Psychological therapies for dementia

Treatment for dementia

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]

## Classification

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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

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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

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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

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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

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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 improvement in the patient's daily life routines.[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 from 2010 by London College tested the efficacy of cognitive stimulation therapy. Participants were tested using an MMSE to test their level of cognitive ability and determine whether they qualified 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 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. The study demonstrated that patients with dementia benefit significantly from CST. As in the 2006 study,[23] the improvement of the participants' cognitive abilities can ultimately improve their daily lives since it helps with activities such as being able to speak and remember words.[24]

In July 2015, the Sheffield Health and Social Care NHS Foundation Trust and the University of Sheffield in the UK undertook trials on the use of a robot seal from Japan in the management of distressed dementia patients. The seal, named "Paro", has some artificial intelligence and can "learn" its own name and repeat behaviours.[25]

## Psychological approaches to neuropsychiatric symptoms

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

## References

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1. ^ "NGC - NGC Summary". Archived from the original on 2008-09-16. Retrieved 2008-02-06.
2. ^ "Early Alzheimer's disease diagnosis gives hope: detection in initial stages could slow progression, perhaps lead to prevention". Archived from the original on 2007-03-22.
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. ^ a b 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.
9. ^ Woods B, Aguirre E, Spector AE, Orrell M (February 2012). Woods B (ed.). "Cognitive stimulation to improve cognitive functioning in people with dementia". The Cochrane Database of Systematic Reviews. 2 (2): CD005562. doi:10.1002/14651858.CD005562.pub2. PMID 22336813.
10. ^ a b c d "Practice Guideline for the Treatment of Patients with Alzheimer's Disease and Other Dementias, Second Edition" (PDF). Practice Guideline for the Treatment of Patients with Alzheimer's disease and Other Dementias. Vol. 1\. American Psychiatric Association. October 2007. doi:10.1176/appi.books.9780890423967.152139. ISBN 978-0-89042-336-3. Retrieved 2007-12-28.
11. ^ Bottino CM, Carvalho IA, Alvarez AM, Avila R, Zukauskas PR, Bustamante SE, et al. (December 2005). "Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study". Clinical Rehabilitation. 19 (8): 861–9. doi:10.1191/0269215505cr911oa. PMID 16323385. S2CID 21290731.
12. ^ Doody RS, Stevens JC, Beck C, Dubinsky RM, Kaye JA, Gwyther L, et al. (May 2001). "Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 56 (9): 1154–66. doi:10.1212/WNL.56.9.1154. PMID 11342679.
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.
14. ^ Robinson L, Hutchings D, Dickinson HO, Corner L, Beyer F, Finch T, et al. (January 2007). "Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review". International Journal of Geriatric Psychiatry. 22 (1): 9–22. doi:10.1002/gps.1643. PMID 17096455. S2CID 45660235.
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.
16. ^ Peak JS, Cheston RI (February 2002). "Using simulated presence therapy with people with dementia". Aging & Mental Health. 6 (1): 77–81. doi:10.1080/13607860120101095. PMID 11827626. S2CID 2097667.
17. ^ Camberg L, Woods P, Ooi WL, Hurley A, Volicer L, Ashley J, et al. (April 1999). "Evaluation of Simulated Presence: a personalized approach to enhance well-being in persons with Alzheimer's disease". Journal of the American Geriatrics Society. 47 (4): 446–52. doi:10.1111/j.1532-5415.1999.tb07237.x. PMID 10203120. S2CID 37188522.
18. ^ Chung JC, Lai CK, Chung PM, French HP (2002). Chung JC (ed.). "Snoezelen for dementia". The Cochrane Database of Systematic Reviews. 2010 (4): CD003152. doi:10.1002/14651858.CD003152. PMC 9002239. PMID 12519587.
19. ^ Spector A, Orrell M, Davies S, Woods B (July 2007). Spector AE (ed.). "WITHDRAWN: Reality orientation for dementia". The Cochrane Database of Systematic Reviews (3): CD001119. doi:10.1002/14651858.CD001119.pub2. PMC 10775827. PMID 17636652.
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. ^ a b 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.
24. ^ Li Y, Daniel M, Tollefsbol TO (August 2011). "Epigenetic regulation of caloric restriction in aging". BMC Medicine. 9 (1): 98. doi:10.1186/1741-7015-9-98. PMC 3175174. PMID 21867551.
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.