The aging of society inevitably leads to an increase in the numbers of elderly with dementia who reside in nursing homes, and delaying disease progression of residents with dementia has become a big concern. Rehabilitation that focuses directly on training cognitive function (e.g. memory training) reveals what patients are unable to do. Realization of their cognitive deficits can devastate their self-confidence and lead to anxiety, depression and the lowering of self-esteem (Small et al., 1997). We propose rehabilitation that encourages patients' motivation for self-improvement through social interaction based on five principles as follows: (1) the activities should be enjoyable and comfortable for patients, (2) therapists should praise the patients naturally to motivate them, (3) the activities should be associated with empathetic two-way communication to make patients feel valued and safe, (4) therapists should encourage the patients to play “social roles” to restore self-worth, and (5) error-less learning based on brain-activating rehabilitation (BAR; Yamaguchi et al., in press) should be adopted wherever possible. It is suggested that the positive feelings activate those areas of the brain related to reward, which plays a critical role in motivation (Berridge et al., 2003), and it is a typical social reward to be praised and appreciated in public.

-This article focuses on social and psychological risk factors for Alzheimer's disease, dementia, and cognitive impairment and presents some key points for prevention in developing countries based on previous studies, a social science theory, and our preliminary survey. Previous population-based studies found that educational and occupational attainment, income, participation in social and mental activities, and psychological distress were associated with dementia risk. According to the theory of path dependence, earlier factors largely determine successive ones, where education is one of these early experiences in life. Our preliminary survey suggested that education sets a path that several psychosocial risk factors are dependent on. The expansion of basic education is indispensable. Resources for prevention should be concentrated on individuals with a low level of education. In order to break from a path creating self-reinforcement of risk factors, it is necessary to implement early and active interventions. Key words: Alzheimer's disease, dementia, risk factors, prevention, developing countries. Dependência da trajetória nos fatores de risco social e psicológico da demênciaResumo -Este artigo foca nos fatores de risco social e psicológico para doença de Alzheimer, demência e comprometimento cognitivo e apresenta alguns pontos chave para prevenção em países em desenvolvimento baseado em estudos prévios, uma teoria da ciência social e nossa pesquisa preliminar. Estudos populacionais prévios encontraram que educação, ocupação, ganhos, participação em atividades mentais e sociais, e estresse psicológico associaram-se com o risco. De acordo com a teoria da dependência da trajetória, fatores precoces determinam os fatores sucessivos e nós podemos afirmar que educação é uma das experiências mais precoces na vida. Nossa pesquisa preliminar sugere que a educação determina uma via em que vários fatores de risco psicossociais são dependentes. A ampliação da educação básica é indispensável. Fontes para prevenção devem ser concentradas nos indivíduos com baixo nível educacional. A fim de desviar da via que cria um auto-reforço de fatores de risco, é necessário implementar intervenções precoces e ativas. Palavras-chave: doença de Alzheimer, demência, fatores de risco, prevenção, países em desenvolvimento.

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