02 Module Two THE ROLE OF SCIENCE 2.1 Understanding Brain ... · ISBN 978-0-9868482-5-4 e 1 02 –...

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02 – Module Two – THE ROLE OF SCIENCE

2.1 Understanding Brain Science

The state of our brains determines how we interact with the world around us – from our

thoughts, emotions and memories to our ability to process information, our relationships with

others and our view of the meaning and purpose of our lives. The brain is complex and

understanding how it works is important in order to help clients successfully integrate the Fit

Minds programs into their lives and fully enjoy all its potential benefits. In this section we will

look at the brain from two perspectives to help get a good overall sense of how the brain

works.

A useful perspective on the structure of the brain is to look at it from a “top-down” orientation,

with the cortex at the top and the subcortex at the bottom. While these two regions of the

brain are distinct, each with distinct responsibilities, they are also integrated, helping the brain

to operate like a symphony.



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A. Cortex

Your brain is two to four pounds and is made up of gray matter and white matter. The gray

matter tends to be contained in an area of your brain called the cortex, a word that translates

to “bark of a tree”. Your cortex is a convoluted mass of cells with folds and flaps that sits snug

within your skull. The white matter is situated more deeply in the brain, beneath the cortex,

and helps to bridge or connect different regions of the brain. White matter helps to propel

information and to insulate cells and nerve tracts. It developed from the back to the front –

meaning that the front part of your cortex is the most recent member or region of your brain to

develop, evolutionally speaking. The cortex is primarily responsible for your most complex

thinking abilities, including memory, language, planning, concept formation, problem solving,

spatial representation, auditory and visual processing, mood, and personality. Processing in the

cortex tends to be conscious and intentional.

The cortex is generally divided into four primary regions, or lobes: the frontal, temporal,

parietal, and occipital. Each of these four lobes has specific behaviors and functions primary to

its regions.



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The frontal lobes are also known as the executive system since they help execute behavior,

organize behavior, plan, conceptualize, maintain cognitive flexibility, and stabilize mood. Your

personality is thought to reside in the frontal region of your brain.

Your temporal lobes are the site of your auditory brain, memory and new learning, language,

and perhaps religiosity. Your parietal lobes help you with spatial orientation, memory, reading

and writing, mathematics, and appreciation of left versus right. Finally your occipital lobes help

you to see, discriminate what you see, and perceive.

B. Subcortex

Sitting just under the cortex and on top of the ascending brain stem are a number of smaller

and generally more primitive structures (relative to the cortex) known as the subcortex. Your

subcortex primarily processes rote skills and procedures. Some, if not most, of the processing

conducted in the subcortex is subconscious. Activities such as driving, dressing, typing, and

most other routine tasks involve multiple routine procedures that are conducted at a

subconscious level. Your cortex and subcortex are distinct regions of the brain, but they do not

sit in isolation of one another. In fact, there are numerous connections between these two

important brain regions.

C. Left and Right Hemispheres

The second perspective or approach is to divide the

brain “left to right”, appreciating that the brain is

comprised of two distinct yet integrated hemispheres we

call the dominant and non-dominant sides of the brain.

We refer to these sides as hemispheres, and you have a

left hemisphere and a right hemisphere. Each



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hemisphere is connected by a bridge known as the corpus callosum.

Each hemisphere has some distinct, yet not necessarily mutually exclusive, responsibilities.

Your behaviors and functions are related primarily to one of these two hemispheres. For

example, most of us – and nearly all right handers – have language distributed in the left

hemisphere. We refer to the hemisphere in which language is based as the dominant

hemisphere as a sign of respect for the importance of language. Left-handers with a parent

who is left-handed, a relatively rare phenomenon, have a higher probability than right-handers

of having language functioning distributed primarily in the right hemisphere. They would be

right-hemisphere dominant. Your dominant hemisphere – left for most of us – also processes details,

is task oriented, logical, analytical, and sequences information. Your non-dominant hemisphere helps

you process non-language information such as size, shapes, sounds, and space.

Your two hemispheres are connected by a bridge of cells referred to as the corpus callosum.

Information crosses from one side of your brain to the other over the corpus callosum, and this

is a critical part of your brain’s ability to remain functional despite its many complex operations

on a daily basis. Interestingly, the female brain is thought to have a larger corpus callosum,

which underscores the notion that female brains process information differently from male

brains. Females tend to utilize both sides of their brains more to process than men, who tend

to rely primarily on one side, the dominant hemisphere.

