Cognitive Rehabilitation

Cognitive rehabilitation focuses on ‘identifying and addressing individual needs and goals, which may require strategies for taking in new information or compensatory methods such as using memory aids.’ [1] The focus of cognitive rehabilitation is to improve function in everyday activities in a real-life context. [2] It is different to cognitive training which is the ‘guided practice on tasks that target specific cognitive abilities and functions, such as memory, attention, or problem-solving.’ [1] Cognitive training and stimulation interventions for people living with dementia are discussed in a separate evidence theme.

This evidence theme is a summary of one of the key topics identified by a scoping review of rehabilitation, reablement, and restorative care research. If you need more specific or comprehensive information on this topic, try using the PubMed search below.

We found three reviews focusing on cognitive rehabilitation for older people living with dementia in aged care. These reviews identified that:

• Weekly group cognitive rehabilitation for three weeks combined with drug therapy improved temporal-spatial orientation and attention for older people with mild dementia. [3, 4]
• Goal-directed and personalised cognitive rehabilitation conducted one hour per week for eight weeks improved capacity for activities of daily living and satisfaction among older people with mild Alzheimer’s disease. It also lowered depression levels of older people and their family carers. [1, 3, 5]
• Comprehensive cognitive rehabilitation using patient-specific care plans in a memory clinic conducted twice a year, was no different to usual care in slowing the rate of functional decline. [3,6]
• A physiotherapist-led cognitive rehabilitation intervention focused on joint, muscle, and functional mobility re-education showed no benefits over a general one-on-one mobility exercise session for people living with dementia. [3,7]
• Cognitive rehabilitation as a component of multifaceted programmes, usually in the form of simulation sessions of activities of daily living, improved or at least maintained activities of daily living performance in older people when compared with usual care. [2]
• Cognitive rehabilitation compared with cognitive training resulted in the following [1]:
• Improved general health and quality of life; however, this was based on only one study with small sample size and a high risk of bias. [8]
• No difference in a global measure of cognition [8,9], mood [8,9], ADLs [8,9], general health and quality of life [9], responsive behaviours [9], participant burden and caregiver burden [9], disease progression [8], language (naming), verbal letter fluency [8], verbal category fluency [8], executive function [8], and speed of information processing. [8]

Ways for a person to use cognitive rehabilitation for an older person living with dementia in aged care include:

• Involve the older person and/or the family and friends in discussions to identify the specific needs and goals of the older person.
• Consider different forms of task-related activities tailored to the interests and goals of the older person.

Organisations can support the use of cognitive rehabilitation for older people living with dementia in aged care by:

• Providing opportunities for staff to undergo training on cognitive rehabilitation.

• Evaluating the impact of the cognitive rehabilitation strategies.

1. Bahar-Fuchs A, Martyr A, Goh AM, Sabates J, Clare L. Cognitive training for people with mild to moderate dementia. Cochrane Database Syst Rev. 2019;3:CD013069.
2. Garrido-Pedrosa J, Sala I, Obradors N. Effectiveness of cognition-focused interventions in activities of daily living performance in people with dementia: A systematic review. Br J Occup Ther. 2017;80(7):397-408.
3. Zabalegui A, Hamers JP, Karlsson S, Leino-Kilpi H, Renom-Guiteras A, Saks K, et al. Best practices interventions to improve quality of care of people with dementia living at home. Patient Educ Couns. 2014;95(2):175-84.
4. Giordano M, Dominguez LJ, Vitrano T, Curatolo M, Ferlisi A, Di Prima A, et al. Combination of intensive cognitive rehabilitation and donepezil therapy in Alzheimer's disease (AD). Arch Gerontol Geriatr. 2010;51(3):245-9.
5. Clare L, Linden DEJ, Woods RT, Whitaker R, Evans SJ, Parkinson CH, et al. Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: A single-blind randomized controlled trial of clinical efficacy. Am J Geriatr Psychiatry. 2010;18(10):928-39.
6. Nourhashemi F, Andrieu S, Gillette-Guyonnet S, Giraudeau B, Cantet C, Coley N, et al. Effectiveness of a specific care plan in patients with Alzheimer’s disease: Cluster randomised trial (PLASA study). BMJ. 2010;340:c2466.
7. Pomeroy W, C. M., Honeycombe, C., Briggs, R. S. J., Wilkinson, D. G., Pickering, R. M., & Steiner, A. Mobility and dementia: Is physiotherapy treatment during respite care effective? Int J Geriatr Psychiatry. 1999;14(5):389–97.
8. Brueggen K, Kasper E, Ochmann S, Pfaff H, Webel S, Schneider W, et al. Cognitive rehabilitation in Alzheimer's disease: A controlled intervention trial. J Alzheimers Dis. 2017;57(4):1315-24.
9. Amieva H, Robert PH, Grandoulier AS, Meillon C, De Rotrou J, Andrieu S, et al. Group and individual cognitive therapies in Alzheimer's disease: The ETNA3 randomized trial. Int Psychogeriatr. 2016;28(5):707-17.