A Caregiver's Guide To Therapeutic Procedures For Dementia

Characterized by a decline in cognitive abilities, dementia can cause significant disruptions to a person's daily life. It is estimated that about one-third of people aged 85 and older have dementia, and the most common cause of dementia is Alzheimer's disease, which causes a progressive decline in memory, thinking, and learning skills.  

If you are caring for a loved one with dementia, it may be helpful to familiarize yourself with the therapeutic procedures for managing dementia and its symptoms. This article serves as a guide to various therapeutic procedures for dementia, focusing on non-pharmacological approaches. With a stronger understanding of the many therapies available for dementia, caregivers may be better equipped to support those with dementia. 

Dementia is a general term used to describe a group of symptoms impacting memory, thinking, and social abilities to the point of disrupting daily life. Dementia is characterized by a decline in cognitive abilities, memory loss, and difficulties with thinking, reasoning, and problem-solving. It is not itself a disease, but rather several diseases can cause dementia. 

There are several types of progressive dementias, including Alzheimer's disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Parkinson’s disease dementia, and other dementias. Other disorders linked to dementia include Parkinson's disease and Huntington's disease. 

The symptoms of dementia can vary depending on the specific type and stage of the condition, but common signs include:

• Memory loss
• Impaired communication
• Cognitive decline
• Confusion and disorientation
• Behavioral changes 
• Difficulty with daily tasks
• Loss of initiative
• Poor judgment
• Changes in visual perception

It's important to note that experiencing occasional memory lapses or difficulties with cognitive function does not necessarily indicate dementia. A diagnosis of dementia requires a comprehensive evaluation by medical health care professionals to determine the underlying cause and distinguish it from other conditions.

Alzheimer’s disease

Dementia and Alzheimer’s disease are related but distinct conditions. Dementia is an umbrella term which refers to a range of symptoms that affect cognitive abilities, memory, and behavior. Alzheimer’s disease is a specific neurological disorder that involves progressive memory loss and a loss of cognitive ability. 

Mild Alzheimer’s disease

During the early stages of Alzheimer’s, also known as mild Alzheimer’s disease, patients typically function independently but begin to experience lapses in cognitive function and memory. They may struggle to remember upcoming events or the name for a specific object; Care needs are typically limited at this point. 

Moderate Alzheimer’s disease

Moderate Alzheimer’s disease is the longest stage and symptoms include confusion, severe memory loss, incontinence, trouble choosing the appropriate clothing, and behavioral changes. During this stage, it can help to identify ways to simplify tasks to encourage any level of independence. It’s also important for caregivers to find ways to receive respite. 

Severe Alzheimer’s disease

During late-stage Alzheimer’s, patients typically require round-the-clock care, struggle to communicate, and lose much of their awareness. They may spend much of their time in bed and are more susceptible to infection. Patients at this stage can still benefit from appropriate interactions like listening to soothing music or receiving gentle touch. 

Vascular dementia

Vascular dementia is the second most common type of dementia after Alzheimer’s disease. It occurs when a lack of blood flow to the brain damages brain tissue. Symptoms include trouble with daily functioning, stroke symptoms, memory problems, and personality changes. 

Treatment options

Most types of dementia cannot be cured, but there are a variety of treatment options available that can help a person manage their symptoms. In cases of progressive dementia, the goals of dementia care may change over time. As the condition advances, the emphasis may shift from actively preserving cognitive function to managing symptoms, promoting emotional well-being, and ensuring a safe and supportive environment. 

Goals for dementia care may include:

• Enhancing cognitive function
• Managing behavioral and psychological symptoms
• Promoting independence and functional abilities
• Enhancing quality of life
• Providing support for caregivers.

Non-pharmacological interventions

Below, we'll explore several types of therapy and other non-pharmacological interventions that may be used for individuals with dementia.

Reminiscence therapy

This type of therapy involves encouraging individuals with dementia to recall and discuss past memories. It can be facilitated through conversations, photo albums, music, or other sensory stimuli associated with personal history. 

Reality orientation

Reality orientation is used to reinforce a person's awareness of time and place, with the aim of decreasing confusion and behavioral symptoms. This therapy involves providing individuals with cues and reminders about their surroundings, such as games, calendars, boards, and more. Reality orientation training can enhance a person's sense of certainty and improve their ability to navigate daily life. In one study, reality orientation provided by family members resulted in slow but reliable progress. 

Validation therapy

Validation therapy is an approach to communication that aims to support the emotions and experiences of individuals with dementia through empathy and active listening. This therapeutic technique recognizes and respects the individual's reality, even if it differs from the actual facts or current circumstances. 

Cognitive stimulation

Cognitive stimulation therapy (CST) involves group sessions led by a trained facilitator, focusing on stimulating cognitive functions through various activities, discussions, and exercises. The sessions typically cover various topics, including memory, attention, language, and problem-solving, and encourage active participation and engagement. CST aims to enhance cognitive abilities and promote social interaction for individuals with dementia. A recent clinical trial found that CST was effective in decreasing behavioral and psychological symptoms of dementia and reducing caregiver burden. 

Bright light therapy is a non-pharmacological intervention that involves regular exposure to outdoor and intense artificial light, typically in the morning or early part of the day, that may be used for people with dementia to help control sleep patterns, improve mood, and alleviate symptoms of depression and agitation. 

Music therapy may help evoke emotions, stimulate memories, improve mood, and facilitate social interaction. It involves listening to or participating in music-based activities, such as singing, playing instruments, or rhythmic exercises and may be particularly beneficial for those with moderate or severe dementia.

