Nonpharmacological Treatment of Cognitive Impairment

Abstract

Memory is a passion no less powerful or pervasive than love"~E llie Wiesel All Rivers Run to the Sea Drugs available to treat dementia produce small improvements in cognition, but the clinical significance of these effects are questionable (1-3). In addition, they produce a variety of side effects including anorexia, weight loss, diarrhea, nausea, abdominal pain, dizziness, bradycardia, syncope and weakness. Thus, while dementia has traditionally been conceptualized from a medical model (4), it has become clear that dementia prognosis is strongly related to the environment and interpersonal relationships (5). Kitwood (5) identified 6 central needs for a person with dementia, viz., love, comfort, attachment, inclusion, occupation and identity. This has led to a variety of lifestyle and non-pharmacological interventions to manage cognitive impairment and behavioral and psychological symptoms of dementia (BPSD) (Table 1) (6).

Loneliness in Old Age: An Unaddressed Health Problem

“…Cognitive impairment needs to be assessed and where possible reversible causes need to be treated (16). Persons with moderate dementia should be offered Cognitive Stimulation Therapy (17,18), an evidence-based, non-pharmacologic individual or group intervention.…”

Development and validity of the Computer‐Based Cognitive Assessment Tool for intervention in community‐dwelling older individuals

“…In task 2, participants recalled the same set of numbers in reverse order. The number of digits gradually increased (3,5,7,8). The maximum number of digits that a participant could recall in the correct order (forward or reverse) was recorded.…”

“…Unfortunately, current drugs are unable to prevent or cure dementia . Therefore, early detection of cognitive decline is essential to prevent dementia.…”

“…2 Unfortunately, current drugs are unable to prevent or cure dementia. 3,4 Therefore, early detection of cognitive decline is essential to prevent dementia. Early detection can effectively identify the disease in its treatable stage and provide lifestyle guidance in an attempt to slow cognitive impairment.…”

Population Health and Aging

“…In fact, the Minister of Aged Care in Australia considers a positive screen on the FRAIL screen to be "the canary in the coal mine" for older persons in that frailty is indicative of poor health outcomes and disability and thus must be treated. From the population health viewpoint, group exercise programs for persons with sarcopenia (61) and frailty, and cognitive stimulation group therapy for those with moderate dementia (62,63) should be available for all members of the population.…”