Effective nonpharmacologic interventions for persons with dementia take advantage of preserved abilities, including procedural memory and skills and habits such as reading, and make use of external cues, including memory aids. These interventions can also be implemented by a wide range of formal and informal caregivers in a variety of settings, and are effective in terms of increasing positive behaviors and reducing inappropriate behaviors.
Spaced-retrieval, which is a shaping paradigm applied memory, circumvents deficits in the explicit/declarative memory system and in executive functioning. It enables a person with dementia to learn information and compensatory strategies "unconsciously" by means of errorless learning and repetition priming. This involves giving practice at successfully remembering target information or performing target behaviors at successively longer time intervals. When a retrieval is successful, the interval preceding the next recall test is increased. If a recall failure occurs, the correct response is given to the participant, who is asked to repeat it. Then the length of the next interval returns to that of the last one at which retrieval was successful. In addition, external memory aids may be incorporated into the technique to facilitate recall. Various types of caregivers can learn to implement spaced-retrieval, including rehabilitation therapists, nursing assistants, family members, and others.
A study of spaced-retrieval, as best practices and procedures for speech therapists, has demonstrated its effectiveness as a billable therapeutic approach that can be utilized in the context of standard speech therapy sessions. Pilot studies are also being conducted using spaced-retrieval with HIV+ older adults, with persons with traumatic brain injury, and over the telephone.
Montessori-based activities draw upon rehabilitation principles, including use of external aids and procedural memory, and are designed to promote independence and positive engagement with the social and physical environment. They include activities related to cognition, motor skills, activities of daily living, and sensory stimulation. Activity tasks use everyday materials, are broken down into steps, and are self-correcting. External cues provide immediate feedback, while repetition enhances procedural memory and motor learning. The Montessori method capitalizes on the first in-last out principle whereby cognitive abilities in dementia are thought to be lost in reverse developmental sequence (with the exception of the ability to read single words or short phrases).
This type of activity programming can be customized to a person's interests and remaining abilities; can be linked with reimbursable restorative nursing care in areas such as range of motion, dressing and grooming, and communication; and can be scheduled within existing program activity periods. Several studies have demonstrated that these activities lead to increased active engagement with the environment and positive affect. Programming has been delivered successfully in numerous settings including long-term care, adult day care, assisted living, and home health care, as well as during family visits.
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