The number of people living with dementia is expected to increase two-and-a-half times between now and 2050! The number quoted is 139 million people who will have a neurodegenerative condition that has profound effects on patients’ everyday function and well-being. This dire projection spawned an in-depth evaluation of the benefits of cognitive rehabilitation in reducing the progression of dementia and improving independence of the individuals.
Cognitive rehabilitation is “person-centered” care focused on individual areas of concern identified by caregiver and patients themselves. Patients identify “daily activities or tasks that they would like to manage better or perform more independently.” One-on-one sessions in the person’s own home are conducted once a week for up to 45 weeks with the primary outcome/goal being improved ability to perform those daily activities previously identified. Secondarily, mood and quality of life were evaluated for improvement as well. The results were based on “standardized, validated self-rating scales” and definitely showed everyday function and well-being improved. Both patients’ and caregivers’ assessments were consistent, and goals were attained to their satisfaction equally.
Cognitive rehabilitation did not significantly effect memory, delayed recall, sustained attention, quality of life, and general functional ability. Thus, the question if it helped dementia symptoms, the answer was a profound “No.” It did, however, have a small positive effect on social and psychological aspects of quality of life for caregivers. So the manifestations and effects of dementia were not affected, but the activities specifically indentified by patients and caregivers were improved based on their self-evaluations.
Patients with mild to moderate dementia who are showing decline in everyday functional ability and overall well-being should be considered for cognitive rehabilitation or occupational therapy. Their dementia-related effects will remain unchanged, but specific daily-life activities that affect them and others can be improved or stabilized by cognitive rehabilitation.
One aspect of this report concerns me. The determination of improvements was not made by independent observers, unless “caregivers” are considered independent, but by patients themselves. Can one really rely on the accuracy of the self-assessment of a patient with dementia. Memory, judgement, and insight are lost in dementia patients so how can one expect them to provide a reliable assessment of their improvement or lack thereof. But this report was published by the Cochrane Database of Systematic Reviews, recognized as the “gold standard for evidence-based healthcare.” Their reviews are up to date, accurate, and reliable and provide clinicians and researchers with the latest research to make good healthcare decisions.
Reference: Bevan J, Costner J, Rey JB. Cognitive Rehabilitation for Patients with Dementia Am Fam Phys 2024 July;110(1):25-26.
AFP Clinical Answers. Does cognitive rehabilitation improve everyday functional ability and well-being in patients with mild to moderate dementia? Am Fam Phys 2024 July;111(6):492
