Reminiscence Therapy for Dementia Patients.

Original: Dec. 15, 2018; Latest Update: Jan. 10, 2019;

Given the societal costs of Dementia, providers are looking for new approaches that could "revolutionize dementia care." One promising approach is the "Reminiscence Therapy, which is a form of palliative treatment for patients with cognitive limitations. The underpinning of such therapy is a workable (intact) long-term memory of those individuals.

Growing Concept: It is traced back to a small "town" setting of assisted living facility called "Hogewey" near Amsterdam, Netherlands. By providing therapy in comfortable & safe structured settings, those patients are deprescribed medication compared to those living in traditional homes, reported the Journal of Dementia Care. This is a healthcare model that fits between home care & assisted living care, noted Scott Tarde, CEO of US-based George G. Glenner Alzheimer's Family Centers. It is similar to Adult Day Care settings wherein participants go home at the end of the day.

The US-based Glenner Town Square is one state-of-the-art dementia day care facility that employs such form of palliative treatment. Along a nondescript boulevard in Chula Vista, Calif., south of San Diego, the Town Square is a 9,000 square-foot indoor replica of a small-town USA, with its 14 storefronts being a throw-back to the era between 1953 and 1961.

This period of time represents the participants' earlier years between age 10 and 30, wherein individuals form their strongest memories. It was an era of iconic places wherein …

"Eisenhower was president and Buddy Holly sang over the PA system and old movies like Rear Window play in 15-minute clips in movie theater, with American flag with 48 stars flies inside city hall, near the shiny back 1959 Ford thunderbird and across from Rosie's Diner, with pictures of Elvis, Audrey Hepburn and James Dean hanging from walls the color of cotton candy."

Helped by the Senior Helpers, their average "reminiscence" treatment unit is 45 minutes. In each unit, the counselors relate scene-specific stories with the individuals. Other palliative procedures include copy inspiring messages on Halloween cards for sick children at a nearby hospital -a poignant moment for the patients & their loved ones. While exhibiting iconic places like the library, bar, barbershop, or opera house, the participants are guided from one exhibit to another in groups of five. The Senior Helpers is a national caregivers' organization.

The reminiscence therapy has been well accepted within the Alzheimer's and Dementia community. In response, two other traditional dementia care centers will operate in San Diego area, in addition to the Glenner Town Square. The long-term plan is to build more than 10 more Town Squares nationwide by 2021.

Therapy Efficacy: Studies have shown added benefits also to patients with Alzheimer's & other forms of cognitive diseases. The therapy "calms" their agitation - a painful hallmark of the disorders. According to other research, it also boosts cognitive ability and reduces depression.

Therapy Corroborated: Such palliative treatment & benefits have been substantiated with actual facts, according to Dr. Richard Isaacson, M.D., Director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York Presbyterian. Though he was originally skeptical about the therapy, the outcomes in the intervening years have changed his assessment. He supports the treatment's efficacy of "bolstering chemicals in the brain without the side effects." With potential ripple effects, the end-result is better cognition, due to more well-rested nights (thus, better sleep). Dr. Isaacson points to the symptomatic benefits extending long beyond the daily palliative treatment hours.

Extended Therapy Benefits: Caregivers from family have also benefited. Before therapy, patients are kept with family, "creating a stressful environment for all." However, the new arrangement has "brought our family closer … not just a bunch of old people sitting around a table like in many other homes."

Case in Point is Officer Joey Tennison of the San Diego Police. His mother Susie's presence at home was very stressful on everyone. She always agitated, always asking repeatedly the same question, and then always forgetting anything a few minutes later. Though she was always "sweet and even keeled," she became "so angry and sad," - a lost soul who couldn't recognize her family. It was "very hard to care for her."

But now, his mom is in better mood and easier to be with. To ease Susie's agitation, Glenner caregivers hit an interesting point. Since she was an accountant, they printed her spreadsheets to fill out and gave her a desk to work at. With her having a purpose now and her getting her dignity back, she is calmer and even ask for new dresses so she could look good. Though "she doesn't have her memory back ... there's a difference ... she has a purpose now … it all feels familiar and safe."

Therapy Finance: The cost is competitive to other arrangements, about $85 a day or $425 a week. Though it is 20% higher than the cost for adult day care, it is cheaper than nursing homes or assisted living facilities. It is considerably cheaper than private care which is about $20 / hour.

Other non-reminiscence services: Other forms of new therapeutic service are offered now to dementia patients, like mental care wellness. Aside from the traditional ones, the new therapy of memory care assist caregivers & loved ones much earlier in their disease. Certified by the Alzheimer's Association, the Memory Care Specialists "combine" therapeutic activities with volunteer-delivered art & music healing. Simultaneously, caregivers receive supporting peer support groups and private counseling. It is important to also "nurture caregivers' brain health" by supporting intentional self-care to maintain a sustainable peace. Memory Care Services include: (www.mymemorymatters.org)

The service also offer reinforcement training for caregivers, as well assist like memory care wellness. We all know that our brain is our last medical frontier. Long a mystery, we erroneously considered the brain as set from birth. We have underestimated the ability of the brain to learn and heal itself.

However, studies over time have shown that the brain can increase its cell count through neurogenesis. Such development is enhanced by neuroplasticity, by which our brains fortify as well as create neural connections. Through interventions like exercise, diet, lifelong learning, staying connected, and meditating & Yoga , we are able to challenge our brain for new tasks. First as lifelong learning, we start Baseline Memory Screening: Via the Montreal Cognitive Assessment (MoCa) tool, counselors can access the patient baseline metrics and shared with doctors;

Counseling & Support::

Peer Caregiver Support; Facilitated by Memory Care specialists,

Private Counseling Service: Offered by a licensed, master's prepared professional counselor, these therapeutic counseling is $85 each session, with $120 for initial intake. session.

Dementia Dialogues: offer expert guidance

Meditation Yoga & Self-Care

Connections Classes: Proactive Early Intervention: are for individuals with early memory loss with the goal of prolong quality of life and productivity and stimulating "brain day" with positive socialization and mutual support. Such connections curriculum-based intensive brain training includes class work, therapeutic art and music, meditation and yoga, individual use of digital training, class use of digital training (based on proprietary software iN2L, Exercise guides, diet Connections Classes are $50 each day.

Compass Day Program: this is for participants with mild to moderate dementia with daily five hours of care to include counseling support, personal care such as Creative art & music; Yoga & relaxation; Exercises for balance; Individual digital training; Class use of iN2L brain-engaging software; Socializing & dancing; Brain-engaging games & puzzles; Laughter & love; Compass Day progam costs $75 each day.

As a side note, some Alzheimer's drugs are showing promise. Based on the concept of the reduction of the amyloid deposits might lead to the reduction of the cognitive decline in those patients, researchers are exploring a variety of pharmacological venues. On the horizon, a large-scale trial of Japanese drug, known as BAN2401 suggests that practical treatments might be around the corner. This drug both reduces the deposits and slowed patients' decline (Opinion, 2018).

References:

Memory Matters. (2019, Jan. 10). Memory Care: Optimizing Brain Wellness with You in Mind. www.mymemorymatters.org - Promotional Paflet.

Opinion. (2018, Dec. 26). Today's Topic: 6 Reasons for Holiday Cheer. USA Today, p. 5A

Wolff, Jennifer. (2018, December). Your Health: Thanks For the Memories - In a re-created 1950s town, men and women with dementia rediscover their comfort zone. AARP Bulletin / Real Possibilities, p. 26, 28, 29