Posted: September 7th, 2024

HEALTH POLICY PAPER

HEALTH POLICY PAPER

Plan for Change to Use Cognitive Training to Help People with Dementia

Cognitive problems and dementia can make life hard for older people. There are evidence-based interventions that can help patients do better, according to real-world data (Chan et al., 2020). As the world’s population ages, dementia is becoming a global problem. Nurses and other health care professionals should look for ways to help patients get the best outcome. Cognitive training is an important way to get good results for patients and improve nursing care for those with dementia (Abdel-Basset et al., 2019). This is an intervention that teaches people how to do standard tasks to load specific cognitive processes, so they can be more independent and do certain tasks without help. Hill et al. (2017) explain how computerized cognitive training (CCT) can be used as a safe, cheap, and scalable way to help older adults keep their minds sharp. To choose and use the best strategy for cognitive training, you need knowledge and skills in medical technology and social skills to improve the emotional lives of older people. This paper takes a critical look at the current evidence about how cognitive training can be used to help an older person with dementia.

Solutions to the health policy problem

(Bahar-Fuchs et al., 2019) say that cognitive training is an important way to help adults with dementia improve how well their brains work. It uses the ideas of neuroplasticity and cognitive reserve to improve brain function and help people with neurological disorders do their best. Patients with this health problem easily forget things and have trouble remembering things, which makes it hard for them to do these basic things. Strategies that encourage the active use of cognitive plasticity help patients get better at what they do (Chan et al., 2020). Hill et al. (2017) say that the intervention focuses on certain cognitive functions like solving problems, remembering things, and paying attention. The interventions are also designed to teach the patients useful skills that will help them improve their working memory. Keeping or improving cognitive skills is easy with guided practice on structured tasks. This means that strategies aren’t aimed at curing dementia, but rather at slowing its progression and helping the person keep their mental abilities. Irazoki et al. (2020) say that a good cognitive training strategy explains the tools and instruments that are needed to improve the health of the patient. When an effective strategy is chosen, it can help the patient find new ways to do mental tasks and remember the memories that have been saved, slowing the progression of dementia. The most important strategy shown by current evidence is the use of technology in cognitive training (Irazoki et al., 2020). Many older people with cognitive impairment have found that computerized cognitive interventions help them. Using new multimedia systems is a big part of how healthy and independent older people can live. The people who work in health care have access to important technological programs that can help improve the health of their patients. Hill et al. (2017) talk about how computerized cognitive training (CCT) can help treat dementia in older people. CCT is thought to be a safe, cheap, and scalable intervention that can help older people improve their thinking skills. The intervention helps people think, learn, remember, and remember what they learned (Bahar-Fuchs et al., 2019). Also, using technology-based cognitive training is an important way for older adults to improve their psychosocial functioning. Chan et al. (2020) say that people can be asked to take a digital cognitive test. The digital test has shown to be just as good at figuring out what’s wrong as the old paper-and-pencil tests. Strategies that use technology are useful for treating people with dementia in different parts of the world. But language barriers and costs can make it hard to use the technology in a way that gets the desired results.

Change Practice and/or Results

Effective cognitive training strategies are important for reducing too much disability and improving overall health. The effects of cognitive training include, but are not limited to, changes in the brain, mood, and behavior (Abraha et al., 2017). The intervention is needed to improve the patient’s mood and give them good results. Cognitive training is one of the most effective ways to treat people with dementia, especially in the early stages, according to real-world evidence (Kallio et al., 2017). But the existing evidence may need to be looked at carefully because of the way the study population was chosen. In fact, Chan et al. (2020) say it is impossible to draw any conclusions about how patients do. But cognitive training works better than other similar methods, so it should be given top priority to lower the risk of disability (Giuli et al., 2016). People in the early stages of dementia can slow the disease’s progress and improve their mental abilities. Irazoki et al. (2020) say that there are different technological solutions that can improve patient outcomes, but that programs must be chosen based on what the patient needs. Cognitive training is very effective when compared to other non-drug treatments (Abraha et al., 2017). Person-centered cognitive training that uses the digital technology that is available works well and leads to good results. This is a good way to treat behavior problems in people with dementia and keep their overall cognitive functions high. Kallio et al. (2017) say that real-world evidence, such as randomized controlled trials, shows that effective cognitive training strategies stabilize both thinking and everyday functioning. Patients get better results from CT programs that are especially intensive and specific. But the results of many trials could be exaggerated because the randomization methods, sample sizes, and CT definitions are not clear (Kallio et al., 2017). It is important to look into high-quality interventions that are needed to help treatment work. These interventions look at tasks that are related to real-world behavior and measure a certain outcome (Lauenroth, Ioannidis, & Teichmann, 2016). Individual efforts are more likely to improve training-related memories than group efforts. Lastly, cognitive training improves the outcome for patients and helps nurses do their jobs better by getting them more involved. To get good results from research, clinical staff must be actively involved in it (Twelvetree et al., 2022).

