Dementia as no cur but it can be treated by non-pharmacological therapies that consist of a range of interventions aimed to people living with dementia without the use of medication. These are evidence-based techniques that have been shown to be effective and can be incorporated into everyday routines.
Currently, these interventions play a complementary role alongside pharmacological treatment, as they directly promote autonomy, stimulate cognitive abilities and functional skills, and enhance physical and emotional well-being.
Cognitive Interventions
Cognitive stimulation
It consists of participation in a range of activities and discussions, usually in a group, aimed at improving cognitive and social functioning. It has a high level of scientific evidence in improving cognitive function and quality of life.
Cognitive training
It is a guided practice on a set of standardised tasks to reflect various cognitive areas such as language, memory, orientation, perceptual-motor ability, among others, through learning and reinforcement. There may be various levels of difficulty with the aim of adjusting the tasks to each person's abilities. It has less evidence of effectiveness than Cognitive stimulation and Cognitive rehabilitation.
Cognitive rehabilitation
It involves identifying relevant goals and working on them with the person and caregiver or family. The focus is on maintaining functioning in daily life, reinforcing strengths and compensating for deficits to support independence. The ultimate goal is not to improve cognition but to compensate for the impairment in activities of daily living, with the resulting benefits.
Reminiscence Therapy
It works on old autobiographical memories that are characteristically retained for longer throughout the course of dementia. It involves discussing activities, events and experiences from one's life history and is generally triggered by the use of evocative objects such as photographs and everyday objects that prompt dialogue.
Validation therapy
It is based on the general principle of validation, acceptance of the reality and personal experience of the other. It allows one to reach the emotional meaning of what is verbalised. The expression and sharing of feelings facilitate emotional connection.
Reality Orientation Therapy
It aims to help the person orient themselves in present space and time, either in a structured and systematic way through calendars, clocks and questions directed at the spatio-temporal situation, or in a more informal way by giving information in everyday interactions.
Other Therapies
· Therapies related to physical activity such s Psychomotricity and Physiotherapy.
· Sensory therapies such as Snoezelen Multisensory Therapy, Aromatherapy and Massage.
Among other therapeutic approaches that have shown benefits are Therapeutic Gardens, Dance, Animal-Assisted Therapy, Light Therapy, Meditation and interventions aimed at the caregiver and the care team.
Bibliographic references
Mainly referring to the page Dementia I Pharmachological Treatment and the page Services I Stimulation Activities I
Alvares-Pereira, G., Silva-Nunes, M. V., & Spector, A. (2021). Validation of the cognitive stimulation therapy (CST) program for people with dementia in Portugal. Aging & Mental Health, 25(6), 1019–1028. https://doi.org/10.1080/13607863.2020.1836473
Clare, L., & Woods, R. T. (2004). Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer’s disease: A review. Neuropsychological Rehabilitation, 14(4), 385–401. https://doi.org/10.1080/09602010443000074
Cohen-Mansfield, J. (2018). Non-pharmacological interventions for persons with dementia: What are they and how should they be studied? International Psychogeriatrics, 30(3), 281–283. https://doi.org/10.1017/S104161021800039X
Cohen-Mansfield, J., Buckwalter, K., Beattie, E., Rose, K., Neville, C., & Kolanowski, A. (2014). Expanded review criteria: The case of nonpharmacological interventions in dementia. Journal of Alzheimer’s Disease, 41(1), 15–28. https://doi.org/10.3233/JAD-132357
Direção-Geral da Saúde. (2023). Norma Clínica n.º 053/2011: Abordagem diagnóstica e terapêutica do doente com declínio cognitivo ou demência (Atualização de 21 de abril de 2023). https://www.dgs.pt/normas-orientacoes-e-informacoes/normas-e-circulares normativas/norma_53_2011_act_21042023-pdf.aspx
Fundación CIEN. (2012). Guía práctica para profesionales que trabajan con enfermos de Alzheimer. Fundación CIEN (Centro de Investigación de Enfermedades Neurológicas). https://www.fundacionreinasofia.es/Lists/Documentacion/Attachments/15/Guia%20profesionales_Alzheimer_final.pdf
Gräsel, E., Wiltfang, J., & Kornhuber, J. (2003). Non-drug therapies for dementia: An overview of the current situation with regard to proof of effectiveness. Dementia and Geriatric Cognitive Disorders, 15(3), 115–125. https://doi.org/10.1159/000068477
Meyer, C., & O’Keefe, F. (2020). Non-pharmacological interventions for people with dementia: A review of reviews. https://doi.org/10.1177/1471301218813234
Olazarán, J., Reisberg, B., Clare, L., Cruz, I., Peña-Casanova, J., del Ser, T., Woods, B., Beck, C., Auer, S., Lai, C., Spector, A., Fazio, S., Bond, J., Kivipelto, M., Brodaty, H., Rojo, J. M., Collins, H., Teri, L., Mittelman, M., Orrell, M., Feldman, H. H., & Muñiz, R. (2010). Nonpharmacological therapies in Alzheimer’s disease: A systematic review of efficacy. Dementia and Geriatric https://doi.org/10.1159/000316119
Ornish, D., Madison, C., Kivipelto, M., Kemp, C., McCulloch, C. E., Galasko, D., Artz, J., Rentz, D., Lin, J., Norman, K., Ornish, A., Tranter, S., DeLamarter, N., Wingers, N., Richling, C., Kaddurah-Daouk, R., Knight, R., McDonald, D., Patel, L., … Arnold, S. E. (2024). Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: A randomized, controlled clinical trial. Alzheimer’s Research & Therapy, 16, Article 122. https://doi.org/10.1186/s13195-024-01482-z