Evidence-Based Intervention Strategies for Alzheimer's and Dementias

This podcast episode, part of a CEU training, provides mental health clinicians with evidence-based intervention strategies for individuals experiencing Alzheimer's and other dementias. It expands the traditional view of counseling beyond talk therapy, emphasizing a holistic approach that includes assessment, diagnosis, treatment planning, and coordination of care within various settings like assisted living facilities, nursing homes, and for those aging in place. The discussion highlights the multidisciplinary nature of dementia care, involving patients, families, facility staff, medical providers, and even other residents, while stressing the importance of appropriate release of information and HIPAA compliance.

The presentation details several common cognitive staging and functional assessment tools, including the St. Louis University Mental Status Exam (SLUMS), the Global Deterioration Scale (GDS), the Montreal Cognitive Assessment (MoCA), and the Functional Assessment Staging Tool (FAST). It explains their purpose, scoring, and implications for diagnosis, staging, and determining appropriate levels of care, such as memory care or hospice. The speaker acknowledges the inherent subjectivity in these tools and advocates for focusing on the individual's ability to live a rich and meaningful life, rather than solely relying on numerical scores.

The core of the training lies in practical, actionable interventions categorized by physical, interpersonal, emotional, cognitive, and environmental domains. Physical interventions include managing pain, circadian rhythms, nutrition, toileting, mobility, and safety. Interpersonal strategies focus on communication, patience, and encouraging social interaction to boost oxytocin and cognitive stimulation. Emotionally, validation, reminiscence therapy, and empowering patient choices are key. Cognitively, the importance of cognitive stimulation therapy, 'joining' the patient's reality (with modifications), and redirection are discussed. Environmentally, managing sensory sensitivities, light levels, temperature, and activity to regulate circadian rhythms and reduce agitation like Sundowning are emphasized.

A significant portion of the episode is dedicated to reminiscence therapy, presented as a powerful cognitive and affective intervention. It involves using sensory prompts (photos, music, objects, scents) to encourage elaboration on past experiences, particularly focusing on the 'reminiscence bump' (memories from ages 15-30). This therapy is shown to activate positive neurotransmitters, help rebalance the sympathetic nervous system, reduce agitation and depression, and strengthen neural circuits, ultimately contributing to a higher quality of life and potentially slowing the progression of dementia by fostering feelings of safety and empowerment.

Counseling is more than talk therapy and I want people to recognize that if you are going in to work in an assisted living facility or um a nursing home you may not be able to effectively engage in what we typically think of as talk therapy.

We need to understand who's part of that system who can provide us information about what's going on and what might help.

Our goal when we're working in Assisted Living um and and just general are to establish and maintain an alliance with the patient and family.

What we really want to focus on is the person's ability to live their rich and meaningful life.

Interaction not only improves oxytocin levels but it also stimulates cognition and that too will help slow the progression of dementia.

Joining is another issue or another thing that we need to consider just like when you're working with somebody with schizophrenia that is in an active um psychotic episode trying to argue with them that their perceptions are inaccurate you're not going to get anywhere.

Reminiscence therapy is a cognitive and affective intervention it uses sensory prompts including photos music objects or scents.

It's important to focus on what they call the reminiscence bump and this is memories that they have from ages about 15 to 30.

Reminiscence therapy helps people go back to a time when they felt safe and empowered and this helps them turn their attention uh to times that triggered positive neurotransmitters.

Reminiscence therapy if you help them focus on positive memories can help them deal with their sympathetic dominance.