The benefits of cognitive therapy

Cognitive impairments can happen for any reason, but dementia/Alzheimer’s seems to be diagnosed more in assisted living and skilled nursing communities. Cognition relates to mental abilities such as knowledge, attention, memory, judgment, reasoning, problem solving and decision making. The goal of cognitive therapy is to provide improved care for patients, better health for the population and lower healthcare costs—in keeping with the Triple Aim.

Cognitive therapy and programming allows individuals to achieve their highest level of function through active involvement in daily living, resulting in a better quality of life. Examples include medication reduction, decreased falls risks and fewer hospitalizations. Job satisfaction also improves as caregivers become more confident in their skills and ability to work with the cognitively impaired.

To begin cognitive therapy, professionals in occupational therapy, speech-language pathology and physical therapy perform formal and informal assessments to determine an individual’s cognitive and functional level. Knowledge of the individual’s cognitive level is invaluable to caregivers and family members. This allows caregivers and family members to recognize common characteristics, performance patterns and abilities, including the following:

• Communication and social skills
• Swallow function
• Cognitive abilities
• Motor skills
• Transfers and ambulation skills
• Visual spatial skills
• Activities of Daily Living (ADLs)
• Instrumental Activities of Daily Living (IADLs)

Once a cognitive level is determined, individual recommendations are given by occupational therapy, speech-language pathology, and physical therapy staff. Recommendations may include approaches for redirecting behaviors, communicating purposefully, promoting ambulation, decreasing falls, cues and environmental modifications to facilitate ADL participation, and activity recommendations to keep the individual actively and socially involved in daily life.

There are multiple stages of Alzheimer’s, and functional performance varies through the stages. An individualized plan is typically developed depending on the stage.

For example, if individuals are functioning in the early to middle stages of dementia/Alzheimer’s, with mild to moderate functional decline, they commonly have significant deficits in working memory and executive thought processes. That means they have difficulties with divided attention or multitasking, problem solving and realizing consequences to actions. They’re highly distractible and rely on long-term memories. There may be decreased self-initiation of tasks. For example, they may not change their clothing or shave often.

We would therefore expect complex tasks to be performed with errors, difficulty or inconsistencies. Medication, financial management and meal preparation can be challenging. Most people with Alzheimer’s are not fully cognizant of their functional deficits. Safety is impaired and driving may no longer be advised. There can be difficulty with recognizing and responding to emergency situations. New learning and judgment are inconsistent and repetition is needed.

Caregiver education highlights the importance of offering choices and establishing routines that promote structure throughout the day. In addition, caregivers may need to manage medication, including filling weekly pill boxes and assisting with prescriptions. Caregivers may also need to monitor frequency and quality of bathing and hygiene, laundry and home management. Use of a calendar and notes/note-taking can be beneficial for organizing appointments, tasks and daily routine.

Because of the progressive nature of dementia/Alzheimer’s, caregiver and family education must be ongoing. For example, family members/caregivers may begin to see behaviors. When those behaviors occur, first and foremost one should ensure basic needs such as thirst, hunger and toileting are met. Assess for and rule out pain. When behaviors such as wandering and sundowning occur, provide structure and redirection with use of appropriate activities based on cognitive level. It’s important to realize behaviors such as wandering may not always be harmful or disruptive and instead offer comfort to the person. Therefore, what may be best is to allow wandering within a safe area.

If someone is demonstrating anxiety and aggression, identify the immediate cause if possible and create a calming environment. Offer activities and exercise as appropriate. Try relaxing activities such as music, massage or aromatherapy. Do not become upset and always speak softly. Again, it is important to ensure basic needs are met and to address pain.

Knowing about cognition and cognitive performance allows you to provide care and meaningful interaction to individuals with dementia/Alzheimer’s. You can promote the ability to achieve the highest level of function, resulting in a better quality of life.

Kristy Brown, MS, CCC-SLP has more than 25 years of management experience as CEO/President of Centrex Rehab. She was formerly executive director of therapy services at Augustana Therapy Services. Brown can be reached at kbrown@centrexrehab.com.

Tamara Althoff, MS, CCC-SLP, has provided speech-language pathology services for all ages in a variety of settings, including outpatient clinics, hospitals and skilled nursing facilities. Since 2000, Atlhoff has provided clinical oversight to all speech-language pathologists at Centrex Rehab. She can be reached at tlalthoff@centrexrehab.com.

Pam Brooks, OTR/L, has provided occupational therapy in hospitals, skilled nursing communities and home health settings. She is the clinical occupational therapy specialist for Centrex Rehab and provides clinical support to all occupational therapy staff. She can be reached at phbrooks@centrexrehab.com.

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