Cognitive rehabilitation

MTC Dementia coverDementia strategies worldwide emphasise the need for early diagnosis, but there has been a dearth of effective evidence-based psychosocial interventions to offer alongside the currently available medications, to enable people with early-stage dementia to live well, cope with their disability and maintain the interests and activities that they value.

Professor Linda Clare FAcSS of the University of Exeter has pioneered the application of a cognitive rehabilitation approach to meet the needs of people with early-stage dementia. Reviewing the existing literature she and her team demonstrated that cognitive training (practising a set of mental exercises) was not beneficial for people with dementia, and that a different kind of approach was needed.

She carried out some feasibility studies and was able to demonstrate that it was possible for people with early-stage dementia to achieve their goals through both compensatory strategies (such as using memory aids) and targeted new learning (e.g. how to use a mobile phone) to bring about behaviour change. This work led to the development of an intervention in which people with dementia and their families work together with a health professional over a number of sessions to identify needs and goals relating to everyday activities, and then devise and implement strategies for achieving these goals.

This programme was tested in an initial randomised controlled trial conducted in North Wales, funded by Alzheimer’s Society.

As a result of the cognitive rehabilitation intervention people with dementia had better cognition, mood and quality of life and were more successful in reaching their goals.

Carers also experienced reduced stress and better quality of life.

Data from brain scans before and after the therapy showed positive changes for the treatment group, which were interpreted as reflecting some restoration of function.

Although a larger study is underway to confirm the scale of the effects already identified, the approach has already become widely used internationally. The work is informing the International Federation on Ageing 2016 Copenhagen Summit on reablement and dementia. The summit is an international high-level knowledge exchange platform of government officials, industry leaders and civil society.

The approach is recommended by both the British Psychological Society (2014) ‘Guide to psychosocial interventions in dementia’ and by the Royal College of Psychiatrists Memory Services National Accreditation Programme.

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