There has been a lot of talk and research that has become available testing the impact of cognitive training for dementia and healthy older people. I do not want this blog post to be all about the research, the number of participants each study used and the flaws of each study. Instead I would prefer to just be more general about the entire topic and whether it is worth a try or not. Cognitive training and dementia is something that I take personal interest in since here at Phoenix Mental Health Services we use it alongside rTMS with people who have Alzheimer’s Disease.
From my own experience of using cognitive training, I have had a lot of positive feedback. I have seen that they are quite proud of their progress and love the challenge. Please bear in mind that we do only use it for people in the mild to moderate stage (as they need to be able to complete the tasks in a timely manner) so I cannot say how effective this would for people in the severe stages.
In my opinion this is something that should be used to keep them engaged and try to keep their brains active in the hope to maintain or improve their cognitive abilities. We cannot say that this is what actually happens when using cognitive training but I have seen some improvement throughout the weeks in patients from when they begin the tests to the end of the treatment. There is no actual proof that it is the cognitive training that does this as we combine it with magnetic brain stimulation (but it would be fair enough to say that it must do something).
The simple premise behind this all is that that healthy older people have a considerable cognitive capacity reserve and are able to improve on tasks whereas people with dementia have a reduced cognitive capacity reserve and as a result do not do as well on tasks. Since people with dementia suffer considerably with memory, a lot of cognitive training for dementia methods focus abilities on abstract memory. Some of the cognitive training tasks we use in our clinic include remembering words, remembering colours and locations of shapes and remembering letters. We also use tasks that challenge language and verbal fluency such as describing pictures.
To summarise the research available, evidence suggests that cognitive training or brain training may help older people manage their daily tasks better. A lot of research uses elderly participants who are healthy but suffer with memory as a normal part of the ageing process. The positive outcomes have been generally applied to dementia. It has led to the idea that this could help with cognitive abilities that decline in dementia but also researchers are trying to better understand how this could help prevent dementia, but longer-term studies are required for this and no assumptions can be made yet.
Putting the research aside, I guess the best way to see if cognitive training helps is to try it yourself. There are a number of applications and games available on smart devices but not many are tailored to people with dementia and some may be too difficult (or easy) and could lead to frustration. It is important to pick up on signals so for example if they are getting impatient or distracted it is likely it is too hard so move on. I would also recommend that you test drive these apps alone first before using it because you can quickly rule one out if you think it will not work. Always look at up to date reviews as they are always a good indicator of how good the app is. Remember to be supportive and patients because it may not be as easy as we think for them. Here are a few that I have researched:
- The Seesaw Challenge
- Fit Brains Trainer
- Brain trainer
- Talking Tom 2
- My Reef 3d
- Let’s create! Pottery
- Flower Garden
- MindMate App– this is an application for people with dementia and is marketed as a friend that is always ready to help and entertain. There are some games, daily reminders, exercise and nutritional advice. The games can be shared with medical professionals to get an insight on the progression of their dementia.
I also thought that it would be worth mentioning another type of cognitive training for dementia that has been used in research a few times, Reality Orientation Training. Studies have demonstrated that using this has improved cognitive functioning for people living with dementia when compared to controls who did not receive it. Some of the strategies for this type of training including talking about orientation (time of day, season, date or date), using their name frequently, referring to clocks and calendars, signage and labels on doors and cupboards and discussing current events.
This sort of therapy requires one to one interaction and the person should be skilled as it needs to be mixed with compassion and understanding of the confusion experienced by someone with dementia – this is part of the reason it has lost its popularity over the years.
To summarise, the answer to the question “does cognitive training actually help?” is… we do not know. Research shows that it does help for many but equally there are other studies that have found that cognitive training for dementia patients does not lead to any improvement in the presentation of the condition. This might sound confusing and the blog post may just seem like a waste of time but that is just how the cookie crumbles. There are no definitive answers when it comes to a condition like dementia and what works for one may not for another.
I think my answer to this question is that it is always worth trying something before you rule it out and how much can this actually hurt? If you notice it is not working or resulting in challenging behaviours, just stop but if it helps a little or creates excitement then that must be win!