularly if photos, scents or music trigger their memory. Reminiscence therapy fosters remembering and relating past experiences, often using stimuli to help unlock memories.

Telling stories and sharing experiences can improve mood and boost self-esteem. For someone who is struggling with forgetfulness, an opportunity to explore their memory can boost confidence. Conversation has been shown to stimulate the brain because it needs a complex combination of skills. There is evidence that face-to-face conversation can improve the cognitive function of people who are elderly.

Reminiscence therapy can be performed one-on-one or as part of a group session. Group therapy can be particularly beneficial, as it promotes chat and social interaction and can mitigate loneliness and isolation, which are sadly very common in people living with dementia. The Alzheimer’s Society says:

‘Many people with dementia enjoy life story work, in which the person is encouraged to share their life experiences and memories. As a person’s dementia progresses, they may also enjoy reminiscence work. Such activities may help improve someone’s mood, wellbeing, and mental abilities.’

Supporting someone close to you

When someone you care for is diagnosed with dementia, the challenges can seem overwhelming. Dementia is a progressive condition which, with time will cause a decline in memory, thought, and communication which will eventually interfere with daily life. However, there are treatment programmes and exercises that may help slow the deterioration, improve function and increase confidence and self-esteem.

See your doctor to ask for guidance and referral; however, you can also use some of the techniques to help support your loved one. Professional home carers will also be able to use occupational therapy methods as part of their daily care so that the person with dementia can maintain higher independence, greater dignity and better quality of life.

Take time to listen: Give your loved one time to relate stories and share their memories. Relating tales allows their brain to fire and increases their sense of worth. Try not to interrupt, correct or dismiss them.

Stimulate the senses: Aromas and images can help memories flood back. Look through a photo album or offer items from nature like flowers or herbs to help unlock forgotten experiences from the past.

Music for dementia: Listen to favourite music together or encourage a sing-along with friends. Melodies and lyrics may be remembered when other memories are lost. Read more about music therapy and dementia here.