D. Neurons

The operation and function of your brain is ultimately conducted by millions of brain cells we

refer to as neurons. A neuron contains a cell body sometimes referred to as soma, a long arm

extending out from the cell body referred to as an axon, and branchlike figures called dendrites

that extend out into the brain environment seeking new information to relay back to the cell

body.



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Information from the cell body travels down the axon into the surrounding brain, while

information from the environment is gathered by the dendrites and brought back to the cell

body. This ongoing exchange of information by the brain is why we refer to it as the central

information processing system.

We are taught that our brains contain millions of brain cells and that each neuron can

communicate with another ten thousand neurons. Interestingly, one neuron never touches

another neuron, but two cells may communicate via chemicals, and this chemical marriage is

called a synapse. The more synaptic connections you develop over your life span, the healthier

your brain may be, because it is building up brain resilience. Brain resilience may have the

ability to delay the onset of neurodegenerative diseases such as Alzheimer’s.

E. Hippocampus

The hippocampus is critical to you and your life story. The hippocampus sits in the middle of

each of your temporal lobes, which lie under your temples on each side of your head.



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Your hippocampus or hippocampi, plural, as you have one in each hemisphere, takes new

information in and maintains the information in a type of working buffer. If you believe the

information is important, and you need to store that information for an extended period of

time, your hippocampus will transition the information to a specific area of your cortex. The

process is not random, but rather very sophisticated, and the process of storage seems to be

stimulus-based. That is, if you are learning information that is visual, your hippocampus will

help store the information permanently in the visual cortex of the brain. The same process is

thought to occur for the other four types of sensory input: sound, touch, taste, and smell.

Your hippocampi represent your vital learning and encoding structures, thereby helping you to

build your life story and maintain your personal memories. Recent research suggests your

hippocampi have tremendous ability, including new brain cell development referred to as

neurogenesis.

F. Brain Plasticity

This is a concept that was first articulated in 1890 by Dr. William James, the father of modern

psychology. The idea was that the brain can continue to change and adapt throughout our

lifetime. This concept was largely ignored until the 1980s when Dr. Paul Rich-y-Bata and Dr.



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Michael Merzenich began their research. They showed that the brain is still able to change in

structure and functional abilities throughout the life of the individual. One study that highlights

this ability is the ACTIVE study.1 The Advanced Cognitive Training for Independent and Vital

Elderly (ACTIVE) study is the first multicentre, randomized controlled trial to examine the long-

term outcomes of cognitive interventions on the daily functioning of older individuals living

independently. This study followed the effects of brain training on individuals over the age of

65. A volunteer sample of 2832 individuals, with an average age of 73.6 years, living

independently in six US cities, was recruited for the study. The study concluded that cognitive

training had a positive impact on cognitive functioning – even at the five-year follow-up. At the

ten year follow-up, individuals who had the cognitive training initially had better ADLs

(Activities of Daily Living) then those who had not received the cognitive training.

The knowledge that our brains are malleable, that they can adapt and change as we grow

older, has changed the whole field of neuroscience. With the advent of new, more sensitive

neuroimaging technology, our understanding of the human brain has increased and changed.

We now know the human brain has “plasticity”, which means it is dynamic, constantly

reorganizing, and malleable – capable of being shaped structurally and functionally by the

environment. The brain is able to continue to produce new brain cells, generating those cells in

the hippocampus. In this way, your brain is very distinct and actually superior to the fanciest

computers because computers will always have built-in limitations and finite capacity. We refer

to the dynamic, constantly reorganizing, and malleable nature of your brain as brain plasticity.

The power of brain plasticity forms the basis of the Fit Minds Stay Sharp™ program – creating

an opportunity for you to implement a proactive program to grow and promote the brain

health of the seniors you work with, as well as benefiting your own brain along the way.

