Direct treatment approaches for Dementia

Question 1

Direct interventions

Answer 1

Direct interventions are those in which the SLP provides individual or group therapy.

Question 2

Indirect interventions

Answer 2

“Indirect interventions are those in which the physical and/or linguistic environments are modified to support communication…”

Question 3

Guidelines of direct intervention

Answer 3

• Strengthen the knowledge and processes that have the potential to improve.
• Reduce demands on impaired cognitive systems.
• Increase reliance on spared cognitive systems.
• Provide stimuli that evoke positive fact memory, action, and emotion.

Question 4

Types of Direct Interventions

Answer 4

• Spaced Retrieval Training (SRT)
• Reminiscence
• Montesorri-based Activities
• Memory Wallets and Books

Question 5

Spaced Retrieval Training 1

Answer 5

• “Spaced Retrieval Training (SRT) is a shaping procedure in which an individual is asked to recall information over increasingly longer intervals of time.”
• Target, number of trials, and interval length are controlled by the clinician.
• SRT can be done throughout the day by the clinician, caregivers, and family.

Question 6

SRT 2

Answer 6

• When a patient is able to successfully recall a piece of information, the interval preceding the next recall test is increased.
• If the patient cannot successfully recall information, he or she is given the correct answer, asked to repeat it, and the interval time is decreased.
• SRT relies on spared nondeclarative memory in dementia patients. The patient may not remember the event of learning, but will still be able to learn and recall associations.
• Cueing is discouraged and each interval must end with a correct recall.

Question 7

Reminiscence therapy

Answer 7

It stimulates recall. When individuals with dementia and healthy adults are presented with pictures, newspaper articles…and props associated with a theme, their personal experiences related to the theme come to mind.”

• It is recommended to use all the senses to trigger memory.
• Good reminiscence therapy sessions require planning. The clinician should take time to choose props or activities that will be relevant to the patient as well as a list of questions to probe for the less obvious recollections.
• Can be done in a group!

Question 8

Suggested activities for reminiscence therapy

Answer 8

• Holidays
• Personal milestones/events (marriage, retirement, birth of a grandchild, etc.)
• World events
• National or cultural traditions
• Food preparation

Question 9

Montessori/multimodal

Answer 9

• “The defining principles of the Montessori method are: having choices, purposeful experience, multi-sensory experience, action-oriented, and incremental learning.”
• Patients who participate in Montessori-based activities are more attentive than when they participate in passive events like watching an event.
• Montessori-based activities can be used in individual sessions as well as groups of varying size.

Question 10

Examples of Montessori/Multimodal

Answer 10

• Examples of Montessori-based activities are:

— Picture sorting by category (animals, colors, facial expressions, etc.)

— Word sorting

— Memory bingo

Question 11

Memory and wallet books

Answer 11

• Sentences with corresponding photographs are printed on index cards or sheets of paper and bound into a booklet.

— Pages should start with personal identification and end with facts about current life.

—– e.g. “My name is Mary Rockport. I was born in Washington, Pennsylvania on August 24, 1946”

—– “On Saturdays, my son, Henry, visits me.” or “I go to bed at 9:00 p.m.”

• Shown to increase the number of on-topic statements (novel and from the memory aid) per minute during conversations