Rehabilitation to live better with dementia

Abstract

The goal of dementia treatment is to improve the quality of life for both people with dementia and their families. Rehabilitation as a non‐pharmacological approach, coordinated with pharmacological treatment, aims to allow patients to live better by slowing the progression, and relieving the behavioral and psychological symptoms of dementia. In dementia, the manifestation of symptoms caused by neurological impairment is modified by various factors; thus, multidimensional assessment and approaches are effective based on the concept of the International Classification of Functioning, which emphasizes the healthy components of every person's functioning. Regarding the process of rehabilitation, every person with dementia should take initiative throughout the course of rehabilitation, and shared decision‐making is a fundamental requirement at every phase of intervention. The needs of rehabilitation differ depending on the stage of dementia. In the early stages, cognitive rehabilitation is needed, and interventions are carried out using preserved functions and compensatory strategies. As the disease progresses, capacities of instrumental and then basic activities of daily living deteriorate, and interventions need to be tailor‐made and carried out in the context of actual living situations. In the early‐to‐moderate stages, prevention and management of behavioral and psychological symptoms of dementia are required. In the interventions to alleviate behavioral and psychological symptoms of dementia, it is critical to consider the individual and the meaning behind his/her behaviors from a holistic perspective. Family carers also need support, and education to learn coping strategies can be beneficial for both people with dementia and their carers. Rehabilitation can empower people with dementia and their families to live better with dementia. Geriatr Gerontol Int 2018; 18: 1529–1536.

Non-pharmacological treatment changes brain activity in patients with dementia

“…The effects of NPTs were independent of the pathological changes in the brain during disease state causing dementia, therefore NPTs are effective in patients with different subtypes of dementia such as VD and dementia due to AD. This is consistent with the novel concept of NPT, which focuses on each patient's function rather than pathophysiological or neurological causes of their disease 21 . In the present study, we further demonstrated that NPT induced similar changes in the brain activities of patients with either VD or dementia due to AD (see Fig.…”

“…This is considered to be the reason why these patients do not respond to pharmacological treatments 5 . This idea is supported by the fact that patients with CIND and MCI show improvements in their cognitive functions after NPTs [18][19][20][21][22][23] , and neuroimaging studies have revealed that these patients still show signs of brain plasticity 16,17 . The present study applied this idea to patients with dementia.…”

“…In this test, a lower score indicates a more severe cognitive impairment 56 , and dementia is suspected when the score is below 23. The DBD-13 is a 52-point behavioural rating scale and consists of 13 items (item #1, 2,3,4,5,15,16,17,21,24,26,27, and 28 of the original version of the Dementia Behaviour Disturbance Scale 57 ) and a lower score indicates a less problematic behaviour (such as agitation, aggression, anxiety, or apathy). There is no reference value for the DBD-13.…”

“…These filtered data were directly used for source-level analyses. To identify the locations of the brain producing the resting-state-induced component, the source inversion procedures were applied to the oscillation components of delta (0-3 Hz), theta (4-7 Hz), alpha1 (7-9 Hz), alpha2 (9-11 Hz), alpha3 (11)(12)(13), beta (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and gamma (low gamma, 26-40 Hz; high gamma, 41-80 Hz) separately, using a maximal smoothness algorithm with a spatially coherent sources model (i.e. COH algorithms implemented in SPM-12) 58 , which is comparable to sLORETA 59 .…”

Promoting dementia‐friendly communities to improve the well‐being of individuals with and without dementia

“…While the ability of self‐reflection is preserved, support should be provided to enhance their self‐management ability to be more resilient. However, in advanced stages, a person with dementia might find it difficult to self‐reflect and remain motivated to change their behaviors . In such cases, people around them should provide special consideration so that maladaptive behaviors do not become apparent …”