1 Ball K, Bersch D, Hlemers K, et al, Effect of cognitive training interventions with older adults: a randomised control trial. JAMA 2002; 288:2271-2281



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G. Dendrite Density

Dendrite density refers to the connections between brain cells. If a brain has more connections

between brain cells it is a healthier brain. An example used by Paul Nussbaum, Ph.D, author of

Save Your Brain2, is to think of the brain as either a jungle or a desert island. From the air, the

jungle is dense with thick and intertwined vegetation to the extent that the ground is totally

covered with green. Contrast that scene with a desert island with a single palm tree on it. The

vegetation is pretty thin and from the air the ground appears fairly barren. If Alzheimer’s

disease can be compared to a weed-whacker that attacks the brain, the brain with greater

density like the jungle would be able to resist the impact of the disease for a longer period of

time than a brain with the density of a desert island.

The brain also reacts to non-use of brain cells and dendrites through dendrite pruning. This is

where the notion ‘use it or lose it’ comes from. If there are components of the brain that are

not being used, the brain will prune these connections and brain cells. Thus those cells will die

and the brain will shrink in size and capacity.

An interesting study of medical students at the University of Hamburg3 showed that students’

brains grew over the course of their studies. The students’ brains were subject to MRI scans

before their exams, half-way through their exams and after their exams were completed. The

results showed an increase in grey matter of the brain as the students went through the

process of studying for their exams. The conclusion we can draw is that learning new material

(not necessarily medical studies) promotes growth in grey matter, increases synaptic density

and will lead to greater cognitive resilience.

2 Nussbaum P, Save Your Brain – 5 Things You Must Do to Keep Your Mind Young and Sharp, McGraw Hill 3 Draganski B, Gaser C, et al; Temporal and Spatial Dynamics of Brain Structure Changes during Extensive Learning: The Journal of Neuroscience (2006): 26(23) 6314-6317



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H. Cognitive Resilience

Cognitive resilience is the capacity that the brain builds over its life span to resist or buffer itself

when attacked by a disease or reconfigure itself if injured by a brain trauma. Cognitive

resilience may be broken into two elements. The brain has both a passive cognitive resilience

which refers to brain structure and an active cognitive resilience which refers to brain

compensation and refers to the ability of the brain to compensate or re-wire itself around

damaged parts. The greater the cognitive resilience of the individual, the greater the brain’s

capacity to buffer against a disease like Alzheimer’s or respond to a traumatic brain injury like a

stroke.

Cognitive resilience is built through learning over the course of your lifetime. As shown in the

medical students study referenced above, learning new and complex material helps the brain

grow and create greater capacity. Continuous learning then becomes a key to maintaining and

improving brain health.

The three concepts of brain plasticity, dendrite density and cognitive resilience are inter-

related concepts and they form the basis of the Fit Minds programs – programming that

presents both novel and complex activities to stimulate and build brain health.

2.2 Research on Aging

A. Aging Well

While there may be general agreement on what a “well-aged” wine or cheese looks like, there

is less consensus around how a person ages well. Some standards emphasize physical ability,

others emphasize social activity and still others emphasize cognitive strength.



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Ann Bowling, a professor at University College London, reviewed the existing literature on

successful aging in 2007. She found that there were two main categories of successful aging

standards: biomedical and socio-psychological.

Biomedical standards compare individuals to an expected path of decline – if you do better or

last longer than expected then you are aging successfully. Some factors that are considered

here are:

> presence or absence of chronic disease

> longevity (how old are you?)

> mobility

> mental functioning

> presence or absence of disabilities

While these are obviously key aging factors – and ones that seniors themselves consider when

planning for the future and reflecting on the present – they do miss something valuable.

When researchers actually asked seniors how they defined successful aging, the gaps in

biomedical perspectives became clear. Life satisfaction places more emphasis on socio-

psychological perspectives.

Socio-psychological standards focus on subjective factors – if you feel you are doing well or

better than you expected, then you are aging successfully. Some factors that are considered

here are:

> life satisfaction

> support and activity gained from social relationships

> sense of purpose



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> ability to cope or adapt

> spirituality

> financial security

The importance of these factors differs from individual to individual.

Physicians, other health care professionals and businesses in the senior care sector need to

understand that seniors’ perspectives on successful aging are layered and complex. It’s

important to value not only biomedical markers but also personal factors like satisfaction and

adaptability. Individuals should be encouraged to develop their own definition of successful

aging and be supported in living up to that definition.

