Overview of non-pharmacological intervention for dementia and principles of brain-activating rehabilitation

Abstract

Non-pharmacological interventions for dementia are likely to have an important role in delaying disease progression and functional decline. Research into non-pharmacological interventions has focused on the differentiation of each approach and a comparison of their effects. However, Cochrane Reviews on non-pharmacological interventions have noted the paucity of evidence regarding the effects of these interventions. The essence of nonpharmacological intervention is dependent of the patients, families, and therapists involved, with each situation inevitably being different. To obtain good results with non-pharmacological therapy, the core is not 'what' approach is taken but 'how' the therapists communicate with their patients. Here, we propose a new type of rehabilitation for dementia, namely brainactivating rehabilitation, that consists of five principles: (i) enjoyable and comfortable activities in an accepting atmosphere; (ii) activities associated with empathetic two-way communication between the therapist and patient, as well as between patients; (iii) therapists should praise patients to enhance motivation; (iv) therapists should try to offer each patient some social role that takes advantage of his/her remaining abilities; and (v) the activities should be based on errorless learning to ensure a pleasant atmosphere and to maintain a patient's dignity. The behavioral and cognitive status is not necessarily a reflection of pathological lesions in the brain; there is cognitive reserve for improvement. The aim of brain-activating rehabilitation is to enhance patients' motivation and maximize the use of their remaining function, recruiting a compensatory network, and preventing the disuse of brain function. The primary expected effect is that patients recover a desire for life, as well as their self-respect. Enhanced motivation can lead to improvements in cognitive function. Amelioration of the behavioral and psychological symptoms of dementia and improvements in activities of daily living can also be expected due to the renewed positive attitude towards life. In addition, improvements in the quality of life for both patients and caregivers is an expected outcome. To establish evidence for non-pharmacological interventions, research protocols and outcome measures should be standardized to facilitate comparison among studies, as well as meta-analysis.

Physical and functional implications of aquatic exercise for nursing home residents with dementia

“…For those with dementia, there is growing evidence that the cost associated with program delivery could be offset in part or full by savings related to participation benefits such as reduced medication and care needs, and falls related injuries. 30,31 Our cohort had moderate to severe dementia, which influenced their ability to follow instructions and their day to day enthusiasm to participate in exercise and/or the assessment. The motivation to adherence challenge of working with this group was demonstrated by the undulating participant attendance to sessions, even though facility staff indicated participants were enthusiastic about the program.…”

Comparing the effects of different individualized music interventions for elderly individuals with severe dementia

“…The current findings suggest that the interactive music intervention may directly stimulate cognitive and emotional function in individuals with cognitive reserve in accordance with the previous reports of an association between the severity of BPSD and residual function due to cognitive reserve in elderly patients with severe dementia (Stern, 2009; Yamaguchi et al ., 2010). Although emotional functioning is reported to remain relatively intact until the very late stages of the disease (Ikeda et al ., 1998), aspects of cognitive dysfunction, such as reduced attention or memory impairment, could inhibit environmental recognition and reduce the ability to communicate.…”

A Randomized Controlled Trial of Brain-Activating Rehabilitation for Elderly Participants with Dementia in Residential Care Homes

“…These findings suggested that group membership plays an important role in maintaining and promoting health and well-being [4]. We proposed a new principle of rehabilitation for dementia, brain-activating rehabilitation (BAR) [5], which consists of 5 principles: (1) enjoyable and comfortable activities in an accepting atmosphere; (2) activities associated with empathetic two-way communication between staff and participant, as well as between participants; (3) praising participants to enhance motivation; (4) offering social roles to participants that enhance their remaining abilities, and (5) supportive care to prevent failure, which causes confusion of participants. In fact, BAR was conducted as a combination of several techniques (e.g.…”

“…reminiscence therapy, reality orientation, games, physical activity, crafts, cooking, and singing) to suit the participants based on these 5 principles. BAR was expected to enhance participants’ motivation and maximize the use of their remaining functions and prevent the disuse of functions [5]. BAR was expected to enable participants to recover both a desire for life and their self-respect.…”