Diseases that fall under the dementia umbrella, like Alzheimer’s, can breed despair — for both caregivers and those affected by the disease. So what hope do we have for individuals suffering from some form of dementia? What can we do or give them that can impact their quality of life in a meaningful way?
One of the most practical tools that is available in the here and now is cognitive stimulation therapy. Cognitive stimulation therapy (CST) is a series of exercises and activities that engage and challenge the individual intellectually so that their brain actually does a workout. There has been a tremendous amount of research in this area with really positive results.
It is important to note that cognitive stimulation therapy is not going to cure Alzheimer’s disease. But it can have a significant positive impact on quality of life for individuals suffering from dementia.
The pivotal piece of research in this area was done in the United Kingdom, by Dr. Aimee Specter at the University College of London. She and her colleagues did an interesting double-blind study using cognitive stimulation therapy. They ran people through the same testing mechanisms that they did with dementia drugs. They found that Cognitive Stimulation Therapy was as effective as several dementia drugs.
Interestingly enough those receiving the treatment reported that their quality of life was significantly enhanced. And if you think about it for a moment it makes sense. If I give you the option of engaging with me for an hour and doing some really fun games, exercises and activities or giving you a pill — which do you think will make you feel more satisfied?
This research also found that caregivers reported reduced stress levels. The key factor for them was that they saw something positive being done with and for their loved ones.
While dementia impacts relationships, it doesn’t end them. You still want to have and build a relationship with your mother. Your father still matters to you. The great thing about cognitive stimulation therapy is that it gives people tools they can use in the here and now to positively impact the lives of those they love.
Over in the United Kingdom there is a body which sets clinical guidelines for healthcare. The National Institute for Health and Clinical Excellence has set out guidelines with respect to cognitive stimulation therapy. Guideline 42 recommends that everyone who has a diagnosis of mild to moderate dementia should be given the opportunity to participate in a group cognitive stimulation program.
An important aspect of this type of therapy is the interaction with other human beings. The social interaction provides a key stimulus to the brain that is not provided by a computer screen. As great as computers are, they are not going to laugh or cry with you. They are not going to have the same level of connection that comes from interacting with another human being.
Cognitive stimulation therapy research has not just been happening in England. In Australia, Dr. Naismith is using cognitive stimulation therapies as a viable, non-pharmacological early intervention strategy. For individuals that have a mild cognitive impairment there is a real risk that they will develop Alzheimer’s disease or another form of dementia. Often, a drug protocol is not appropriate immediately after diagnosis.
Imagine having to wait for the disease to progress to a point where the drugs are appropriate. You know you have this diagnosis but you have to wait — that is incredibly stressful! What you can do is begin a program of cognitive stimulation therapy that is non-invasive, doesn’t react with other medications that you may be taking and can help reduce anxiety and stress by giving you a positive pro-active therapy to engage with.
In Japan, Dr. Yamaguchi is looking at cognitive therapies as playing an important role in delaying disease progression. We know that isolation and loneliness are major factors in cognitive decline. It is natural however after receiving a diagnosis of some form of dementia to want to withdraw and isolate yourself. Your self-confidence is shaken and you don’t know if at some point you will forget where you are or who you are talking to. It is potentially embarrassing and even dangerous.
Using cognitive stimulation therapy, individuals are supported in having meaningful interactions with other human beings. Their social networks are strengthened and they do not withdraw the way they would have if they had been left alone. They do not decline as quickly as they would have otherwise.
In 2010 Medscape published a training module for physicians of all the research that has been done on Cognitive Stimulation and Interaction with individuals with Alzheimer’s and other forms of dementia to see what kind of conclusions they could reach.
They found that cognitive interventions slow decline*, alleviate caregiver distress and improve functional competence. In some cases, people will regain some of the functioning they lost when they start a cognitive stimulation therapy program.
This makes logical sense.
Leonardo da Vinci had a great quote: “Iron rusts from disuse; Water loses its purity from stagnation — even so does inaction sap the vigour of the mind.”
And I think Leonardo’s quote applies to this situation. Your brain is a muscle. It gets bigger and stronger by being exercised and gets smaller and weaker by lack of exercise. Brain exercise means challenging your brain with new and complex activities.
It is easy to get into a rut and just drift. You need to have a certain amount of self-motivation to push yourself towards brain exercise. When we were in school our teachers and parents did that for us. Once out of school it really becomes a matter of self-motivation. One of the problems with individuals with Alzheimer’s disease is the feeling of apathy that come with it. It is very difficulty to motivate yourself — you need help.
So if you haven’t been doing anything and then you start on a cognitive stimulation program, you will improve because you are re-invigorating your mind.
One final comment about the Medscape review. The research shows that comprehensive cognitive stimulation* is best. That means exercising all areas of your brain — not just memory. You can think of it as cross-training your brain. All the best athletes cross-train. It works their muscles in different ways and adds significantly to their overall fitness. Brain fitness follows the same principles. If you work all the different areas of your brain, you will have a better effect than if you just focus on one area.
In review, it is pretty clear that a cognitive stimulation therapy program is important for individuals who are suffering from Alzheimer’s disease or another form of dementia. These programs improve the quality of life and bring hope to individuals who are walking this journey.
*Medscape Review — Cognitive Intervention in Alzheimer’s Disease – Verena Buschert; Arun L.W. Bokde, PhD; Harald Hampel, MD CME Released: 8/17/2010
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