B. The Nun Study

The Nun Study is a study that has followed 698 School Sisters of Notre Dame, ranging in ages

from 74 to 106 years over 15 years (at the time of initial publication) as well as reaching back to

study archival documents of the sister’s convent life. The study was initiated by David

Snowdon, PhD who began the study in 1986 and followed this unique population from that

point through the aging process. All the participants in the study agreed upon their death to

have their brains autopsied, to allow further insight into the effects of aging and Alzheimer’s

disease on the human brain. As Sister Rita Schwalbe stated in Aging with Grace, the book about

the study,

“Our congregation was founded to work with the poor and the powerless. Who’s more

powerless than someone with Alzheimer’s disease?”

This incredible study has produced many remarkable and provocative findings and the research

is on-going. Some conclusions from the research are:



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A stronger brain has more reserve and symptoms may not appear even though

Alzheimer’s has done significant structural damage to the tissue.

Age does not wear out the mind.

There is a clear link between higher education and healthy functioning of the brain.

Depression may work in tandem with Alzheimer’s to increase the severity of the

symptoms. The identification and proper treatment of depression becomes important in

reducing the risk of developing Alzheimer’s disease.

High idea density in early life seems to protect the brain from developing Alzheimer’s

late in life. High idea density develops when individuals have complex thinking patterns.

Thus reading to your kids is an important element for giving them high idea density.

Small strokes can serve as a trip switch causing the symptoms of dementia to emerge.

Focus on effective strategies for stroke prevention such as reducing blood pressure,

exercise and a diet high in fruits and vegetables and low in fats, since a stroke-free brain

can resist the damage of Alzheimer’s disease.

The higher the levels of folic acid in the blood, the lower the chance of brain atrophy.

This finding was also supported by the OPTIMA study.

Positive emotional outlook strongly predicted the nuns who would lead the longest

lives.

Two factors that cannot be scientifically tested but which David Snowdon attributed as

contributing to the longevity and mental health of the nuns were their deep spirituality

and the power of community.

Depression, isolation and lack of interest are often critical factors in the development of the

symptoms of dementia and the individual has to be nourished heart, mind, body and soul.

Following are two highlighted examples of nuns who participated in the study – their lives and

the conclusions the study drew from them:

Sister Bernadette is one of the nuns who participated in the Nun Study. She died of a massive

heart attack at 85. During her lifetime she was physically and mentally active. She was a school



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teacher and had a Master’s degree. She scored well on all the cognitive testing done on her

prior to her death and her MRI’s indicated that she had significant cognitive reserve (grey

matter). When her brain was autopsied on her death, the doctor performing the autopsy

diagnosed her as being severely impaired with a BRAAK stage VI level of Alzheimer’s disease in

her brain. The team concluded that because of her cognitive reserve she was able to stave off

the effects of Alzheimer’s disease impacting her cognitive functioning.

As young novices of the School Sisters of Notre Dame, sisters Maria and Dolores both fled Nazi

Germany prior to the beginning of the World War II. They disembarked at Ellis Island and made

their way to Milwaukee, Wisconsin and took up their lives as School Sisters of Notre Dame. In

later years, Sister Maria became afflicted with Alzheimer’s disease while Sister Dolores was

spared. While there was much similar about their lives, there were some differences.

Sister Dolores went on to become a college professor, earning a Ph.D. while Sister Maria

worked in elementary schools but spent most of her career as a seamstress. Another significant

difference between the two sisters, which the researchers believe was very relevant, was found

in their early lives. Sister Maria had a much tougher family life and suffered from depression as

a young adult, while Sister Dolores had a happy family life and continued to be very engaged in

her work.

When Sister Maria retired, Sister Dolores went to Kenya at the age of 67 to devise and begin a

remedial program that could aid the residents to combat starvation. In 1996 Sister Dolores

returned from Kenya at the age of 80, the same year that Sister Maria, weakened by

Alzheimer’s disease, died of pneumonia. Sister Dolores certainly disproved the myth that age

wears out the mind.

One of the conclusions that the research came to was that individuals who suffered from

depression earlier in life had almost double the risk of developing Alzheimer’s disease as they



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aged. There are also many studies that suggest that a significant proportion of individuals who

have Alzheimer’s disease also suffer from depression.

After Sister Maria’s death video clips of her mental examinations became part of the

presentation done on the Nun Study at scientific conferences, colleges and community centres

around the USA. While the videotapes show the progressive loss of her short-term memory, as

Dr. Snowdon pointed out, “they also demonstrated that some of the most beautiful parts of her

brain and minds were still intact.” As Dr. Snowdon reiterates, “Regardless of her mental and

physical difficulties, she remained very much human.”

