Cognitive training in people with dementia: techniques and objectives

Cognitive training in people with dementia Its aim is to tackle the symptoms that affect the quality of life of these patients and it has been shown to be useful in slowing down or delaying the deterioration of the affected cognitive functions.

Let's see what this form of cognitive training consists of and how it can help people with dementia.

• Related article: "Types of dementias: the 8 forms of loss of cognition"

What is cognitive training?

The concept of cognitive intervention or training encompasses multiple methods and tools whose objective is to work with the patient's cognition to improve cognitive performance (or stop her deterioration) and behavior, with the ultimate aim of improving her quality of life.

Most of these cognitive training programs intervene in all areas of the individual: at a functional, cognitive, psycho-affective and social level. It has been proven that a comprehensive intervention is more effective than working on aspects separately.

On the cognitive level, 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 disease (being the most common form of dementia), they usually present an insidious onset and a progressive course, characterized by a loss of cognitive abilities and behavior changes that progressively interfere with the autonomy of the patient.

This decline in function is initially seen in the advanced and instrumental activities of daily living, such as washing clothes, using a telephone, or handling medication. Later on, basic activities such as grooming, dressing or toilet training are also compromised.

In the initial phases, memory is usually the most impaired cognitive function, although it is not the only one nor does it deteriorate evenly. It is also common for the person to be less and less able to plan activities, to start and follow conversations, to remember names and places, etc.

As dementia progresses, more severe disturbances appear, such as errors in the recognition of objects (agnosia), reduced speech and inability to understand more or less complex phrases and sentences (aphasia), and inability to carry out voluntary movements or gestures (apraxia).

The combination of this variety of symptoms usually leads to aphasic-apraxo-agnosic syndrome, which characterizes Alzheimer's dementia and relegates the patient to a state of permanent dependence, with assistance from a caregiver 24 hours a day.

Goals 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 that we will see below.

1. Restoration

Altered cognitive functions are stimulated and enhanced acting directly on them. In the case of dementias in advanced stages, the use of this technique is questionable, since the deterioration is already irreversible.

2. Compensation

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

3. Substitution

Is about teach the patient different strategies and tools that help you minimize the problems derived from impaired cognitive functions. For example, educating in the use of external aids.

• You may be interested: "Cognitive processes: what exactly are they and why do they matter in psychology?"

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, can slow or decrease functional and cognitive decline.

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

1. Reality orientation therapy

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

This information makes it easier for the patient to orient themselves and better understand her environment, giving her a greater sense of control and an improvement in self-esteem.

The main objectives of this therapy are: to provide basic systematic and repetitive information so that patients can better orient themselves; achieve an improvement both at a functional, social and family level; and stimulate communication and interaction of the patient with other people, as a complement to the modification of maladaptive behaviors.

2. Reminiscence therapy

Reminiscence therapy is a cognitive training technique with which you it is about maintaining the personal past and perpetuating the identity of the patient. Tools for stimulation, communication and socialization of the person are used.

People with dementia tend to keep memories that are older, fixed and repeated or that have special emotional or personal significance. Stimulation of memories and their expression can be of great difficulty in those with language disorders, but songs or other sensory stimulation (such as smells or sounds) can be used to achieve the desired effect.

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

3. Tárrega comprehensive psychostimulation program

This psychostimulation or cognitive training program part of a global and ecological vision of people with dementia, and is based mainly on the neuroplasticity, in the practical application of cognitive neuropsychology and behavior modification techniques.

Patients who do this program attend 5 days a week, 8 hours a day, and participate in the following workshops: Cognitive psychostimulation in which orientation, attention, concentration, memory, language, calculation, praxis and gnosis are worked; reminiscence workshop; kinesitherapy workshop (treatment through the use of movements); psychoexpression and music therapy; occupational workshop and maintenance workshop for activities of daily living.

The implementation of this type of cognitive training programs requires few resources and has considerable beneficial effects. It's not just about entertaining patients, but about establishing a routine and discipline and incite cognitive effort with different objectives: pay attention, make the mind work, etc.

New technologies with therapeutic potential

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

Multimedia systems for neuropsychological rehabilitation have been created by computer, video games and cognitive training games, online platforms of cognitive stimulation and even EEG-based devices and brain-computer interface technologies designed to generate changes neuroplastics.

Other technological tools such as virtual reality systems or tele-assistance, allow people with dementia to perform cognitive training exercises from home, with the advantage that this supposes for them, since they do not have to travel and be able to carry out tasks in a safe environment.

Bibliographic 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. Psicothema 23 (1): 44-50.
• Lorenzo, J. & Fontán, L. (2001). The rehabilitation of cognitive disorders. Uruguay medical magazine.
• Tárraga, L. (1998). Soft therapies: Comprehensive Psychostimulation Program. Therapeutic alternative for people with Alzheimer's disease. Journal of Neurology, 27 (1), 51 - 62.