The Hearthstone Alzheimer Care
Cognitive Strengthening Program

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Background

The Cognitive Strengthening Program is a treatment program for people with Mild Cognitive Impairment (MCI) and early Alzheimer's disease. It is available in several Hearthstone Residences. The Cognitive Strengthening Program builds on the latest research into treatment to improve the cognitive abilities of those with early dementia. In particular, it seeks to use these new findings to delay the progression of Mild Cognitive Impairment.

Mild Cognitive Impairment and Early Alzheimer's Disease

Mild Cognitive Impairment is the name given to a syndrome of impaired cognitive function, especially impaired memory, in people who otherwise do not meet the criteria for dementia. Many of those who are initially diagnosed with Mild Cognitive Impairment will go on to develop Alzheimer's or a related dementing illness. The rest have diverse other medical or psychiatric difficulties, often compounded by sensory deficits that cause similar symptoms.

Researchers believe it is advantageous to diagnose and treat even the mildest symptoms as early as possible. It appears that early pharmacological and non-pharmacological treatment can delay the progression of dementing diseases and reduce cognitive decline.

Potential Effects of Cognitive Strengthening Program

In addition to cognitive problems such as memory impairment and difficulty concentrating and completing complex tasks, psychiatric symptoms are often seen in people with MCI. For example, many people with early Alzheimer's and MCI also suffer from depression, anxiety and suspiciousness. These are also responsive to appropriate treatment.

How Mild Cognitive Impairment and Early Alzheimer's Affect Memory

There are several types of memory, not all of which are equally impaired in people with dementia. Researchers tend to divide memory into three main groupings: Episodic, Semantic, and Procedural. While older episodic memories are typically maintained, new episodic memory (like what one had for breakfast) is usually the first type of memory to be impaired. Semantic memory, the ability to understand the meaning of words, and even of things in the world, is typically intact in early Alzheimer's and MCI. Procedural memory, like how to ride a bike, or how to act in social situations, is preserved long into the disease.

The Hearthstone Cognitive Strengthening Approach

Hearthstone has long been interested in research-based, non-pharmacological treatments for dementia. Hearthstone co-founder and Chief Executive Officer, Joan Hyde, Ph.D., states, "The unevenness of early neurological damage results in uneven patterns of decline. Initially, these patterns are so markedly uneven that individuals can usually function well within the normal level in most endeavors. Although different parts of the brain are responsible for different functions, often multiple parts must coordinate to produce a particular result, and people can compensate effectively for deficits by using remaining capacities to achieve the same result."

A person with Mild Cognitive Impairment may have difficulty with automatic information storage and retrieval (episodic memory). At the same time, that person may have acquired more skill in recording needed information manually than he had earlier in life and improved his ability to refer to the notes he has taken (procedural memory). He may also have improved social skills that make him a better listener, and thereby become better able to elicit and use cues regarding other people's identities (which he would otherwise have forgotten) and the purpose of their conversation. While some individuals with such compensatory strategies are "self-taught," it is entirely possible to train those with mild cognitive impairment and early Alzheimer's in their use. Skill reinforcement and specific memory enhancing techniques not only increase function in the present, but also may provide the continued stimulation the brain needs to slow decline.

In conjunction with new medications that improve memory in early Alzheimer's, and maintaining physical and mental health, reinforcing retained skills can delay the onset of symptoms and improve the function and quality of life of those with dementia.

The Cognitive Strengthening Program

The Cognitive Strengthening Program emphasizes individual evaluation to pinpoint areas of strength on which to build. Residents in this program continue to have considerable self-determination. For example, they are involved in deciding what they would like help in remembering, and are then provided with exercises that have been proven effective in doing so. Their interests and preferences are respected, and the results of their evaluation are used to modify tasks so they can continue to enjoy successful completion of them.

While the program is more challenging to residents than Hearthstone's Life Quality Program, residents are not allowed to fail in their attempts to the point of feeling discouraged. Positive emotions are central to continued cognitive improvement.

The Cognitive Strengthening Program Tends to Each Individual's Physical Health

Physical health is attended to and any potential conditions that might aggravate cognitive decline are addressed. In particular, many people with MCI also experience depression, which, if untreated, itself can cause cognitive decline. With pharmacological and supportive therapeutic treatment, the individual can maintain a much higher level of function. Untreated pulmonary and cardiological conditions can reduce the amount of oxygen to the brain, causing further cognitive symptoms. Mild chronic infections and hormonal imbalances can also cause cognitive slippage or exacerbate existing impairment.

People with MCI/early Alzheimer's often do not compensate effectively for sensory impairments like hearing and vision loss, which are so common in the elderly. Program staff work with health professionals to ensure that well-fitting glasses and hearing aides are used properly, and other prosthetic measures such as large print books are available. In addition, the physical environment is designed to reduce glare and unnecessary background noise, and the staff are trained to interact with residents in a way that maximizes each resident's ability to understand the stimuli being offered.

Finally, physical conditioning brought about by strength, flexibility, and endurance training, has been found to improve overall health, and with it improved cognitive ability. Residents are enrolled in an exercise program that meets their needs and builds on their interests. Research has shown that such a program can reduce falls, maintain strength and flexibility needed to perform everyday tasks, while improving mood.

Activities Stimulate the Mind and the Spirit

Activities are designed to enhance memory and function and to preserve skills by giving people practice in the skills they already have, as well as by bringing about positive emotions and maintaining them throughout the day.

The program uses multi-sensory stimulation to bring new approaches to tasks, compensate for damaged areas of the brain. Word games, story-telling, structured social situations that call upon preserved social skills, musical and art events, crafts (crocheting, woodworking), cooking and housekeeping tasks, golf and other recreational activities are all opportunities for using and building on remaining abilities. At the same time, the program strives to maintain positive emotions through challenges that result in success, guided self-determination, exercises to increase attention span, and self-actualization through reminiscence, and spiritual pursuits.

Examples of Sensory and Other Activities that Improve Cognitive Function

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