Art therapy utilizes various art mediums, such as painting, drawing, sculpting, and collage, to facilitate self-expression, enhance communication, and stimulate cognitive abilities. It may provide a non-verbal and sensory-rich outlet for individuals with dementia to express their emotions, memories, and experiences, even when verbal communication becomes challenging.

Occupational therapy

Occupational therapy is tailored to the individual needs of a dementia patient in order to support their daily functioning. For example, an occupational therapist may help strengthen motor skills, work on communication skills, and support reasoning and thinking skills.  

Research has shown that occupational therapy can benefit both patients with Alzheimer’s as well as their caregivers. It’s most beneficial for patients with mild to moderate Alzheimer’s disease. Once they have progressed to late-stage dementia, occupational therapy would focus on educating caregivers and families on how best to support the patient. 

Other types of interventions

There are several other types of psychotherapeutic interventions for dementia that may be used, such as cognitive behavioral therapy (CBT), problem-focused therapies, emotion-focused and meaning-based therapies, interpersonal therapy, mindfulness-based and compassion-focused therapies, and group therapy.

More research is also looking into the efficacy of alternative therapy options to help treat symptoms, such as massage therapy and pet therapy. 

Pharmacological interventions

While there is currently no way to cure dementia, medications may be used to help manage dementia symptoms. Doctors may prescribe medications that help balance the levels of certain chemicals in the brain, which can improve cognitive function. Medication for dementia often includes cholinesterase inhibitors and NMDA receptor antagonists, among others. 

Dementia medication can help improve symptoms and quality of life. However, it may not be suitable for all individuals with dementia, and the effects can vary. It may be important for caregivers to help manage medications and be aware of any side effects and recommendations. For example, the Alzheimer Society recommends only using antipsychotic medications as a last resort, instead encouraging caregivers to focus on person-first care. 

Lifestyle interventions

Lifestyle interventions that aim to improve overall health and reduce inflammation may also help manage dementia. Making lifestyle changes may be crucial for both reducing risk and managing dementia:

Improving nutrition

Poor nutrition and unhealthy eating habits may increase dementia risk, while a balanced and nutrient-rich diet can contribute to brain health and potentially reduce the risk of cognitive decline. Those living with dementia may benefit from maintaining an anti-inflammatory diet rich in vegetables, whole grains, fish, lean proteins, and healthy fats. 

As certain types of dementia, such as Alzheimer's, are commonly associated with diabetes, it may also be important to control blood sugar through diet and medication. Additionally, individuals with dementia often experience challenges related to eating, such as appetite loss, difficulties with swallowing, or forgetfulness about mealtimes. This can lead to inadequate nutrition, weight loss, and further cognitive decline. Caregivers may consider monitoring whether physical or behavioral limitations could be contributing to these challenges and seek appropriate support from healthcare professionals.

Finally, researchers are looking into the benefits of dietary supplements as dementia treatments. The most promising supplements have been omega-3 fatty acids and vitamin E. 

Physical activity

Research has found that physical exercise may help to reduce the risk of cognitive impairment and dementia. It may be an important part of managing dementia, slowing its progression, and preventing other diseases. Exercise may improve mood, reduce anxiety, and preserve cognitive function,  as well as help control sleep patterns and reduce sleep disturbances. Exercise can also decrease a person’s risk of developing cardiovascular disease, which research has confirmed to be a risk factor for dementia. 

Caregivers may help by encouraging and facilitating suitable and enjoyable exercise routines, such as gentle walks, yoga, chair exercises, and guided stretching. It may also be worth considering other ways of staying active that reduce the amount of time spent sedentary. Daily activities such as shopping, cooking, or running errands can be incorporated as opportunities for light physical activity. 

Improved sleep

Regular and plentiful sleep can have significant benefits for individuals with dementia. Sleep disturbances are common in individuals with dementia, and poor sleep hygiene can worsen symptoms. To promote better sleep for individuals with dementia, caregivers can help establish a consistent sleep routine by ensuring a regular bedtime and wake-up time, creating a calming sleep environment, and implementing relaxing activities before bed. 

Limiting daytime napping, encouraging regular physical exercise, and avoiding stimulating substances like caffeine and alcohol close to bedtime can also help control sleep patterns. Additionally, it may be important to consult with a doctor to discuss any underlying physical or medical conditions that may be contributing to sleep disturbances.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Seeking therapy as a patient or caregiver

Various types of therapy, as detailed above, can help support those living with dementia. In cases of mild to moderate dementia, therapy can be helpful for coping with the emotional effects of cognitive decline. As dementia progresses, the focus may shift to other types of therapy that focus on managing the symptoms of dementia. 

The focus of geriatric psychiatry is to treat Alzheimer’s disease. This specialized mental health professional is trained to perform clinical assessments, provide treatment, and educate others about mental health issues that older adults may face. 

Caregivers may also benefit from the support of a trained therapist. The physical and emotional demands of caregiving may interfere with one's ability to care for oneself, which can lead to stress, anxiety, and other mental health concerns. Talk therapy may be important for preventing burnout and working through any mental or emotional difficulties related to caregiving so you can develop helpful coping behaviors. For some caregivers, online therapy may feel more convenient if caretaking duties make it challenging to attend in-person appointments. With online therapy through BetterHelp, you can meet with a therapist wherever you have the internet, including your own home. 

Plus, research has found online therapy to be an effective option for family caregivers of people with dementia. One such study examined the effectiveness of an online cognitive behavioral therapy program for family caregivers of people with dementia. It found that the online therapy program reduced the behavioral and psychological symptoms of dementia (BPSD) of people with dementia and the related distress in their caregivers.