Alzheimer’s and other dementias are some of the most destructive health issues facing our aging population today. Beyond the crippling effects of these conditions on the people suffering from them, they also exact a harsh toll on friends, family and other loved ones. Watching a loved one in cognitive decline is truly heartbreaking.
For the person suffering from Alzheimer’s, life becomes gradually more confusing and frightening as the condition progresses. Not only is the person likely unaware of their drop in cognition, they’re often confronted with situations that should be familiar, but are often foreign to them, such as talking with someone they’ve known for years, but who they can no longer identify.
Faced with an increasing unfamiliarity of the world around them and the often-morose nature of the people they interact with—friends and family they’re no longer able to recognize—life becomes largely uncomfortable for Alzheimer’s sufferers. They become reclusive and depressed, often feeling isolated and disconnected with reality, which only hastens the onset of their cognitive decline. It’s a horrible cycle that’s hard to disrupt, largely due to the inability to connect with the sufferer in a meaningful way.
The theory of reminiscence therapy
Reminiscence therapy (RT) is a personalized approach to combating the degenerative effects of Alzheimer’s, built on a recursive framework that stimulates the memory centers of the brain. More than just encouraging a feeling of nostalgia, RT has also been shown to improve social outlook, alongside mood.
How reminiscence therapy works is simple. Individuals are introduced to stimuli that are specific to them—usually in the form of pictures, video or music from their past. Some reminiscence therapy examples include:
- Photo albums documenting the person’s past
- Home video of life events and milestones
- Audio of a person the individual is familiar with
- Music that the person remembers from high school
- Objects of sentimental or significant importance
The theory of RT is that introducing powerful stimuli will trigger remembrance in an individual—or at the very least, trigger positive feelings, even if they’re disassociated from actual events. For example, a man shown his own wedding picture may feel happy emotions or a feeling of joy, despite not recognizing himself or his wife outright.
RT is about more than just inspiring positive feelings, however. Webster's Reminiscence Functions Scale (RFS)—a benchmarking process for RT outlined in the 1993 Journals of Gerontology—identifies 8 unique functions of reminiscence and how they may contribute to better mental wellbeing, especially for those with cognition in decline:
- To combat boredom
- To address bitterness
- To prepare for death
- For conversation
- To self-identify
- To maintain intimacy
- To solve problems
- To teach and inform
For those with Alzheimer’s, addressing these 8 crucial criteria may mean enabling a person to lead a happier, more fulfilled life, even as they cope with their illness and its ultimate result. For example, reminiscence therapy effects can combat boredom, which may otherwise lead to idle depression. Similarly, self-identification through RT may help individuals grasp an understanding of who they are, even when the world around them may be unfamiliar.
Reminiscence therapy for Alzheimer’s has shown tremendous promise through the tangible benefits exhibited in individuals who have undergone extended therapy. More specifically, positives have been identified in mental cognition corresponding to the 8 unique functions of reminiscence outlined by Webster. Some of the most notable benefits of reminiscence therapy include:
- A decrease in depressive bouts or severity of depression
- Improved psychological wellbeing
- Understanding of self-identity
- Retention of skills
- General cognitive performance
- Positive and productive social interactions
The reason for these improvements can be attributed to two key factors: the personalized interaction promoted by RT and the impact of these personalized stimuli on brain chemistry:
Unlike traditional group therapies or therapies that are more clinical in nature, RT is a more informal, yet personal approach to treatment. The nature of the approach puts people at ease and allows them to focus more intently on the experience, rather than trying to understand the setting. And, when the experience is shared with a caregiver or a very small group, the effects can have a higher impact. The nature of peer-to-peer communication is more personal and informal, putting less stress on the interaction and allowing the intended effects of RT to land with the person.
Due to the personal nature of the stimuli used in RT, individuals are able to make a more profound connection. While not always consciously recognized, many stimuli force unconscious results, which is why certain feelings or emotions are elicited, even when they aren’t completely lucid. Neuroimaging has actually shown “increases in cortical glucose metabolism in bilateral anterior cingulate and the left inferior temporal lobe”—areas of the brain that subconsciously access memories. This reaction may not be understood by a person, but is nevertheless felt.
