An overview of "Alzheimer’s and cognitive rehabilitation": their significance over the years
The editorial staff of Emianopsia.com is pleased to host Dr Graziana Romano: graduated in psychology with a master in cognitive neuroscience. Dr Romano will give us an overview of Alzheimer’s and cognitive rehabilitation.
The progressive importance of rehabilitation in cases of cognitive decay
In recent years there has been an increasing interest in the potential of cognitive rehabilitation in Alzheimer’s disease, which have been undoubtedly stimulated by:
- the "standstill" of research in drug therapy;
- acknowledgment of the limitations of anticholinesterase drugs.
From the available studies, the rehabilitative paradigm (functional recovery through a specific stimulation activity) has proven to be useful in the early and moderate phases of AD, but we cannot underestimate the value of the emotional and environmental sphere in which the patient lives.
Here is a video published by the University of Padua explaining what cognitive rehabilitation is all about.
Alzheimer’s and cognitive rehabilitation: which goals do we have?
Goals of rehabilitation cannot be identified in the healing or repair of already damaged or lost functions but rather in:
- enhancing existing capacity.
- improving interaction with the environment.
- reducing excess disability.
- promoting compensation strategies.
- maintaining functional autonomy.
- protection of the human and social value of the person in their environment and with the limits imposed by the pathology, its functional damages and residual cognitive resources.
These objectives are in perfect agreement with the World Health Organization, that defines "rehabilitation" as "a set of interventions aimed at the development of a person at their highest potential in physical, psychological, social, occupational and educational terms, in relation to their physiological or anatomical and environmental deficit".
The 3R Rehabilitation Program
Among the multi-layered approaches, the most widespread and effective (both on the cognitive and behavioural level) is the 3R rehabilitation program, which includes three complementary interventions (3R), always aimed at strengthening the residual capacity of the patient. The interventions are divided into:
- Reality Oriented Therapy (ROT): it aims to redirect the patient through a series of stimuli related to time and space, as well as autobiographical information. Through the stimulation of orientation in space, time, attention, language, and sense-perceptive skills, we try to maintain and strengthen the residual abilities and improve the relationship with the surrounding environment.
- reminiscence: it is the stimulation of memory through past events and autobiographical experiences. In this way, we try to stimulate memory functions by retracing the personal history and significant events in the life of each individual subject, using different tools such as photographs, slides, newspapers, etc.
- re-motivation: it encourages the discussion of some issues related to the current context of life and/or problems that the person faces day-to-day. This aims to help the patient in rediscovering the motivation to still feel part of the world and the reality in which they live. Through the discussion of current events and topics, we try to counteract the tendency to isolation.
Alzheimer’s and cognitive rehabilitation: training
The rehabilitation methods defined as cognitive training are another example of cognitive stimulation; these are standard exercises concerning one or more cognitive areas such as:
- executive functions..
The use of these rehabilitation interventions assumes that the repetitive execution of exercises related to a certain task (memory, for instance) can increase or maintain performance in that specific task. The training includes both individual sessions and small groups. The exercises used are standard and not customized.
Cognitive training also implements computer exercises aimed at activating cognitive functions. Computer techniques are an additional tool for the individualized treatment of memory disorders.
More recently, in the field of at-home rehabilitation, Assistive Technology (AT) has been used, intended as "any commercially acquired object, piece of equipment or system that is used to maintain or improve the functional capabilities of individuals with disabilities" (WHO and Word Bank, 2011).
Other kinds of approaches
A further approach to rehabilitation is the therapeutic use of non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). These methods of brain stimulation can:
- interact with the activity of the central nervous system;
- modulate motor behaviours and cognitive performance;
- facilitate the individuation of "weakened" brain networks due to a decrease in synaptic efficacy linked to the disease, aiming to preserve the activity of such brain networks and thus, the ability of individuals to perform daily functions.
Furthermore, brain changes induced by these methods have proven to last beyond the period of stimulation.
We thank Dr Romano for this excursus on "Alzheimer’s and cognitive rehabilitation" and if you liked it, you may also be interested in reading: "Alzheimer’s: its cases are destined to double every 20 years".
Psychologist in Parma, specializing in cognitive neuroscience.
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