Which Cognitive Training Method is Best For My Client with Alzheimer’s Disease?
Addressing cognitive decline in Alzheimer’s patients is a common concern of activity directors, occupational therapists, psychologists, speech-language pathologists, and other clinical professionals working with this patient demographic. Alzheimer’s disease is caused by the build of tiny plaques throughout the brain tissue, causing the brain tissue to not receive nutrients and oxygen thus leading to cell and tissue death. Cognitive decline in Alzheimer’s patients is first seen in episodic memory, followed by declarative and procedural memory, and later on key executive functions such as attention. Literature has shown that patients with Alzheimer’s disease do have some cognitive reserve capacity. Because Alzheimer’s patients do have cognitive reserve capacity, utilizing non-pharmacological ways to improve cognitive functioning such as cognitive training are of interest as elderly clients tend to favor these kinds of interventions as there are no adverse side effects and they are relatively cost-effective.
In a study with mild and moderate Alzheimer’s patients, Italian researchers studied the efficacy of two methods of cognitive training: procedural memory training and residual cognitive functions training. In the procedural memory training group, participants performed 24 activities based on activities of daily living (ADL) such as making coffee or tea and writing a letter. In the residual cognitive functions training group, participants performed activities aimed to target attention skills and working memory such as searching for specific words within a matrix and digit recall. Participants in this group also performed cognitively challenging language and verbal memory tasks. Each group participated in therapy for a duration of 5-weeks. Therapy sessions were delivered individually for 3-days a week, 2-sessions per day, with each session lasting for 45 minutes. Therapy was delivered by a physical therapist trained in cognitive rehabilitation therapy.
Results of the study showed that both groups improved on FLSA scores, but not significantly on the ADL or iADL. However, the researchers attribute the lack of significant improvement on the ADL and iADL to be attributed to low sensitivity. It was noted that the procedural memory training group did perform better on the attention and verbal fluency assessment after completing therapy than did the residual cognitive functions training group. What the researchers hypothesized as a result of their study is that this improvement on neuropsychological scores seen in the procedural memory training group could be due to the practice of procedural skills which allows for more automatic behavior and less attentional control as needed by other cognitive tasks. However, both groups performed similarly at baseline levels on neuropsychological assessments when reassessed 3-months later.
What does this mean for clinical practice?
This means that cognitive training for clients with Alzheimer’s disease should be focused on procedural tasks that engage the cognitive and motor systems and that this form of cognitive training should be ongoing. Due to the need of ongoing cognitive training, many therapists turn to using functionally relevant digital cognitive therapy tools. Especially during the COVID-19 pandemic, an interest in the use of computer-based cognitive training programs for elderly people has emerged as telehealth therapy services are being delivered to keep elderly clients safe. Therapists may seek ways to have their clients perform procedural memory tasks remotely by using teleconferencing, webcam, and by having their clients use household objects available during a therapy session.
When performing cognitive training for clients with Alzheimer’s disease, therapists may want to focus on providing their clients with procedural memory tasks. The practice in doing specific tasks that are a part of a client’s activities of daily living may help them automate the cognitive and motor skills needed to perform the task while decreasing their need for attentional control. Constant cognitive training should be given to help clients build and maintain their cognitive reserve capacity and cognitive skills. One way to continue practicing cognitive skills is by using a digital cognitive therapy tool. Because of the need for remote therapy services, clinical providers may want to implement computerized cognitive training for elderly people and find ways to do procedural memory tasks using objects found in the client’s home environment.