As the benefits of RT are realized, they have a tendency to trigger other positives for individuals. A person experiencing better social interactions will undoubtedly experience fewer instances of isolated boredom, which may result in fewer bouts of depression, for example. In this way, reminiscence therapy for depression may displace other activities that have proven unsuccessful for a person, such as traditional group therapies.
Because RT impacts different people in different capacities—based largely on the progression of their illness and their cognitive capacity to understand the therapy—results can be far ranging. Nevertheless, studied cases of RT indicate that, at the very least, there are benefits to be reaped from exposure to personal stimuli.
Alzheimer’s is erosive to all forms of general cognition, however memory suffers first and to the harshest degree. Early onset dementia is marked primarily by the inability to remember and minor confusion during memory recall situations. As the disease progresses into Alzheimer’s, memories may be completely expunged, leaving behind a spotty and ever-decreasing personal history of self-identification.
RT strives to help refresh memories and preserve cognition through consistent recall. Showing individuals the same photographs and video over and over again serves to evoke connections that may be disintegrating, creating stronger bonds to people, time periods, emotions and other factors associated with each piece of stimuli. Some simple examples may include:
- Showing a photo of the individual with another person may help them to remember that person’s name, even if they may not remember the instance when the photo was taken or even the person’s affiliation to them. Likewise, they may not recall the person’s name, but may recall the setting depicted in the photo.
- A video clip of a birthday party may help someone to contextualize their affiliation with the person or people delivering reminiscence therapy. Or, it may help them to relive a moment they vaguely remember, helping to add details and context for better clarity.
- Hearing an audio clip they recognize can help individuals talk through the context of the clip—how they know it, who’s speaking, what their relationship is to the person speaking, etc.
The connections made through RT may not be detailed or consistent, but their repetitious nature can help ensure the overall memory isn’t lost. Repeated stimulation of the brain in regards to specific memories may also provoke conversation and recognition of other memories, both associated and non-affiliated with the stimuli. This can also elicit the benefits of RT, allowing people to experience positive emotions, better social interaction or a sense of self awareness.
Ultimately, the goal is to help foster connections to people, places, feelings and details that may otherwise fade into obscurity as cognitive decline worsens. Practicing consistent recall brings specific memories to the forefront and forces the brain to unpack them, which may help to preserve the details associated with them. It’s a form of mental exercise, as well as therapeutic release, which together have the power to improve a person’s quality of life even when circumstances are weighted in opposition.
Patient-centric, family-driven approach
The personalized nature of RT cannot be understated in its ability to evoke specific, powerful connections with past events. This is only amplified when the caregiver is a family member or close friend who’s also affiliated with the stimuli being delivered.
For example, the son or daughter of an Alzheimer’s patient may show them pictures of themselves as a young child. Being able to identify the child in the pictures as their own may help evoke feelings of happiness and pride. Making the connection between the child in the photo and the adult in front of them may only intensify these feelings and create an overwhelming instance of joy.
This extreme example is offset by numerous smaller ones. If the caregiver is a family member, they may be able to help a person remember details just out of grasp, such as names, dates or context clues. This small helping hand can be powerful enough to unlock additional details and memories, which may bring with them their own cognitive benefits and positive responses. A single RT session can be fill with epiphanies and crystalizing moments that boost cognition—largely in part to the intimate nature of the caregiver as someone close to the individual.
The comfort factor of a familiar face is also invaluable in RT. One-on-one therapy with a trusted individual alleviates the confusion and stress of interacting with an unknown person. Often, physicians, nurses and even social workers or caregivers are met with trepidation during face-to-face interaction. Even earned trust can dissipate as cognition declines, making it harder for caregivers to connect with individuals as opposed to a loved one they still may recognize or trust.