2.3 The Science of Cognitive Stimulation

This section looks at cognitive impairments and examines the science of cognitive stimulation

and interaction that can positively affect cognitive functioning.

A. Definitions

A.1 Cognitive Impairment

The ability of the brain to function can be impaired or damaged by trauma or disease.

Traumatic brain events like chemotherapy, accidents or strokes physically damage parts of the

brain, impacting on processes in that particular area of the brain. Diseases may have a

degenerative effect on the brain and cause dementia. Alzheimer’s disease, vascular dementia,

frontotemporal dementia, semantic dementia and dementia with Lewy bodies are all different

diseases that share overlapping symptoms of dementia. Generally these symptoms are an

inability to remember and a reduced ability to learn and to reason. As dementia progresses,

other functions may decline such as the ability to dress, feed and toilet oneself.

A.2 Mild Cognitive Impairment



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Mild Cognitive Impairment (MCI) is a diagnosis given to individuals who have cognitive

impairments beyond that expected for their age and education. These cognitive impairments

can affect complex daily living activities such as planning, flexibility and abstract thinking. Some

individuals can recover from MCI, others remain at this stage and do not progress. Typically

individuals who progress to some form of dementia will have suffered from MCI.

Apathy is a common symptom at this stage and remains a persistent symptom throughout the

course of the disease. Usually individuals with MCI can still maintain many of their daily

activities. MCI is considered to be a transitional stage between normal aging and dementia.

Typically individuals with MCI progress to Alzheimer’s disease at a rate of 10% - 15% per year.

A.3 Dementia

Dementia is an umbrella term for the cognitive and functional impairments that occur from a

number of different diseases. Alzheimer’s disease, vascular dementia, frontotemporal

dementia, semantic dementia and dementia with Lewy bodies are all different diseases that

share overlapping symptoms of dementia.

A.4 Alzheimer’s Disease

While each individual reacts differently through the course of the disease, the disease is

characterized by progressive patterns of cognitive and functional impairments. The first stage is

often referred to as pre-dementia or MCI. The first symptoms of the disease are often

attributed to aging or stress.

Early Stage

Usually individuals receive a diagnosis at this stage in the disease. The most common

impairment is related to memory, though not all memory is affected equally. Memories from

early life, facts learned and the memory of how to do things are affected to a lesser degree

than new memories. Language impairment is generally observed as a shrinking vocabulary and

decreased word fluency; however the individual is still able to communicate basic ideas. The



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performance of fine motor tasks such as writing, drawing or dressing may cause some difficulty

but the individual is usually able to manage them independently.

Moderate Stage

The progression of the disease eventually hinders independence; with subjects being unable to

perform common activities of daily living, such as cooking. Word recall becomes more difficult

so vocabulary shrinks and reading and writing skills are also progressively lost. Coordination

becomes an issue so the risk of falling increases as the disease progresses. Memory will

continue to deteriorate and long-term memory is affected such that the individual may fail to

recognise close relatives or misidentify them with someone from his or her past (calling her

daughter by her sister’s name). Behavioural changes become more prevalent and wandering,

irritability, aggression or resistance to caregiving often occur at this stage. This is the stage at

which most caregivers find they are unable to cope at home and move their loved one to a

long-term care or assisted-living facility.

Advanced Stage

During this last stage the individual becomes completely dependent upon caregivers. Language

skills are much reduced eventually leading to complete loss of speech. Despite the loss of verbal

language abilities, individuals still understand and return emotional signals – such as smiling,

holding hands and feeling affection. Typically at this stage individuals suffer from extreme

apathy and mobility deteriorates to the point where the individual is bedridden, and loses the

ability to feed him or herself. While Alzheimer’s disease is terminal the cause of death is

typically an external factor, such as pneumonia, not the disease itself.

A.5 Vascular Dementia

Vascular dementia presents very similarly to Alzheimer’s disease. Individuals will typically have

a history of hypertension. Individuals with vascular dementia typically perform worse than

individuals with Alzheimer's disease in frontal lobe tasks such as verbal fluency. They also tend

to exhibit a general slowing of processing ability and impairment in abstract thinking.



