Anna Giulia Cattaneo, M.D.
The incidence of cognitive impairment and dementia significantly
increases with age. The aging process is not merely related
to the frequency, instead it differentiates greatly the healthy
and the wellness of individuals affected by dementia, as well
as the prognostic values and the therapeutics.
The significant amount of efforts spent in the last half
century to improve the personal wellness and the social adequacy
of younger people affected by different syndromes reducing
their psychological and mental performances resulted in many
cases in a surprisingly high degree of rehabilitation.
In the case of older individuals, the physiological decrease
of a number of abilities influencing the cognitive process
negatively affects the expectation. In the elderly, mainly
when associated with cognitive impairment, both psychological
attitudes (like the learning ability, the interest in doing
new experiences, the personal skills to face changes in life)
and physical abilities, sensorial or motor, are frequently
The relative and however important state of poverty is in
many cases a disadvantage affecting the frailest people, the
older among others. The care givers and the society themselves
shows a general indifference to the wellness of people considered
no more productive and a heavy social burden, with death in
a near future. The attention paid to major dementias, like
the Alzheimer disease, seems in many cases that shared by
all the nightmares of our society, all the conditions implying
the introduction of a frail ring in the social network. This
is the reason why the economical factors surroundings the
taking care of the elder people are so often underlined even
in scientific literature.
From the point of view of the older, this attitude is a font
of stress, a risk added to the eventual loss in cognitive
skills, which in fact in the elderly rise from a mixed pathology,
only in part degenerative and (or) vascular, but in part secondary
to depression, loss of interest , and sensory inadequacy.
A recently published study (Dement. Geriatr. Cogn. Disord.
2010, 30: 161-178) summarizes the results of a large multicenter
project defined to evaluate and standardize the non pharmacological
therapy for the Alzheimer disease. The approach ranges from
cognitive training, music and light use, to massage and therapeutic
touch, or transcutaneous electric stimulation. The indications
vary for the different approaches: some methods are especially
aimed to improve mood, other to ameliorate physical skills.
Learning new activities improves self-esteem and preserves
intellectual abilities and motion, when done in small groups
this method has also positive influence on the maintenance
of social relationships and affectivity. However, the standardization
of the methods applied and their precise timing is required
to optimize the results. Every different type of intervention
is accurately described in the cited paper, and the original
work is clearly cited, to facilitate the reproduction of the
treatment in a standardized manner.
This approach could be successfully extended to all types
of cognitive impairment, and however it should be considered
that its limits are especially evident in the case of the
most seriously compromised subjects. The non pharmacological
approach, in fact, does seem to be equally effective on all
the needs of demented people, and it rarely reaches a potential
grade A level of recommendation. In particular, it does not
reduce the risk of falls, the mortality rate and the need
of psychotropic drugs, does not improve the compromised motility
nor the serious loss of cognition. Its best score is reached
in reducing the need of institutionalization. Its efficiency
is lower, but good when the improvement of behaviour, mood
and affectivity is considered. The same is true when intellectual
ability and necessary skills for the Activities of Daily Live
(ADL) are under question. In general, a careful personalization
of the treatment and a high degree of standardization seems
to be unavoidable to reach the best results.
In summary, a personalized rehabilitative approach to the
older subject affected by cognitive impairment should be regarded
as sufficiently efficient, and poorly expensive in comparison
with traditional care. According to the Authors, it should
be affordable and economy saving even for developing countries.
DBSF, Università dell'Insubria
via J.H. Dunant,3 - 21100 Varese
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