Psychological therapies for dementia

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Psychological therapies for dementia are starting to gain some momentum.[ when? ] Improved clinical assessment in early stages of Alzheimer's disease and other forms of dementia, increased cognitive stimulation of the elderly, and the prescription of drugs to slow cognitive decline have resulted in increased detection in the early stages. [1] [2] [3] Although the opinions of the medical community are still apprehensive to support cognitive therapies in dementia patients, recent international studies have started to create optimism. [4]

Contents

Classification

Psychological therapies which are considered as potential treatments for dementia include music therapy, [5] reminiscence therapy, [6] cognitive reframing for caretakers, [7] validation therapy, [8] and mental exercise. [9] Interventions may be used in conjunction with pharmaceutical treatment and can be classified within behavior, emotion, cognition or stimulation oriented approaches. Research on efficacy is reduced. [10]

Behavioral interventions

Behavioral interventions attempt to identify and reduce the antecedents and consequences of problem behaviors. This approach has not shown success in the overall functioning of patients, [11] but can help to reduce some specific problem behaviors, such as incontinence. [12] There is still a lack of high quality data on the effectiveness of these techniques in other behavior problems such as wandering. [13] [14]

Emotion-oriented interventions

Emotion-oriented interventions include reminiscence therapy, validation therapy, supportive psychotherapy, sensory integration or snoezelen, and simulated presence therapy. Supportive psychotherapy has received little or no formal scientific study, but some clinicians find it useful in helping mildly impaired patients adjust to their illness. [10] Reminiscence therapy (RT) involves the discussion of past experiences individually or in group, many times with the aid of photographs, household items, music and sound recordings, or other familiar items from the past. Although there are few quality studies on the effectiveness of RT it may be beneficial for cognition and mood. [15] [ needs update ] Simulated presence therapy (SPT) is based on attachment theories and is normally carried out playing a recording with voices of the closest relatives of the patient. There is preliminary evidence indicating that SPT may reduce anxiety and challenging behaviors. [16] [17] Finally, validation therapy is based on acceptance of the reality and personal truth of another's experience, while sensory integration is based on exercises aimed to stimulate senses. There is little evidence to support the usefulness of these therapies. [8] [18]

Cognition-oriented treatments

Design draft for a reality orientation board used to help people with dementia or in post-operative delirium. Reality Orientation Board.png
Design draft for a reality orientation board used to help people with dementia or in post-operative delirium.

The aim of cognition-oriented treatments, which include reality orientation and cognitive retraining is the restoration of cognitive deficits. Reality orientation consists in the presentation of information about time, place or person in order to ease the understanding of the person about its surroundings and his place in them, for example using an orientation board. On the other hand, cognitive retraining tries to improve impaired capacities by exercitation of mental abilities. Both have shown some efficacy improving cognitive capacities, [19] [20] although in some works these effects were transient and negative effects, such as frustration, have also been reported. [10] Most of the programs inside this approach are fully or partially computerized and others are fully paper based such as the Cognitive Retention Therapy method. [21] [22]

Stimulation-oriented treatments

Stimulation-oriented treatments include art, music and pet therapies, exercise, and any other kind of recreational activities for patients. Stimulation has modest support for improving behavior, mood, and, to a lesser extent, function. Nevertheless, as important as these effects are, the main support for the use of stimulation therapies is the improvement in the patient daily life routine they suppose. [10]

A study published in 2006 tested the effects of Cognitive Stimulation Therapy (CST) on the demented elderly's quality of life. The researchers looked at the effect of CST on cognitive function, the effect of improved cognitive function on quality of life, then the link between the three (CST, cognition, and QoL). The study found an improvement in cognitive function from the CST treatment, as measured by the mini–mental state examination (MMSE) and the Alzheimer's disease assessment scale (ADAS-Cog), as well as an improvement in quality of life self-reported by the participants using the Quality of Life-AD measure. The study then used regression models to explain the correlation between the CST therapy and quality of life to see if the improved cognitive function was the primary mediating factor for the improved quality of life. The models supported the correlation and proposed that it was the improved cognition more than other factors (such as reduced depression symptoms and less anxiety) that led to the participants reporting back that they had a better quality of life (with significant improvements especially in energy level, memory, relationship with significant other, and ability to do chores.) [23]

