Dementia Management - Accentuate the Positive

Susie Almon | posted June 24, 2009 |

There are several different forms of dementia as well as other conditions, like depression and Parkinson’s, which mimic the disease. Therefore, it’s important to have a doctor determine if a patient or your family member is, in fact, suffering from dementia, and if so, whether it is a progressive form (e.g., Alzheimer’s).  Some types of dementia are caused by illness or an adverse reaction to a medication and are reversible. In this blog, I will focus on managing the progressive forms of dementia including Alzheimer’s.

Having been a speech-language pathologist for many years, I can remember when, as therapists, we believed there wasn’t much we could do to help dementia patients improve their cognitive function. I’m happy to write that, because of the advances in brain research and cognitive therapy, these opinions have changed dramatically, and now there’s a lot we can do. It’s exciting to know that at certain levels of decline it’s been proven that many persons with dementia are still able to learn new things. It may be something small, like learning how to find their room in a skilled nursing facility. But things like this are really important because it helps foster a form of independence in patients and keeps them more engaged in their activities of daily living.

I feel fortunate that at Aegis Therapies, we have many resources available to help us address a broad range of dementia issues. Aegis offers a comprehensive core program in dementia management that first utilizes the Allen Cognitive Disability Model to identify a patient’s cognitive level. This model takes observations about a patient’s attention to sensory cues, sensorimotor associations and motor actions, categorizing them into six cognitive levels of decline.

Once the patient’s Allen Cognitive Level is determined, an Aegis team of therapists will develop a therapy course that focuses on what the patient can do versus what he cannot do. Our dementia management program is also based on the assumption that cognitive decline seen in dementia mirrors, in reverse, the cognitive development stages from birth. For example, from birth, learning to feed yourself typically comes before toilet training.  Therefore, a patient with dementia will lose the ability to handle toileting needs before losing the ability to feed himself.

One aspect of the dementia management program we often use and have had a lot of success with is called Spaced-Retrieval (SR), which is a memory intervention tool that was developed by Cameron Camp, Ph.D. With this tool, we have patients practice recalling information correctly over progressively longer intervals of time. We begin with a 10-second interval and gradually increase the intervals. If at any interval increase, the patient is unable to recall the correct information, we then have the patient go back and start the recall practice back at a successful level.

SR is an effective technique that’s easy to teach. It can be used in many different settings by care givers, therapists and the health care staff. For example, patients with dementia often have difficulty remembering the safe sequence for transferring, for example, from a wheelchair to a standing with a walker.  The SR method can help the patient remember the transfer sequence or help the patient to remember to refer to a card where the bulleted steps are written. This technique can also help patients with dementia learn to read a calendar, use adaptive equipment, remember the names of objects related to their basic and medical needs, and perform activities of daily living at higher levels of independence.

Another valuable tool we use is called Brains Storms, which is a cognitive-stimulation program developed by speech-language pathologist Lou Eaves. Communication issues are often at the heart of many of the challenges faced by patients who have dementia. Behavioral problems seen with dementia are often due to inability to communicate effectively. For example, if a patient is in pain but unable to tell this to the facility staff or caregiver, the patient’s frustration may then mount into anger or acting out.

Another devastating effect of communication problems with dementia is that it often leads to increased isolation from friends and family. This can cause increased anxiety and depression with the patient. Sadly, you’ll see where family visits will become fewer and farther between. This sometimes happens because family and friends become frustrated with the lack of conversation with their loved one, but our therapists have seen the Brain Storms program work wonders in many cases. Through 130 different exercises outlined in the program, cues are developed to help engage the patient. Interestingly a pilot study, where therapists also worked with patients’ families by teaching them these cues, found there was an increase in the number of patient visits by friends and family. Also, the study showed that after six months the patients’ speech and language function on certain variables either remained the same or had even improved.

Although treatment in dementia management begins with the therapist, I believe it must involve a continuum of care with the patient’s nurses, activities coordinator and family members to get the best possible results.