For self-guided instances and tech-enabled digital reminiscence therapy—such as the tablet offered by ReminX—family plays an integral role in the delivery of the actual therapy. Family members must source original stimuli from pictures, video and audio clips, compiling everything in a single tablet. This call to action often leads to a more involved response from family and friends, bringing out powerful examples of stimuli and even prompting visits and more personal interactions with the individual.
Because any family member can participate in RT and the stimuli are unique to the individual receiving therapy, it’s easy to take initiative. This can mean better results for the individual undergoing therapy. Reminiscence therapy activity ideas can be crowdsourced from a network of people with close ties to that person, ensuring that all stimuli compiled have authentic meaning and relevance to that person. This increases the chance of response and extrapolates the potential that individuals will see a marked improvement in their quality of life and mood.
A soothing, passive treatment method
Alzheimer’s sufferers fall on a very large barometer of severity. For those with early onset symptoms, signs of decline may be small and allow the person to live a relatively ordinary life. On the other end of the spectrum, severe progression may leave sufferers unable to recognize close friends, family members or even themselves. Ultimately, this means the scope of care must range as large as the scope of the condition.
The chief obstacle for many clinical therapies is the delivery method. Those still able to live on their own or with minimal caregiver assistance may require routine visits for cognition therapy. For institutionalized or assisted-living scenarios, inpatient therapies are often unsettling for the recipient because they don’t understand or have context for them. This combination of infrequent exposure or unnerving surroundings do little to slow the decline of mental health.
Reminiscence therapy activities set themselves apart from other cognitive therapies because they can be delivered anywhere, at any time, by virtually anyone. So long as the stimuli are accessible, people can undergo therapy wherever they happen to be each day, giving them the opportunity to train their brains and promote mood improvement in a way that’s unimpeded by extraneous circumstances.
Not only does the adaptable nature of RT lend itself to consistent treatment, it’s also able to be continually changed and restructured around the response of the person. Moderators can identify the stimuli that elicit a positive response versus those that may yield no response or a negative one, removing the latter from the group of stimuli. New multimedia can be added to a RT session to help promote cognition through great responses and more powerful emotions.
There’s also the passive nature of RT to consider. Because it’s something that can be done during idle time and doesn’t need to be scheduled or structured, it generally sees a more favorable response from individuals. They may not feel coerced or forced to participate like they might with cognitive exercises or traditional therapy sessions. Likewise, they may even decide to undergo RT by themselves unprompted.
A complement to clinical treatment
Though considered an alternative or holistic treatment, RT has made great inroads in delivering verifiable data of its effectiveness in improving the cognition of Alzheimer’s patients in decline. Its efficacy in brain stimulation and general quality of life improvements has made it the perfect complement to more clinical treatment approaches, as well as an early stage option for caregivers before institutional levels of care are required (and even after).
Because reminiscence therapy goals are clearly defined and its methods are structured, yet easily tailored to the individual, it’s a viable approach to improving mood and social outlook for most individuals, regardless of where they fall on the spectrum of condition. Personal involvement also plays a vital role in its effectiveness, allowing family members to feel like they’re contributing to the care of a declining loved one. In this sense, it’s therapeutic for both individuals and their loved ones.
There’s virtually no limit to the potential for reminiscence therapy. Finding meaning in memories is entirely dependent on each person going through therapy and the state of their condition, which makes it a worthwhile endeavor for anyone seeking to help improve the quality of life and general morale of a loved one suffering from cognitive decline.
As we learn more about the nature of debilitating, devastating diseases like Alzheimer’s and other dementias, the need for cognitive stimulation becomes increasingly important in delaying and mitigating symptoms of decline. Reminiscence therapy for older adults could prove useful as both a tool for combating early-stage memory loss, as well as downplaying the social isolation effects commonly caused by its accompanying depression and anxiety.
As more reminiscence therapy studies are done and methodologies for administration are developed, reminiscence therapy protocol will become more defined, potentially unlocking the keys to combating cognitive conditions on an even more effective scale. Click here to learn more about ReminX.