3.3 Cognitive therapies and rehabilitation

There are three main types of treatments to maintain or improve memory and thinking: cognitive stimulation, cognitive training and cognitive rehabilitation. The word ‘cognitive’ relates to the thinking processes in the brain.

Cognitive stimulation therapy

Cognitive stimulation therapy involves participating in themed discussion and activity sessions. Over 14 sessions usually, conducted in a small group of 5-8 people, each session lasts around 45 mins and is run by a health professional. Attending two series of sessions (i.e. 28 sessions overall) has been found most effective. Each session has a discussion theme such as current affairs, food or movies. There are different (and fun) puzzles, games and activities related to the theme. It is suitable for people living with mild-moderate dementia.

Cognitive stimulation therapy is designed to boost concentration and language including naming, word finding, comprehension and memory. It also can help rebuild confidence to join in group conversations.

You can ask the GP, a dementia advisor or at carer’s groups if cognitive stimulation groups are run in your area. These might be run as a community program or a hospital outpatient program. A mental health plan from the GP may assist with the cost of the program.

Cognitive training or brain training

Brain training has become popular in recent years. Brain training is designed to maintain or improve particular thinking skills such as recalling memories, attending to a task and improving attention span. Brain training is sometimes described as an ‘exercise program’ for your brain. It involves repeating thinking exercises that gradually increase in difficulty. Many programs are offered online and work like video games, or there are pen and paper options.

There is evidence that brain training is effective to improve memory and thinking for people with mild cognitive impairment and it may be helpful to delay dementia, but it is not clear if brain training helps people with diagnosed dementia. Research has shown that if you do brain training you will most likely improve the particular skill you are practising, but it doesn’t tend to generalise to general improvements in thinking overall.

However, below are some options to “exercise” your brain:

• Jigsaw puzzles: Can help maintain or develop visual-spatial abilities. This is the ability to organise visual information, interpret patterns and have the brain practice how objects fit together.
• Play music or sing: Listening to music, singing in a choir or even learning a musical instrument have all been shown to help brain function. You don’t have to become a virtuoso on the violin, and there are drumming groups which don’t require any previous musical training. Research has even shown that listening to happy tunes can help your brain ‘think’ more creatively than trying to figure out a problem in silence.
• Learn to dance (or juggle): Learning dance steps or a new physical skill challenges the brain and can help with memory and recall of patterns. It is also good for balance and can be a physical workout and promote socialisation as well. If balance or being light on your feet is not for you, another physical skill like juggling might be fun. As always start with something simple and master one move before trying something more complicated.
• Play cards: Some studies found challenging yourself with card playing may build the volume of the brain and could help boost memory and thinking. Solitaire is a great solo option or card games with small groups adds a social element.  Choose familiar card games or start with simpler games and progress from there.
• Word and number puzzles: Crosswords, anagram games and word search puzzles; number puzzles such as Sodoku and Ken Ken; and picture puzzles like ‘spot the difference’ can be fun but have not been shown to transfer to improvements in general memory or thinking. Don’t let this be a reason to stop if you enjoy these types of puzzles.
• Socialise: Keeping socially active is not only important for mental wellbeing, but importantly it can help with attention and memory. Conversation with other people helps mental ‘flexibility’ as you need to interpret situations from different perspectives. Socialisation doesn’t mean having a big party, it can be a simple get together with one or two other people.

The person with dementia (and you) can do lots of activities in the list above in a social situation – joining a choir, playing cards or dancing with others and so on will multiply any benefits you get, and you will have fun too!

Cognitive rehabilitation

Cognitive rehabilitation is an individual approach to treatment. A therapist will do an assessment and work with the person to set personally meaningful goals. For someone with dementia a goal might be to cook a hot meal because they have burnt things repeatedly by leaving something cooking on the stove and forgetting about it.

What happens in cognitive rehabilitation is very individual. Treatment may consist of developing new ways of doing daily tasks. For the example of cooking a hot meal, the therapist may practise improving attention using computer games, simplify favourite recipes to shorten the cooking time or using external memory aids like an alarm for an unattended stove. These are just a few of the strategies that are used in cognitive rehabilitation.

Cognitive rehabilitation has been used with people with speech and language difficulties, people with mild cognitive impairment and mild dementia. It can be time consuming and intensive so it is worth talking with a rehabilitation specialist or occupational therapist to see if your person may benefit from cognitive rehabilitation. Their GP can refer them to an outpatient rehabilitation or a private clinic for an initial assessment.