Another study that was done in 2010 by London College that tested the efficacy of the Cognitive Stimulation Therapy. Participants were tested using an MMSE to test their level of cognitive ability and see if they qualified as a demented patient to be included in the study. The participants had to have no other health problems allowing for the experiment to have accurate internal validity. The results clearly showed that those who were given the Cognitive Stimulation Therapy did significantly better on all memory tasks than those that did not receive the therapy. Out of the eleven memory tasks that were given ten of the memory tasks were improved by the therapeutic group. This is another study that supports the efficacy of CST, demonstrating that the elderly that have dementia greatly benefit from this treatment.. Just like it was tested in the 2006 study, [23] the improvement of the participants' cognitive abilities can ultimately improve their daily lives since it helps with social influences being able to speak, remember words etc. [24]

In July 2015 UK NHS trials were reported of a robot seal from Japan being in the management of distressed and disturbed behaviour in dementia patients. "Paro", which has some artificial intelligence has the ability to "learn" and remember its own name. It can also learn the behaviour that results in a pleasing stroking response and repeat it. The robot was being evaluated in a joint project involving Sheffield Health and Social Care NHS Foundation Trust and the University of Sheffield. [25]

Psychological approaches to neuropsychiatric symptoms

Out of a number of psychological therapies examined, only behavior management therapy has demonstrated effectiveness in treating dementia-associated neuropsychiatric symptoms. [26]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

<span class="mw-page-title-main">Dementia</span> Long-term brain disorders causing impaired memory, thinking and behavior

Dementia is the general name for a decline in cognitive abilities that impacts a person's ability to perform everyday activities. This typically involves problems with memory, thinking, and behavior. Aside from memory impairment and a disruption in thought patterns, the most common symptoms include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Dementia ultimately has a significant effect on the individual, caregivers, and on social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than what is caused by normal aging.

Vascular dementia (VaD) is dementia caused by problems in the blood supply to the brain, resulting from a cerebrovascular disease. Restricted blood supply (ischemia) leads to cell and tissue death in the affected region, known as an infarct. The three types of vascular dementia are subcortical vascular dementia, multi-infarct dementia, and stroke related dementia. Subcortical vascular dementia is brought about by damage to the small blood vessels in the brain. Multi-infarct dementia is brought about by a series of mini-strokes where many regions have been affected. The third type is stroke related where more serious damage may result. Such damage leads to varying levels of cognitive decline. When caused by mini-strokes, the decline in cognition is gradual. When due to a stroke, the cognitive decline can be traced back to the event.

<span class="mw-page-title-main">Fibromyalgia</span> Chronic pain of unknown cause

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<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, is a general term describing damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerves are affected. Neuropathy affecting motor, sensory, or autonomic nerves result in different symptoms. More than one type of nerve may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Donepezil</span> Medication used for dementia

Donepezil, sold under the brand name Aricept among others, is a medication used to treat dementia of the Alzheimer's type. It appears to result in a small benefit in mental function and ability to function. Use, however, has not been shown to change the progression of the disease. Treatment should be stopped if no benefit is seen. It is taken by mouth or via a transdermal patch.

Mind–body interventions (MBI) or mind-body training (MBT) are health and fitness interventions that are intended to work on a physical and mental level such as yoga, tai chi, and Pilates.

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.

Reminiscence is the act of recollecting past experiences or events. An example of the typical use of reminiscence is when people share their personal stories with others or allows other people to live vicariously through stories of family, friends, and acquaintances while gaining an authentic meaningful relationship with the people. An example of reminiscence may be grandparents remembering past events with friends or their grandchildren, sharing their individual experience of what the past was like.