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A.6 Dementia with Lewy Bodies

Lewy Body dementia has a rapid onset and decline happens very quickly in the first few months

of the disease. The specific symptoms of this disease are great variations in attention and

alertness from day to day and even hour to hour, visual hallucinations (particularly of people

and animals that aren’t there) and some motor features similarly found in Parkinson’s disease.

A.7 Frontotemporal Degeneration (FTD)

Frontotemporal degeneration affects the frontal and anterior temporal regions of the brain.

These areas of the brain control personality, social behaviour, speech and executive functions

such as reasoning, decision-making and planning. Individuals suffering from this disease exhibit

a gradual deterioration in these areas.

A.8 Delirium

Delirium is not a disease but rather a set of symptoms affecting the brain with varying degrees

of intensity, such as hallucination, disorientation and drowsiness. An individual suffering from

delirium loses the capacity for coherent thought. Delirium is often confused with dementia but

the underlying causes of delirium can usually be treated.

B. Cognitive Stimulation Therapy in the United Kingdom

Dr. Aimee Spector and Dr. Martin Orrell at the University College of London along with other

researchers designed a Cognitive Stimulation Therapy (CST) program around the main non-

pharmacological therapies for dementia. The most effective elements of the different therapies

were combined to create the CST program. The program was then evaluated in 23 centres as a

randomized controlled trial (RCT). The 201 participants with a diagnosis of dementia were

randomly allocated to either CST groups or a ‘no treatment’ control group.



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The results of the trial showed that CST led to significant benefits in people’s cognitive

functioning. These results were measured by the Mini-Mental State Examination (MMSE) and

the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-COG). These tests primarily

investigate memory and orientation, but also language and visuospatial abilities. Since these

outcome measures are used in the dementia drug trials, direct comparisons could be made

between the effect of a CST program and dementia drug trials.

The scientific analysis suggested that for larger improvements in cognition, CST is equally

effective as several dementia drugs. Further, CST led to significant improvements in quality of

life, as rated by the participants themselves using the Quality of Life – Alzheimer’s Disease

(QoL-AD) measure. This measure is important as it was developed for individuals with

dementia, based on patient, caregiver, and expert input, to focus on quality of life domains that

are important in cognitively impaired older adults. Finally, and perhaps most significantly, there

were no reported side-effects with the use of CST.

Interestingly, The London School of Economics studied the cost-effectiveness of CST and found

that it is more cost-effective than traditional care for individuals suffering from dementia.

C. National Institute for Health and Clinical Excellence – Guideline 42

The National Institute for Health and Clinical Excellence (NICE) is an independent organization

responsible for providing national guidance on promoting good health and preventing and

treating ill health in the United Kingdom.

Clinical Guideline 42 gives guidance and best practices for dementia care. In particular section

6.1 of the guideline states:

“People with mild / moderate dementia of all types should be given the opportunity to

participate in a structured group cognitive stimulation programme. This should be



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commissioned and provided by a range of health and social care workers with training and

supervision. This should be delivered irrespective of any anti-dementia drug received by the

person with dementia”.

Therefore, a cognitive stimulation program is the treatment of choice for people in earlier

stages of dementia (with a Mini-Mental State Score above 20).



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D. Cognitive Intervention in Alzheimer’s Disease

A review published in Nature provided an overview of the use of cognitive intervention in the

healthy elderly population as well as among patients with Alzheimer’s disease. We have

summarized the findings below. This study provides evidence for the effectiveness of cognitive

stimulation therapy as an approach. This review was the basis for a Medscape Continuing

Medical Education (CME) online forum designed to encourage medical professionals to

incorporate cognitive interventions as treatment strategies for the management of Alzheimer’s

disease.

Cognitive reserve. The meta-analyses of over 29,000 individuals showed that individuals with a

high cognitive reserve had a 46% reduced risk of developing dementia compared with

individuals with low cognitive reserve. Of all the factors that influence cognitive reserve

(education, mentally demanding occupations and mentally stimulating lifestyle pursuits)

mentally stimulating activities were shown to have the largest effect on dementia risk.

MCI. A review of cognitive intervention in Mild Cognitive Impairment (MCI) indicates that

cognitive interaction is an efficient method of delaying cognitive decline. The studies showed

that memory, mood and behaviour improve with cognitive intervention.

