Cognitive training in people with dementia: techniques and goals

Cognitive training in people with dementia aims to end the symptoms that affect the quality of life of these patients and has been shown to be useful in slowing or delaying the impairment of affected cognitive functions.

Let’s take a look at what this form of cognitive training is and how it can help people with dementia.

    What is cognitive training?

    The concept of intervention or cognitive training encompasses multiple methods and tools in order to work with patient cognition to improve cognitive performance (Or curb their deterioration) and their behavior, with the ultimate goal of improving their quality of life.

    Most of these cognitive training programs intervene in all areas of the individual: functional, cognitive, psychoaffective and social. A holistic intervention has proven to be more effective than working on aspects separately.

    Cognitively, it is common for such a program for people with dementia to include a wide variety of activities to stimulate thinking and memory through games, music, crafts, etc.

    Cognitive impairment in people with dementia

    Dementias, and taking the case of Alzheimer’s disease (to be the most common form of dementia), often present an insidious onset and progressive course, characterized by loss of cognitive abilities and changes in behavior which gradually interfere with the patient’s autonomy.

    This impairment of functions is initially observed in advanced and instrumental activities of daily living, such as laundry, using a telephone or managing medication. Later on, basic activities such as personal cleansing, dressing or sphincter control are also compromised.

    In the early stages, memory is usually the most impaired cognitive function, Although it is not the only one and it does not deteriorate evenly. It is also common for the person to be less and less able to plan activities, initiate conversations, remember names and places, etc.

    As dementia progresses, more serious disorders develop, Such as object recognition errors (agnosia), decreased speech and inability to understand more or less complex sentences and phrases (aphasia), and inability to perform voluntary movements or gestures (apraxia) ).

    The combination of this variety of symptoms usually gives rise to the aphaso-apraxo-agnósico syndrome, Which characterizes Alzheimer’s dementia and relegates the patient to a state of permanent dependence, with the assistance of a caregiver 24 hours a day.

    Objectives of cognitive training in people with dementia

    The goal of cognitive training in people with dementia is improve the adaptive functioning of patients in the family and social context.

    The most used techniques and strategies can be grouped into three levels which we will see below.

    1. Catering

    Impaired cognitive functions are stimulated and improved acting directly on them. In the case of advanced dementias, the use of this technique is questionable, as the deterioration is already irreversible.

    2. Compensation

    It is assumed that impaired cognitive function cannot be restored and it seeks to promote the use of alternative mechanisms or preserved skills in the patient.

    3. Substitution

    This is teach the patient different strategies and tools which help him to minimize problems resulting from impaired cognitive functions. For example, educate in the use of external aids.

      Main interventions of this type

      Most cognitive training programs are based on the idea that keep the person active and stimulated, both physically and intellectually, May slow or decrease functional and cognitive decline.

      Here are the main cognitive training programs used in people with dementia:

      1. Reality-oriented therapy

      This intervention is a therapeutic method focused on improving the quality of life of people with dementia who suffer from states of confusion, through the presentation of orientation information (Time, space and person).

      This information allows the patient to orient himself and better understand his environment, giving him a greater sense of control and an improvement in self-esteem.

      The main objectives of this therapy are: to provide systematic and repetitive basic information so that patients can better orient themselves; achieve both functional and social and family improvement; and stimulate patient communication and interaction with other people, in addition to modifying maladaptive behaviors.

      2. Reminiscence therapy

      Reminiscence therapy is a cognitive training technique with which it is about preserving the personal past and perpetuating the patient’s identity. Tools to stimulate, communicate and socialize the person are used.

      People with dementia often have the oldest memories that are fixed and repeated, or those that have special emotional or personal significance. Stimulating memories and their expression can be very difficult in people with language impairments, but songs or other sensory stimulation (such as smells or sounds) may be used to achieve the desired effect.

      The ultimate goal of reminiscence therapy is promote the expression of past experiences in the patient, In order to enhance their personal identity. For this, group sessions are usually organized with people of similar age and similar affinities, and practical resources are used such as the autobiographical books of the person in which he talks about his childhood, his work, his children or grandchildren, etc.

      3. Tárrega’s complete psychostimulation program

      This psychostimulation or cognitive training program it starts from a globalizing and ecological vision of people with dementia, And is primarily based on neuroplasticity, the practical application of cognitive neuropsychology and behavior modification techniques.

      The patients who carry out this program leave 5 days a week, 8 hours a day, and participate in the following workshops: cognitive psychostimulation in which orientation, attention, concentration, memory, language, arithmetic, praxis and gnosis; reminiscence workshop; physiotherapy workshop (treatment by the use of movements); psychoexpression and music therapy; professional workshop and maintenance workshop for activities of daily living.

      The implementation of this type of cognitive training programs it requires few resources and has considerable beneficial effects. It’s not just about entertaining patients, it’s about establishing routine and discipline, and inducing cognitive effort with different goals: paying attention, exercising the mind, etc.

      New technologies with therapeutic potential

      In recent years, a multitude of technologies and software applied to cognitive prevention and rehabilitation in people with cognitive impairment.

      Neuropsychological rehabilitation multimedia computer systems, video games and cognitive training games, online cognitive stimulation platforms and even EEG-based devices and brain-computer interface technologies designed to generate neuroplastic changes were created.

      Other technological tools such as virtual reality systems or remote assistance, they allow people with dementia to perform cognitive training exercises at home, With the advantage that this implies for them, when they do not have to move and be able to carry out the tasks in a safe environment.

      Bibliographical references:

      • Fernández-Calvo B, Pérez R, Contador I, Santorum R, Ramos F. (2011). Efficacy of cognitive training based on new technologies in patients with Alzheimer’s dementia. Psicothem 23 (1): 44-50.
      • Lorenzo, J. and Fontán, L. (2001). Rehabilitation of cognitive disorders. Uruguay medical journal.
      • Tárraga, L. (1998). Soft therapies: complete psychostimulation program. Alternative therapy for people with Alzheimer’s disease. Journal of Neurology, 27 (1), 51-62.

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