A cognitive intervention is a form of psychological intervention, a technique and therapy practised in counselling. It describes a myriad of approaches to therapy that focus on addressing psychological distress at a cognitive level. It is also associated with cognitive therapy, which focuses on the thought process and the manner by which emotions have bearing on the cognitive processes and structures. The cognitive intervention forces behavioral change. Counselors adopt different technique level to suit the characteristic of the client. For instance, when counseling adolescents, a more advanced strategy is adopted than the intervention used in children. Before the intervention, an initial cognitive assessment is also conducted to cover the concerns of the cognitive approach, which cover the whole range of human expression - thought, feeling, behavior, and environmental triggers.

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease that affects the central nervous system (CNS). Several therapies for it exist, although there is no known cure.

Cognitive impairment is an inclusive term to describe any characteristic that acts as a barrier to the cognition process or different areas of cognition. Cognition, also known as cognitive function, refers to the mental processes of how a person gains knowledge, uses existing knowledge, and understands things that are happening around them using their thoughts and senses. A cognitive impairment can be in different domains or aspects of a person's cognitive function including memory, attention span, planning, reasoning, decision-making, language, executive functioning, and visuospatial functioning. The term cognitive impairment covers many different diseases and conditions and may also be symptom or manifestation of a different underlying condition. Examples include impairments in overall intelligence ,specific and restricted impairments in cognitive abilities, neuropsychological impairments, or it may describe drug-induced impairment in cognition and memory. Cognitive impairments may be short-term, progressive or permanent.

<span class="mw-page-title-main">Neck pain</span> Medical condition

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Mild cognitive impairment (MCI) is a neurocognitive disorder which involves cognitive impairments beyond those expected based on an individual's age and education but which are not significant enough to interfere with instrumental activities of daily living. MCI may occur as a transitional stage between normal aging and dementia, especially Alzheimer's disease. It includes both memory and non-memory impairments. The cause of the disorder remains unclear, as well as both its prevention and treatment, with some 50 percent of people diagnosed with it going on to develop Alzheimer's disease within five years. The diagnosis can also serve as an early indicator for other types of dementia, although MCI may remain stable or even remit.

The management of schizophrenia usually involves many aspects including psychological, pharmacological, social, educational, and employment-related interventions directed to recovery, and reducing the impact of schizophrenia on quality of life, social functioning, and longevity.

<span class="mw-page-title-main">Reminiscence therapy</span> Intervention technique with brain-injured patients

Reminiscence therapy is used to counsel and support older people, and is an intervention technique with brain-injured patients and those who appear to have "Alzheimer's and other forms of cognitive disease."

As populations age, caring for people with dementia has become more common. Elderly caregiving may consist of formal care and informal care. Formal care involves the services of community and medical partners, while informal care involves the support of family, friends, and local communities. In most mild-to-medium cases of dementia, the caregiver is a spouse or an adult child. Over a period of time, more professional care in the form of nursing and other supportive care may be required medically, whether at home or in a long-term care facility. There is evidence to show that case management can improve care for individuals with dementia and the experience of their caregivers. Furthermore, case management may reduce overall costs and institutional care in the medium term. Millions of people living in the United States take care of a friend or family member with Alzheimer’s disease or a related dementia.

Simulated presence therapy (SPT) is an emotion-oriented non-pharmacological intervention for people with dementia developed by P. Woods and J. Ashley in 1995. SPT was created as part of a study conducted in a nursing home where 17 individuals with the disease listened to a recording of a caregiver over a stereo. The study was originally conducted in order to combat one of the side effects of dementia such as disturbances of behavior which are called behavioral and psychological symptoms (BPSD) associated with dementia. This therapy is based on psychological attachment theories and is normally carried out by playing a recording with voices of the closest relatives of the patient in an attempt to treat BPSD in addition to reducing anxiety, decreasing challenging behavior, social isolation, or verbal aggression.

<span class="mw-page-title-main">Alzheimer's disease</span> Progressive neurodegenerative disease

Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens, and is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation, mood swings, loss of motivation, self-neglect, and behavioral issues. As a person's condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the typical life expectancy following diagnosis is three to nine years.