Alzheimer’s disease. A review of cognitive intervention for individuals with Alzheimer’s disease

showed that cognitive intervention slowed cognitive deterioration, significantly improved

functional competence in daily living and alleviated caregiver distress.

It is interesting to note that cognitive intervention programs focusing on global cognitive

stimulation were found to be more effective at enhancing cognitive and non-cognitive

functioning in individuals with Alzheimer’s disease than programs that trained specific cognitive

functions, which were more effective for individuals with MCI. The study concluded that



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cognitive interventions that support global functioning could delay the onset of Alzheimer’s

disease by five years in patients who will eventually develop this condition.

E. The Cochrane Report

The Cochrane Database of Systematic Reviews did a systematic review of all the literature on

cognitive stimulation to evaluate the effectiveness and impact of cognitive stimulation

interventions aimed at improving cognition for people with dementia, including any negative

effects.4

There was consistent evidence from multiple trials that cognitive stimulation programmes

benefit cognition in people with mild to moderate dementia over and above any medication

effects.

2.4 – Sleep Disorders and Dementia

A good night’s sleep is critical for good brain functioning yet many older adults and particularly

those with dementia have trouble sleeping. It is estimated that between 40 to 60% of people

with dementia also have a sleep disorder.

Sleep disorders interfere with cognitive functioning, increase the risk of falls and increase the

risk of depression and aggressive behaviour. Getting treatment for this underlying disorder may

have a significant effect on cognitive functioning and there are a range of non-pharmacological

options.

4 Woods, B; Aguirre, E, Spector, A.E. Orrell, M (2012) Cognitive stimulation to improve cognitive functioning in people with dementia (Review), Cochrane Database of Systematic Reviews, 2012, Issue 2.



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Research out of the University of Alberta’s Sleep and Function Interdisciplinary Group (SAFIG)

of the Faculty of Rehabilitation Medicine offers the following suggestions.

A. Daytime Activity

Increased daytime activity and light physical exercise improves sleep in people with dementia.

Enjoyable daytime activities increase the production of hormones and chemicals that improve

mood and decrease anxiety.

The InterAct® Program contains many enjoyable exercises, games and activities that can be

used to increase daytime activity. Physical activity can improve circulation and digestions and

reduce joint stiffness and pain. Sleep quality also improves with physical activity.

A daily activity routine helps prevent daytime napping so that individuals are ready to sleep at

bedtime. Activities should be spread throughout the day to avoid becoming overtired. Avoid

activity close to bedtime.

B. Sleep Hygiene

Good sleep hygiene or habits are essential for a good night sleep. Suggestions for creating an

environment conducive to getting a good night’s sleep are:

1. Have a fixed time to go to sleep and a fixed time to wake-up that are the same every

day;

2. Create a bedtime ritual – play a certain piece of music, use a specific hand lotion, have a

bedtime snack that is the same each night. All these cues help the body recognize that it

is time to go to sleep;

3. Avoid caffeine, alcohol and very spicy foods 4 to 6 hours before bedtime; and,

4. Use passive body heating to signal to the brain it is time to go to sleep. Raise your body

temperature through a warm bath, shower or a hot water bottle on the lap or torso.

http://www.wix.com/carybrown/sleep-dementia#%21



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Once the heat source is removed body temperature will drop, signalling the brain that it

is time to go to sleep.

Some tips to improve the bedroom’s sleep-inducing qualities:

1. Have the overnight temperature a bit cool;

2. Keep the room well ventilated; and,

3. Run a fan that creates neutral ‘white’ noise that can help block out disturbing sounds.

C. Bright Light Therapy

The body’s sleep/wake cycle is strongly influenced by the melatonin hormone, which is created

by the exposure of the eye to bright light. Bright light therapy has shown good results in

improving the sleep/wake cycle for individuals suffering from sleep problems. The best source

of bright light is natural daylight – so getting outside every day is essential for a good night’s

sleep. If that is not possible, there are other options, such as the use of blue spectrum lights

that may be purchased at drug stores.

The best time to be exposed to bright light lamps is in the morning. This will increase daytime

alertness. Bright light lamps should not be used after 4pm. Check with your pharmacist for the

best way to use a bright light lamp in your particular circumstances.

02 Module Two THE ROLE OF SCIENCE 2.1 Understanding Brain ... · ISBN 978-0-9868482-5-4 e 1 02 –...

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