A new approach to Alzheimer's disease

Individualised goal-oriented cognitive rehabilitation therapy appears to change the lives of Alzheimer’s patients allowing them greater independence and control.

There will be one million people with Alzheimer’s by the year 2025, according to estimates, and with no preventative medication or cure in sight dealing with a diagnosis of the disease can be extremely tough for both the patient and their family and friends.

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A clinical trial undertaken by researchers at the University of Exeter, UK, shows positive outcomes for patients and their carers, however, using a specific type of therapy – goal-orientated cognitive rehabilitation – and some patients are already enjoying better lives as a result of the treatment. 

“Our aim is to enable people to function as best they can,” says Clinical Psychology of Ageing and Dementia Professor Linda Clare, of Exeter University. “We identify what the person wants or needs to do and what the person is currently able to do, and find strategies to address the mismatch between these two things.”

Clare developed the cognitive rehabilitation approach for people with memory difficulties and with funding from the National Institute for Health Research, is now overseeing the trial, titled Goal-oriented Cognitive Rehabilitation in Early-stage Alzheimer’s and Related Dementias Trial (GREAT). 

The therapy may focus on restorative techniques where patients may be taught new skills to enable to do something they used to do, or compensatory techniques where new techniques are utilised to make difficult tasks easier.

So, for example, says Clare, one of their study participants wanted to be able to go food shopping just as she used to, but since suffering with cognitive decline she had lost confidence in her ability to find her way and was worried that she might get lost or confused during the outing.

“She needed a strategy that would give her confidence to go out,” says Clare. “The therapist taught her to use a mobile phone to make calls so that she could contact her husband if she had difficulties when she went out. This meant she was able to go out independently and continue doing what she had always done, buying food for her family.

“In another case, enabling the person with dementia to develop a habit of referring to his diary to find out his routine for the day, and to use the telephone and TV remote control independently, reduced the stress that his wife was experiencing and improved his confidence.” 

Learning these simple techniques not only helps boost confidence and makes specific activities or behaviours possible, it also often helps the patient with other tasks or activities. 

“One of the most rewarding experiences is when we see a person with dementia, or family, taking up this approach and applying it to other needs or difficulties,” says Clare.

“One participant learned to use a calendar so that she could find out for herself what day it was and what was due to happen instead of asking her husband, who found her repeated questions stressful. This worked very well. Soon afterwards her washing machine broke down and they bought a new one. She thought she would never be able to learn to use it, but by applying the problem-solving approach they had applied earlier, she and her husband developed a list of instructions and taped it to the front of the machine. That meant she was able to carry on doing the washing.”

Enabling a patient to do more doesn’t just improve their day-to-day life in terms of activity, it also helps improve their relationship with people close to them. For example, Clare mentions a patient who had trouble finding the right word during conversation and this made doing normal activities such as cooking with her partner stressful and unpleasant. The therapist worked on finding a strategy for both to address those situations and the result was that conversation was made easier and they couple were able to enjoy doing things together again.

This kind of therapy isn’t available everywhere in the UK nor is it offered routinely to patients or their families, but Clare hopes that might change. “If the evidence from this trial does show that cognitive rehabilitation is effective, and more beneficial than other methods, I think that the NHS would recognise its value,” she says.

“However, resources would need to be reallocated so that it can be implemented. This means firstly enabling staff to spend time delivering this intervention instead of doing other things, and secondly training staff who need to develop the skills to work in this way.”

There are, however, things you can try at home. “This is a very practical, problem-solving approach that is about making best use of the abilities each person has,” says Clare. “While sometimes a therapist’s skills are needed, there are many situations where a common-sense approach can produce improvements; I’m sure a lot of people do this intuitively.”

Practical tips to help loved ones retain as much independence as possible in the early stages of dementia

So, for example, helping a patient to understand how to use a simple phone so that if they do get lost or confused they know they can call for help. Or taping instructions to things around the home, providing written details of the routine for the day and so on. 

The researchers overseeing the study are developing a self-help guide based on the results, which will be available for people living with dementia and their carers.

“As for right now, probably the main message is that when faced with a challenge or difficulty, rather than giving up or letting someone else take over, it’s worth thinking as creatively as possible about possible solutions and trying different strategies or ways of getting around the problem,” says Clare.