For patients with Alzheimer's disease, music therapy provides a beneficial interaction between a patient and an individualized musical regimen and has been shown to increase cognition and slow the deterioration of memory loss. Music therapy is a clinical and evidence-based intervention that involves music in some capacity and includes both a participant and a music therapist who have completed an accredited music therapy program.

References

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  3. ↑ Satcher David; et al. (1999). "Alzheimer's Disease Mental Health: A report of the Surgeon General".
  4. ↑ Werheid K, Thöne-Otto AI (May 2006). "[Cognitive training in Alzheimer's dementia]". Der Nervenarzt (in German). 77 (5): 549–57. doi:10.1007/s00115-005-1998-2. PMID   16228161. S2CID   35499378.
  5. ↑ van der Steen, Jenny T.; Smaling, Hanneke Ja; van der Wouden, Johannes C.; Bruinsma, Manon S.; Scholten, Rob Jpm; Vink, Annemiek C. (23 July 2018). "Music-based therapeutic interventions for people with dementia". The Cochrane Database of Systematic Reviews. 2018 (7): CD003477. doi:10.1002/14651858.CD003477.pub4. ISSN   1469-493X. PMC   6513122 . PMID   30033623.
  6. ↑ Woods, Bob; O'Philbin, Laura; Farrell, Emma M.; Spector, Aimee E.; Orrell, Martin (1 March 2018). "Reminiscence therapy for dementia". The Cochrane Database of Systematic Reviews. 2018 (3): CD001120. doi:10.1002/14651858.CD001120.pub3. ISSN   1469-493X. PMC   6494367 . PMID   29493789.
  7. ↑ Vernooij-Dassen M, Draskovic I, McCleery J, Downs M (November 2011). Vernooij-Dassen M (ed.). "Cognitive reframing for carers of people with dementia". The Cochrane Database of Systematic Reviews (11): CD005318. doi:10.1002/14651858.CD005318.pub2. hdl: 2066/97731 . PMID   22071821. S2CID   205178315.
  8. 1 2 Neal M, Barton Wright P (2003). Neal M (ed.). "Validation therapy for dementia". The Cochrane Database of Systematic Reviews (3): CD001394. doi:10.1002/14651858.CD001394. PMID   12917907.
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  13. ↑ Hermans DG, Htay UH, McShane R (January 2007). Htay UH (ed.). "Non-pharmacological interventions for wandering of people with dementia in the domestic setting". The Cochrane Database of Systematic Reviews. 2010 (1): CD005994. doi:10.1002/14651858.CD005994.pub2. PMC   6669244 . PMID   17253573.
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  15. ↑ Woods B, Spector A, Jones C, Orrell M, Davies S (April 2005). Woods B (ed.). "Reminiscence therapy for dementia". The Cochrane Database of Systematic Reviews (2): CD001120. doi:10.1002/14651858.CD001120.pub2. PMID   15846613.
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  20. ↑ Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth M, Orrell M (September 2003). "Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: randomised controlled trial". The British Journal of Psychiatry. 183 (3): 248–54. doi: 10.1192/bjp.183.3.248 . PMID   12948999.
  21. ↑ Early Intervention for Alzheimer's Disease Archived July 6, 2011, at the Wayback Machine
  22. ↑ Section C2 Alzheimer's Society of Canada [ permanent dead link ]
  23. 1 2 Woods B, Thorgrimsen L, Spector A, Royan L, Orrell M (May 2006). "Improved quality of life and cognitive stimulation therapy in dementia". Aging & Mental Health. 10 (3): 219–26. doi:10.1080/13607860500431652. PMID   16777649. S2CID   23516549.
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  25. ↑ Griffiths, Andrew (2014-07-08). "How Paro the robot seal is being used to help UK dementia patients | Andrew Griffiths". The Guardian.
  26. ↑ Livingston G, Johnston K, Katona C, Paton J, Lyketsos CG (November 2005). "Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia". The American Journal of Psychiatry. 162 (11): 1996–2021. doi:10.1176/appi.ajp.162.11.1996. PMID   16263837.
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