Helping dementia patients with everyday activities

Cognitive rehabilitation brings healthcare workers into the homes of dementia patients to learn which everyday activities they are struggling with.
Cognitive rehabilitation brings healthcare workers into the homes of dementia patients to learn which everyday activities they are struggling with.ST PHOTO: JASMINE CHOONG

NEW YORK • He was a retired factory worker, living with his wife outside a small town in Britain.

Once outgoing and sociable, he had been jolted by a diagnosis of early dementia.

A few months later, at 70, he would not leave the house alone, fearful that if he needed help, he could not manage to use a cellphone to call his wife. He avoided household chores he had previously undertaken.

When his wife tried to show him how to use the washer, he could not remember her instructions.

"He'd lost a lot of confidence," said Ms Linda Clare, a clinical psychologist at the University of Exeter. "He was actually capable, but he was frightened of making a mistake, getting it wrong."

She directed a recent trial of cognitive rehabilitation in England and Wales in which the patient was enrolled. Cognitive rehabilitation, which Ms Clare has been researching for 20 years, evolved from methods used to help people with brain injuries.

The practice brings occupational and other therapists into the homes of dementia patients to learn which everyday activities they are struggling with and which abilities they want to preserve or improve on.

In weekly sessions over several months, the therapists devise strategies that can help, at least in the early and moderate stages of the disease. The therapists show patients how to compensate for memory problems and practise new techniques.

Cognitive rehabilitation has its limitations. "We never suggest this can reverse the effects of dementia," Ms Clare said.

But she and other European researchers have demonstrated that people with dementia can significantly improve their ability to do the tasks they have opted to tackle.

Those improvements persist over months, perhaps up to a year, even as participants' cognition declines in other ways.

This approach may represent the future for the growing number of older adults around the world with dementia.

Trials of drugs to prevent or treat dementia have failed repeatedly.

Even if some future treatment demonstrated effectiveness, millions of people and their stressed family caregivers need help now.

"We can't wait another 20 years for some magic pill," said Ms Laura Gitlin, dean of the College of Nursing and Health Professions at Drexel University.

She has developed the Tailored Activity Programme, somewhat similar to cognitive rehabilitation, which also brings occupational therapists into people's homes.

"We're trying to lay the scientific basis for non-pharmacological approaches," Ms Gitlin said.

"These studies signal that they can have powerful effects on peoples' lives."

In Britain, a governmentsupported trial involving 475 people with early-stage dementia found that after cognitive rehabilitation, most participants attained their goals, while those in a control group did not, and they maintained improvement at three and nine months.

One could argue that even when it works, cognitive rehabilitation has only a modest impact. Compared with the devastation dementia eventually inflicts - the years-long toll on family caregivers, the healthcare costs - how much of a triumph is it to be able to use a TV remote for a few additional months or a year? To make a cup of tea or walk the dog?

But there is so little good news for people with dementia. They and their families might welcome reports of a rehabilitative approach that could reduce frustrations and make life easier, even for a limited time.

"It's so sensible," said Mr Steven Zarit, a long-time researcher of dementia and caregiving at Pennsylvania State University.

"Instead of trying to delay changes in cognition, it tries to delay changes in function.

"People can do more for themselves and have a better life because of it."

NYTIMES

A version of this article appeared in the print edition of The Straits Times on January 14, 2019, with the headline 'Helping dementia patients with everyday activities'. Print Edition | Subscribe