1. Interventions for Cognitive- Linguistic Disorders Associated with Alzheimer’s disease

2. Purpose of Presentation The purpose of this presentation is to take a look at four different type of interventions used to treat cognitive-linguistic disorders associated with Alzheimer’s disease and give future and/or present speech-language pathologist some ideas on how to implement these approaches.

3. Basic Goals for Intervention “Designing interventions for persons with dementia should take into account the communication environment. Factors in this environment would include opportunities for interaction and typical communication partners. Caregivers maintain that eroding communication is the single most distressing problem they face in managing the disease. Therefore, prolonging communication for as long as possible, and at as high a level as possible, is a critical goal of intervention” (Ripich, D., & Horner, J., 2004 p.3).

4. Interventions Reminiscence Therapy Graphic and Written Cues Montessori- Based Interventions Spaced- Retrieval Training

5. Graphic and Written Cues Uses familiar photographs and/or factual information to promote communication. Recognition memory and the ability to read aloud are skills that clients with Alzheimer’s dementia are likely to be able to use. Photographs and factual information can be incorporated into most therapy sessions whether group or individual (Hopper, T. 2005).

6. How to Implement Graphic and Written Cues The speech-language pathologist can implement the client’s pictures into memory books which are photo albums with captions. The SLP can use these to help the client retrieve the names of family members/caregivers, for example. When discussing daily activities such as eating or bathing, the speech-language pathologist can incorporate pictures of food or clothing to help the client with topic maintenance.

7. Reminiscence Therapy Reminiscence therapy is a way for clients with Alzheimer’s disease to practice communication skills using a variety of materials such as pictures or music, or activities such cooking, or painting, that the client once or currently enjoys. This type of therapy can be used with verbal and non- verbal clients “Maintains cognitive stimulation, improves memory recall, and improves/maintains communication skills” (Ripich, D 2005 p 6).

8. How to Implement Reminiscence Therapy The speech-language pathologist could use the client’s pictures as a way of facilitating conversation about events or times that were enjoyable to the client. Photos usually represent enjoyable experiences and help to summon memory. A client who may not want to interact with the speech- language pathologist may be more inclined to talk while painting or even cooking. Reminiscence therapy can be used in individual or group settings The use of family and friends can further enhance reminiscence therapy and even help the client to be more engaged (Kennard, C. 2005).

9. Montessori-Based Interventions “Basic technique is to create structured, stimulating activities that are appropriate to an individual’s cognitive abilities, allowing engagement in tasks and the opportunity for social interaction. Can be used in individual and group settings” (Hopper, T. 2005 p.3).

10. How to implement Montessori-based Interventions The speech-language pathologist could use an activity such as gardening, in a group setting, to maintain basic sequencing skills by giving each client a turn to explain what step comes next. Use very obvious external cues such as the written word “rake” on that item, and make sure all of the items for the activity are easily accessible.

11. Montessori-based Interventions cont…. “ Dr. Camp has developed a number of general categories that compartmentalize Montessori- based activities and these include……….”(Elliot, G.,2005 p.28)

12. Compartmentalized Montessori-based Activities General Categories Group or Social Activities (question asking, reading, memory bingo, and group sorting) Cognitive Activities (category sorting, matching and arranging Items in a series) Motor Activities (range of motion tasks, fine and gross motor skill practice, balance) Care of the Environment (making flower arrangements, using place settings, watering plants) Care of the Person (activities of daily living; self care) Sensory Discrimination (sound, color, smell, touch and weight)

13. Spaced-Retrieval Training Memory training technique “Gives clients with Alzheimer’s disease practice at successfully recalling information over longer intervals of time” (Brush & Camp, 1998). “The goal is to teach a functional piece of information or behavior that can be used in everyday situations (i.e room number, caregiver name)” (Hopper, T. 2005 p.3). “Spaced-retrieval techniques recognize that explicit memory is impaired but capitalize on implicit memory and spared capacity” (Elliot, G.,2005 p.27).

14. How to Implement Spaced-Retrieval Training Let’s say one of the client’s goals is to remember one of their caregiver’s names. The SLP would ask the client, for example, “What is your doctor’s name?” Then provide the answer “Dr. Smith.” That particular question could then be asked at the beginning of every session for 6 sessions. The main goal would be to then generalize that particular question.

15. Additional Articles Effect of Presentation Modality on Immediate and Delayed Recall in Individuals With Alzheimer's Disease Effect of Presentation Modality on Immediate and Delayed Recall in Individuals With Alzheimer's Disease Effects of Cognitive-Communication Stimulation for Alzheimer's Disease Patients Treated With Donepezil Effects of Cognitive-Communication Stimulation for Alzheimer's Disease Patients Treated With Donepezil Effectiveness of Communication Strategies Used by Caregivers of Persons With Alzheimer's Disease During Activities of Daily Living Effectiveness of Communication Strategies Used by Caregivers of Persons With Alzheimer's Disease During Activities of Daily Living

16. References Brush, J.A. & Camp, C.J. (1998). A Therapy Technique for Improving Memory: Spaced-Retrieval, Beachwood, Ohio, Menorah Park Center for Senior Living. Carnahan, N., Lingle, A., &McCullough, K. (2005) Using Spaced Retrieval Training in the Treatment of Alzheimer’s Dementia. Retrieved on November 28, 2005 from http://convention.asha.org/handouts/293_Carnahan_Natalie_072927_111405094554. pdf Elliot, G (2005) Spaced Retrieval and Montessori for Dementia: Interventions Know to Enhance Function in Dementia. Hopper, T. (2005, Nov. 8). Assessment and Treatment of Cognitive-Communication Disorders in Individuals with Dementia. The ASHA Leader, pp10-11 Kennard, C. (2004, Mar.31). Reminiscence Therapy. Retrieved on November 28 from Yahoo’s About website: http://alzheimers.about.com/b/a/076219.htm Ripich, D. & Horner, J. (2004, April27). The Neurodegenerative Dementias: Diagnosis and Interventions. The ASHA Leader, pp.4-5, 14 Ripich, D. (2005, Feb.3). Alzheimer’s Disease, Assessment and Intervention. p6