A Cognitive Intervention Protocol for Dementia: Its Derivation from and Application to a Neuropsychological Case Study of Alzheimer's Disease.

Most interventions in dementia address behavioral or social, rather than cognitive functioning. Cognitive remediation of brain damage in general, is a recent development. Cognitive changes presumably underlie, at least indirectly, most behavioral and affective problems in dementia. The rarity of cognitive intervention in dementia may be attributed to therapeutic nihilism, poor generalization and maintenance of gains, or poor underst and ing of the cognitive processes in dementia. The objective of this dissertation was the development of a general method for cognitive (i.e., neuropsychological) intervention in dementia. Current underst and ing of cognition in dementia, derived primarily from experimental investigations of discrete functions in early stages, and on caregiver anecdotal accounts of the behavioral course, is fragmented and limited. Four naturalistic case studies of dementia were conducted over a twelve month period, to gain a more comprehensive and dynamic view of cognition. Analysis of the case studies resulted in an intervention protocol designed to be individualized and to address cognitive functioning throughout the dementing course. The protocol includes, for assessment and intervention purposes, a detailed task analysis of dressing with a delineation of underlying cognitive functions, and a model of task complexity for task assessment and modification. One case study (an 84 year old woman in Reisberg's stage six of cognitively advanced Alzheimer's Disease) is presented in detail here. She was observed and formally assessed in seven sixteen hour sessions, two overnight sessions, and additional twenty-four hour periods over eleven months, on a stimulating and supportive dementia unit in a retirement home. Her cognitive functioning was recorded and analyzed in detail in all aspects of her daily living, as well as on an extensive battery of st and ardized and nonst and ardized cognitive assessment measures. Competencies as well as deficits were elucidated. The emerging profile of cognitive functioning yielded a quasi continuum of impairment, from greatest impairment in higher cognitive functions, particularly memory, new learning, and abstraction, to less impairment in praxic, then perceptual and comprehensive functions, to least impairment in sensory and motor functions. There appeared to be an attraction, without discrimination, toward the strongest stimulus at any given time. Implications for intervention are discussed in detail. The intervention protocol is applied to the case study.Ph.D.Clinical psychologyGerontologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/161482/1/8712237.pd