Cognitive training for people with dementia: techniques and objectives.

A review of the objectives and variants of cognitive training for people with dementia.

Cognitive training for people with dementia aims to address the symptoms that affect the quality of life of these patients and has proven useful in slowing 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.

What is cognitive training?

The concept of cognitive intervention or cognitive training encompasses multiple methods and tools that aim to work with the patient's cognition to improve cognitive performance (or slow cognitive decline) and (or slowing down their deterioration) and behavior, with the ultimate goal of improving their quality of life.

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

On the cognitive level, it is common for a program of this type for people with dementia to include a wide variety of activities to stimulate thinking and memory through games through games, music, arts and crafts, etc.

Cognitive impairment in people with dementia

Dementias, and taking the case of Alzheimer's disease (being the most common form of dementia), usually present an insidious onset and a progressive course, characterized by a loss of cognitive abilities and behavioral changes that progressively interfere with that progressively interfere with the patient's autonomy.

This impairment of functions is initially observed in advanced and instrumental activities of daily living, such as washing clothes, using a telephone or handling medication. Later, basic activities such as personal hygiene, dressing or bowel and bladder control are also compromised.

In the early stages, memory is usually the most impaired cognitive function, although it is not the only one, nor is it the most common.Although it is not the only one, nor does it deteriorate uniformly. It is also common for the person to become less and less able to plan activities, to engage in and follow conversations, to remember names and places, etc.

As dementia progresses, more severe disturbances appear, such as errors in recognizing people's names and places.as the dementia progresses, such as errors in object recognition (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 results in the aphaso-apraxo-agnostic syndromeThe combination of these symptoms usually results in the aphasia-apraxia-agnostic syndrome, which characterizes Alzheimer's dementia and relegates the patient to a state of permanent dependence, with 24-hour care by a caregiver.

Objectives of cognitive training in people with dementia

The objective of cognitive training in people with dementia is to improve the adaptive functioning of patients in the family and social context..

The most commonly used techniques and strategies can be grouped into three levels that we will see below.

1. Restoration

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

2. Compensation

It is assumed that the impaired cognitive function cannot be restored, and the use of alternative mechanisms or skills preserved in the patient is encouraged. in the patient.

3. Substitution

The aim is to teaching the patient different strategies and tools that help to minimize the problems derived from the altered cognitive functions. For example, educating in the use of external aids.

Main interventions of this type

Most cognitive training programs are based on the idea that keeping the person active and stimulated, both physically and intellectuallycan slow or slow functional and cognitive decline.

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

Reality orientation therapy 2.

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

This information helps the patient to orient himself and better understand his environment, giving him a greater sense of control and improved self-esteem.

The main objectives of this therapy are: to provide systematized and repetitive basic information so that patients can orient themselves better; to achieve an improvement both at functional and social and family level; and to 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 it is a matter of maintaining the personal past and perpetuating the patient's identity.. Stimulation, communication and socialization tools are used to stimulate the person.

People suffering from dementia tend to retain the oldest, fixed and repeated memories or those that have special emotional or personal significance. Stimulation of memories and their expression can be very difficult for people with language disorders, but songs or other types of songs can be used. songs or other sensory stimulation (such as smells or sounds) can be used to achieve the desired effect. can be used to achieve the desired effect.

The ultimate goal of reminiscence therapy is to to encourage the expression of past experiences in the patientin order to enhance the patient's personal identity. For this purpose, group sessions are usually organized with people of similar age and similar affinities, and practical resources are used, such as autobiographical books of the person in which he or she talks about his or her childhood, work, children or grandchildren, etc.

3. Tárrega's integral psychostimulation program

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

Patients in this program attend 5 days a week, 8 hours a day, and participate in the following workshops: cognitive psychostimulation in which they work on orientation, attention, concentration, memory, language, calculation, praxias and gnosias; reminiscence workshop; kinesitherapy workshop (treatment through the use of movements); psychoexpression and music therapy; occupational workshop and workshop for the maintenance of daily living activities.

The implementation of this type of cognitive training programs requires few resources and has beneficial effects. requires few resources and has considerable beneficial effects.. It is not only a matter of entertaining patients, but also of establishing a routine and discipline and encouraging cognitive effort with different objectives: paying attention, making the mind work, etc.

New technologies with therapeutic potential

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

Computer-based neuropsychological rehabilitation multimedia systems, cognitive training video games and games, online cognitive stimulation platforms and even EEG-based devices and brain-computer interface technologies designed to generate neuroplastic changes have been created.

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 for the patient and his or her family.This is advantageous for them, as they do not have to move and can perform the tasks in a safe environment.

Bibliographic references:

• Fernández-Calvo B, Pérez R, Contador I, Santorum R, Ramos F. (2011). Effectiveness 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. Revista medica Uruguay.
• Tárraga, L. (1998). Soft therapies: Integral Psychostimulation Program. Therapeutic alternative for people with Alzheimer's disease. Revista de Neurología, 27(1), 51 - 62.