Cognitive Rehabilitation in Mild and Moderate Dementia
- Aleksandra KudlickaAleksandra KudlickaThe Centre for Research in Ageing and Cognitive Health (REACH), School of Psychology, University of Exeter
- and Linda ClareLinda ClareThe Centre for Research in Ageing and Cognitive Health (REACH) andAlzheimer's Society Centre of Excellence, University of Exeter
The number of people living with dementia is growing, and with limited pharmacological treatment options the importance of psychosocial interventions is increasingly recognized. Cognitive rehabilitation is particularly well placed to address the needs of people living with mild and moderate dementia and their family supporters, as it offers a range of tools to tackle the complexity of the condition. It utilizes powerful approaches of problem solving and goal setting combined with evidence-based rehabilitative techniques for managing cognitive impairments. It also incorporates strategies to address emotional and motivational aspects of dementia that may affect a person’s well-being. It is provided on an individual basis, usually in people’s homes, making it directly applicable to everyday life. It is also genuinely person-centered and flexible as the therapy goals are agreed in a collaborative process between the therapist, person with dementia, and family members. Cognitive rehabilitation does not claim to address underlying pathology, but instead focuses on a person’s functional ability and enjoyment of life.
Evidence for effectiveness of cognitive rehabilitation in the context of mild and moderate dementia, mostly Alzheimer’s disease (AD), is gradually accumulating with a number of randomized control trials demonstrating that people with mild and moderate dementia can significantly improve their functioning in targeted areas. For example, the GREAT trial with 475 people with mild to moderate Alzheimer’s, vascular, and mixed dementia completed in 2017 in the United Kingdom demonstrated that cognitive rehabilitation improves everyday functioning in relation to individual therapy goals.
There is a growing interest in cognitive rehabilitation and the focus shifts to extending evidence to less-common forms of dementia, particularly in people with non-amnestic presentation. Future efforts need to concentrate on promoting the approach and optimizing application in real-life settings with the aim of maximizing benefits for people living with dementia and their families.