Needs to Have to Choose and Use the Best Strategy

Caring for older people with dementia takes a lot of different skills and abilities. This includes having the right technology skills and social skills to help patients get better. I’ve gotten better at research, which has helped me figure out the best ways to improve cognitive functions (Twelvetre et al., 2022). Research experiences are also important for putting the strategy into place because they help people make decisions based on high-quality evidence. The best strategy for cognitive training also needs people skills to be put into action (Bahar-Fuchs et al., 2019). Both interactions with technology and interactions that don’t involve technology are important and need to be done in collaboration with healthcare professionals and clinical staff.

Conclusion

When caring for old people with dementia, cognitive training is an important thing to do. The intervention is very important and includes things like improving memory, attention, and other cognitive skills. Compared to other cognitive ways to treat people with dementia, it has the best results for both the patient and the practice. The best strategy based on facts is to use technology through the different programs that are available. Certain personalized programs give the best results for both the patient and the nurse. Different skills and abilities are needed to choose cognitive training and put it into action. Better patient outcomes depend on how well healthcare professionals and clinical staff work together.

References

Abdel-Basset, M., Manogaran, G., Gamal, A., & Smarandache, F. (2019). A framework for making decisions as a group based on the TOPSIS method for choosing smart medical devices. Journal of medical systems, 43(2), pages 1-13.

Abraha, I., Rimland, J. M., Trotta, F. M., Dell’Aquila, G., Cruz-Jentoft, A., Petrovic, M., Gudmundsson, A., Soiza, R., O’Mahony, D., Guaita, A., and Cherubini, A. (2017).

Systematic review of ways to treat behavioral problems in older people with dementia that don’t involve drugs. The SENATOR-ontopseries. BMJ Open, 7(3), e012759.

Bahar-Fuchs, A., Martyr, A., Goh, A. M., Sabates, J., and Clare, L. (2019). Training for people with mild to moderate dementia to help them think more clearly. The Cochrane Database of Systematic Reviews (3). Doi: 10.1002/14651858.CD013069

Bahar-Fuchs, A., Webb, S., Bartsch, L., Clare, L., Rebok, G., Cherbuin, N., & Anstey, K. J. (2017). A randomized controlled trial of tailored and adaptive computerized cognitive training for older people who are at risk for dementia. Alzheimer’s Disease Journal, 60(3), 889–911

Chan, J. Y., T. K. Chan, T. C. Kwok, S. Y. Wong, A. T. Lee, and K. K. Tsoi (2020). A systematic review and meta-analysis of randomized controlled trials of cognitive training interventions and depression in people with mild cognitive impairment and dementia. Age and ageing, 49(5), 738-747.

Giuli, C., Papa, R., Lattanzio, F., & Postacchini, D. (2016). Results from the My Mind Project show how cognitive training helps older people. Rejuvenation Research, 19(6), pp. 485–494. https://doi.org/10.1089/rej.2015.1791

Hill, N. T., L. Mowszowski, S. L. Naismith, V. L. Chadwick, M. Valenzuela, A. Lampit, and A. Lampit (2017). A systematic review and meta-analysis of computerized cognitive training for people over 65 with mild cognitive impairment or dementia. The American Journal of Psychiatry, Vol. 174, No. 4, pp. 329–340. https://doi.org/10.1176/appi.ajp.2016.16030360

Irazoki, E., Contreras-Somoza, L. M., Toribio-Guzmán, J. M., Jenaro-Río, C., Van der Roest, H., & Franco-Martín, M. A. (2020). People with mild cognitive impairment and dementia can use technology to train their brains and help them recover from brain damage. A look at everything. Frontiers in psychology, Vol. 11, No. 648. https://doi.org/10.3389/fpsyg.2020.00648

Kallio, E., Ohman, H., Kautiainen, H., Hietanen, M., & Pitkala, K. (2017). Cognitive training for people with Alzheimer’s disease: A review of the evidence. Journal of Alzheimer’s Disease, vol. 56, no. 4, pp. 1349-1372.

Lauenroth, A., Ioannidis, A. E., & Teichmann, B. (2016). A systematic review of the effects of combining physical and mental training on the mind. BMC geriatrics, 16(1), 1-14.

Twelvetree, T., J. Suckley, N. Booth, D. Thomas, P. Thomas, and P. Stanford (2022). Creating a sustainable research capacity for nurses and other health professionals. Nurse Researcher, 30 (2). Doi: 10.7748/nr. 2019.e1618.

