Alzheimer's disease (AD) is a genetic and sporadic neurodegenerative disease that is
associated with a decline in cognitive function, memory, speech, and ultimately sensory
and motor problems. The onset of these changes may be gradual or sudden. In people with
mild Alzheimer's, symptoms such as learning and memory problems, poor judgment, mood
swings, depression, and restlessness occur.
The absence of an effective pharmacological treatment that halts or delays the
development of the disease has aroused interest in non-pharmacological therapies (NPT) as
a complement to pharmacological treatment that can improve the quality of life of older
adults with AD. One of the most researched NPT and with the greatest tradition in this
field is Reminiscence Therapy (RT).
RT implies the discussion of past activities, events and experiences, usually with the
help of triggers (e.g., photographs, home objects and other familiar items from the past,
music, any object or stimulus) that serve to stimulate memories. In its application to
dementias, RT is based on the fact that the memory deficit of people with dementia
implies that they are able to remember events from their past life, especially from
childhood to early adulthood, but not newer facts. It focuses on preserved capacities and
memories, promotes communication and enables the person to connect with his past and
recover his sense of personal identity. In this way, the RT can be understood as an
intervention on the edge of those of cognitive orientation and those centred on emotion,
with potential interactive effects on autobiographical memory and psychological
well-being.
In simplified form, there are at least two approaches to RT. The first approach as a
"life review" where participants are guided through significant experiences of their
biography trying to give meaning to their lives. This type of RT is more structured and
is usually conducted in an individual format. It may involve the production of "life
books". This approach is considered to have an integrative function aimed at achieving a
sense of validation, coherence and reconciliation with one's past. Another approach that
call general or simple reminiscence, implies the stimulation of autobiographical memory
during conversations on specific themes of the past (e.g, holidays, food and drink, work)
using stimulus to trigger memories. It has been described as an unstructured
autobiographical memory narration. This reminiscence format can be conducted both
individually and in groups and promotes communication between participants who share
their memories and stories.
In either format that RT is applied on, the introduction of triggering stimulus (e.g.,
photographs, music, old objects) to help memory is considered fundamental. These triggers
can be generic, reflecting common experiences in the lives of people relevant to their
age group (e.g., a school manual can serve as a reminder of the experience during their
school stage), or specific, with stimulus related to the person's own experiences (e.g.,
photographs of an important vital event such as their wedding day or a journey during
their youth).
As for the effectiveness of RT, according to a review by Woods et al. in Cochrane, there
is some evidence on its positive effects on cognition, QoL, communication and possibly on
the mood of people with dementia, even if the benefits are small. Despite the distinction
between the two different approaches to RT (general reminiscence vs. life history), the
therapy modality does not seem to be as important to achieve positive effects as the
individual or group format of the sessions and the context in which the intervention is
administered (people living in the community or institutionalised).
In particular, according to the results of the review study, the RT seems to be able to
generate a small benefit on cognitive function immediately after the intervention,
although it usually does not continue after a longer follow-up period. Regarding the
administration format, the individual RT seems slightly superior in its effects on
cognition both immediately and after a follow-up period. In any case, its effects seem
comparable to those of other cognitive stimulation modalities.
As for the effect of RT on quality of life (QoL), an individual RT study based on life
review, showed an improvement in Qol-AD. The effects with a group modality do not seem
consistent, showing little or no effect on QoL, although the key factor may be the
context of application (community vs. institution), with better group RT results in
institutionalised patients.
In a multicentre study conducted in Portugal with older adults with neurocognitive
disorders, in individual format, there was a significant effect on the overall cognition,
memory and QoL of the participants. Group RT was associated with a likely effect on
communication both after the intervention and in the follow-up. This effect was not
replicated in the individual RT, with uncertain results.
Finally, despite the evidence on the effect of RT on the mood of older adults without
dementia, in the case of people with dementia only a small effect on mood was found for
those participating in individual RT. In the portuguese multicentre studies there were no
significant differences in depressive symptomatology.
Based on the above, this research proposal aims to evaluate the effectiveness of
individual RT program within a general reminiscence format, to improve overall cognitive
function, emotional state (depression and anxiety), and QoL of older adults with AD
attending social care and support services in the Portugal.
It is proposed to evaluate the efficacy of the intervention in the endpoint assessment.
Furthermore, an analysis of results based on the diagnosis of the participants is
proposed for those diagnoses with sufficient representation in the sample (more than 15
cases in each group). Additionally, it is proposed to analyze the factors that predict
the response to the intervention (responder analysis). Finally, the results of this study
will be compared and can be analyzed together with those of a previous studies that used
the same individual RT program and the same experimental design.