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Some form of cognitive decline is likely to affect most people in their senior years. But even those diagnosed with Alzheimer’s and other kinds of dementia are benefitting from new approaches to cognitive care.

One emerging trend in the management of cognitive health is a holistic focus on the entirety of the individual rather than on the disease progression.

What this involves is a process of discovery: who the patient is, who they used to be, and how their strengths and skills sets can be preserved to maximize their quality of life.

From going back to university at the age of 80 to driving, working or serving on boards of directors, people who have been diagnosed with dementia often lead full, rich lives.

Through keeping an active mind and body, even someone who has been diagnosed with Alzheimer’s can function at a higher level, says neuroscientist Dr. Saskia Sivananthan, who has witnessed all the scenarios above.

“When people think of dementia they think end-stage: sitting in a wheelchair, in a nursing home and unable to speak,” says Dr. Sivananthan, Chief Research and Knowledge Transfer Experience Officer at the Alzheimer Society of Canada.

“Yes, it does have that decline and can be very devastating. But people can live well with dementia for 20 years. The key is that they need the support to be able to do it.”

The exact same disease can look strikingly different from one individual to another, says Dr. Heather Palmer, National Director, Cognitive Well-being at Amica Senior Lifestyles, a community of seniors’ residences across Canada. A cognitive aging and dementia specialist who conducts rehabilitation work, Dr. Palmer is especially interested in the brain’s ability to rewire itself – known as neuroplasticity.

“Evidence shows that the right tools and approaches can help people continue to function well or even better than they did before. Even at the senior age, you can build new brain pathways and nurture existing ones,” she says. “While we can’t stop the disease, we can manage the cognitive abilities that are affected by it like memory, language and multi-tasking.”

Dr. Palmer has had several patients move from assisted to independent living after conducting cognitive rehabilitation work. In one instance, one of her patients, who had been diagnosed with Alzheimer’s in her early fifties, had that diagnosis questioned later on by doctors.

“Normally it is a progressive disease, so seeing improvement in her symptoms made them question the diagnosis,” she explains. “The challenge is that to see these improvements, the person must have the cognitive capacity to follow through on what they are learning. This requires a certain level of self-awareness that they are not thinking their best and there is something they can do about it.”

While a patient whose decline is advanced might be more challenged, care partners and adult children can be trained to fill in some of the gaps, ensuring two important functions – the retaining of their dignity and their capacity to experience joy.

“We’re a big fan of using multi-sensory approaches for those who can no longer verbally communicate. Instead of saying, ‘it’s time to brush our teeth,’ you might show them a toothbrush and put it in their hand. You would look for behavioural indicators like smiling, accepting or resisting,” Dr. Palmer says.

“Something we do for our residents in memory care is build a story box filled with personalized items that help them interact and reminisce in meaningful ways. For instance, if they grew up on an apple farm, there could be an apple-scented candle in there to bring back fond memories, or clothing patterns if they used to be a dressmaker.”

“They might not verbally be able to say, ‘this reminds me of when,’ but you can still see the happiness and relaxation come over their face as they go to a place that once brought them joy.”

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Hands-on therapy

Before he was struck with an aggressive form of dementia, Suzanne Lemire’s father, Nelson Johnson, 77, worked tirelessly with his hands. The desire to build things did not leave the former sheet metal worker as he aged, and so when he started to take apart his glasses, staff at the Amica Little Lake residence in Barrie, Ont. brought him mechanical toys to manipulate and gave him tasks like peeling apples for making pies.

“At first he was in the assisted living area at Amica with my mother, but after a few months he needed to be moved into the memory care area where he was under the care of a geriatrician,” says Ms. Lemire. “The geriatrician noticed an improvement in his alertness and responsiveness and commented that he seemed to be thriving in the new setting.

“The staff have residents doing a variety of things every single day – sand therapy one day, singing along to music from their era the next, taking them to see the Christmas lights or the fall colours on the bus. They do everything they can to involve the residents and make them feel useful.”

Research shows socialization and feeling connected to other human beings is vital to our cognitive health, says Dr. Palmer.

“If I were to walk into a residence and saw each person individually painting their own art, that’s a nice activity. An even better activity is if those people were helping each other on the same project or making comments on each other’s art.

“It’s not about how closely you can get your art to look like van Gogh, but the engagement in conversation while you do both at the same time; you have to pay attention, think ahead what your next question is going to be and remember what the other person has said. Those are the regions of the brain that fail us as we age. If you were to look inside their brains while they were chatting while painting, they'd be lighting up like crazy.”

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