Cognitive Rehab for Geriatrics

Aging is a process that requires ongoing adaptation to and compensation for the losses that are imposed on human beings from the outside world and the internal physiological changes that occur with the passage of time. One of the most common of all these is dementia.

Dementia

Dementia refers to a group of symptoms associated with a decline in mental ability. It is caused by disorders affecting the brain, and are described by a collection of symptoms affecting the brain. Dementia has an effect on thinking, behaviour and social interaction, as well as functional abilities. Dementia affects approximately 47 million people worldwide and is projected to increase to 75 million in 2030 and 132 million by 2050. Dementia is generally associated with age but early onset can also occurs.

The most common types of dementia are:

• Alzheimer's disease,  the most common type, accounting for 60-70% of cases of dementia.
• Vascular dementia, the second most common type.
• Lewy body dementia.
• Fronto-temporal lobar degeneration dementia.
• Huntington’s disease.

Risk factors

Dementia risk factors can be categorised into modifiable and non-modifiable risk factors.

• Modifiable risk factors include physical inactivity, tobacco use, unhealthy diets and harmful use of alcohol and smoking, and certain medical conditions such as hypertension, diabetes, hypercholesterolemia, obesity and depression. 
• Non-modifiable risk factors include age and genetics.

Physiotherapy

Physiotherapy is useful in cognitive rehab as on a physical level it can reduce the risk of falls, and improve sleep and cardiovascular health. On a mental level it can lift moods, ease stress, and slow mental decline.  When physiotherapy is used for geriatric cognitive health, it should follow a 3-step process:

• the first stage is to maintain functional status and prevent falls
• the second stage is to maintain active daily living and educate the family on how they can support their family members
• the third stage is to manage muscle contracture and positioning.

Exercise

Exercise should focus on increasing joint range of movement and muscle strength to make daily tasks easier. Exercises should be both active and passive, with an emphasis on stretching to reduce joint inflammation.

Balance Training

Balance training is important in patients with dementia to improve confidence and reduce the risk of falling. As balance is position specific both standing and sitting exercises are encouraged. Training should begin with weight shifts in both sitting and standing in order to help the patient develop an appreciation of his limits of stability.

Strength Training

Strength training helps in building lean muscle mass, increasing metabolism, controlling blood sugar levels. These can be performed at home with light-weight dumbbells and therabands.

Gait Training

Gait training helps in improving mobility and functional ability without support. The major goals are to lengthen stride, broaden base of support, improve stepping, and increase contralateral movements.  These can be done at home with the correct support.

Aerobic Exercises

Aerobic training helps in improving cardiovascular health,  and strengthens the immune system.

Aerobic exercise includes jogging, cycling, swimming or any physical activity that rejuvenates the patients pulmonary and cardiac capacity.

Cognitive and memory improvement therapy

Cognitive stimulation therapy (CST) aims to improve your mental abilities by keeping your brain active. This is done through a series of themed activity sessions carried out over several weeks

People in later stages of dementia may enjoy simpler exercises that relate to their own interests and capabilities. Such exercises could include:

• Doing simple calculations.
• Reading aloud from books.
• Storytelling, including brief stories and role playing in longer stories, to help increase attention and participation and to stimulate emotions and memories.
• Imagery exercises to stimulate the senses, such as recalling a peaceful nature scene.
• Dancing.
• Playing musical instruments.
• Listening to music.
• Taking a cooking class.
• Learning a foreign language.
• Drawing a map from memory.
• Challenging your taste buds. When eating, try to identify individual ingredients in your meal, including subtle herbs and spices.
• Refining your hand-eye abilities. Take up a new hobby that involves fine-motor skills, such as knitting, drawing, painting, assembling a puzzle, etc.

Role of Family members

Family members are an important part of the care team and often derive satisfaction in knowing that they can still help with the care and comfort of their loved ones. To facilitate this, staff may provide suggestions for activities that the family members can engage in with the resident.

References

Urmi Chavan. Physiotherapy in Dementia. Gerontol & Geriatric Stud .4(2). GGS.000581.2018. DOI: 10.31031/GGS.2018.04.000581.

Physiotherapy in Dementia, Jaswinder Kaur, Shweta Sharma et al.2012.