PLAN CHANGE ON HEALTH POLICY PROJECT

Plan for Change to Use Cognitive Training to Help People with Dementia

Nurses need to help find ways to improve the care they give to their patients. Nurses must use what they know about science, research, and other fields to find solutions to problems that affect them and their patients. This helps them figure out which solutions work best. When caring for people with dementia and other conditions that make them unable to speak for themselves or have limited cognitive abilities, nurses must use the right evidence, decision-making skills, and negotiation skills to give the best care. Cognitive training is one of the evidence-based methods that can be used to help people with dementia. When making changes to how people with dementia are cared for, it’s important to read what the evidence says and make sure to negotiate with the patients and other people who have a stake in the matter so they can agree to the changes.

Training the mind

Cognitive training is a way to help people with memory or thinking problems by having them do exercises that are meant to improve their mental capacity (Chan et al., 2020). Cognitive training for people with dementia is meant to help them learn skills that will help them become more independent and do things with less help. Most of the time, cognitive training involves teaching people how to do things so they can use the skills they learn on other things. For example, if a person is taught how to self-medicate in a safe way, they may be able to use that skill in other similar situations. This could help someone with dementia recover and be able to do things on their own more often.

Cognitive training, like other treatments for dementia, is based on the ideas of neuroplasticity and cognitive reserve to help people think better (Chan et al., 2020). Cognitive reserve is the brain’s ability to work even though it is getting older and changing in ways that make it less able to do so. So, people with more cognitive reserve are more likely to live longer and be less hurt by things like atrophy, injuries, and other things that make it hard for the brain to work. So, Bahar-Fuchs et al. (2019) think that cognitive reserve affects how often people get dementia. That is, people with less cognitive reserve are more likely to get dementia and have it get worse faster than their peers with more cognitive reserve. Neuroplasticity, on the other hand, means that people’s brains change because of their surroundings. So, in neuroplasticity, people’s brains make new connections to make up for the ones they’ve lost. This lets the brain work normally even after changes in the environment that would normally make it unable to work.

Cognitive training tries to use the ideas of neuroplasticity and cognitive reserve to improve the way people’s brains work. This way, even if they have neurological disorders, they can still do their best. (Bahar-Fuchs et al., 2019) For example, dementia is caused by changes in the way the brain looks that come with getting older, like Alzheimer’s. So, these people forget easily and may forget simple everyday things like how to do things and other things. People with dementia need cognitive training to help them use their brain’s ability to change into new patterns that will help them work better. Cognitive training also slows the progression of dementia by improving working memory. This makes it easier for people to learn the skills they need for everyday tasks and to use the skills they learn in their other important activities.

Change Strategies and Goals

The plan is to help the patient get better at doing everyday tasks that most people their age can do. Most cases of dementia can’t be cured, but its progress can be slowed down a lot. The treatment will try to use the ideas of neuroplasticity and cognitive reserve to help people with dementia keep their abilities and slow the disease’s progress. Setting goals for the change and understanding the strategy will help come up with and use the steps needed to improve the outcomes for patients. Irazoki et al. (2020) say that cognitive training mostly affects the working memory, but it also affects the skills of patients. When cognitive training is done on a regular basis with patients, it may help them become rehabilitated and develop new pathways for completing mental tasks and remembering the memories that have been kept. This can slow down the progression of dementia and help people function better even as dementia gets worse.

Also, only people with moderate or mild dementia will get the treatment, because research shows that it works best for this group. According to Bahar-Fuchs et al. (2019), people with mild to moderate dementia can benefit from cognitive training. Changes in the proteins in the neurons cause morphological proteins, which cause dementia. The changes affect how people think and act and make it harder for them to do things on their own. The situation gets worse until the patient can no longer do anything at all. People with different levels of dementia live in the nursing home. (Bahar-Fuchs et al., 2019) The change will help patients slow down the rate of memory loss and improve their ability to do things. People who already have dementia may also benefit from the treatment, but the effects will be very small. Applying it to people in their early stages instead of their later ones makes their lives better and makes them less of a burden on their communities.

Different Solutions

There are a number of other ways to help people with dementia improve their ability to do things. One alternative is using drugs to treat the problem. In pharmacologic treatment, chemicals that change how the body works are used to improve cognitive function. There are drugs like Donepezil and Galantamine that can help people with dementia remember things better and feel less confused. Donepezil is a drug that changes the amount of neurotransmitters in the nervous system. This helps people with dementia improve their memory and ability to do things. The medicine works for mild and moderate dementia, so it can be used as an alternative way to treat dementia and help people function better. Even though using the medication with psychotherapy or cognitive training makes it work better, you may also be able to use it on its own.

Cognitive stimulation is another way to help people with dementia. Cognitive stimulation is the use of general exercises to improve thinking and help people do things on their own more often. Some ways to stimulate the brain are reminiscence therapy and discussions. Even though the measures help people get better at what they do, they don’t work as well because patients aren’t directly given tasks that require them to use their working memories.

Cycle of Making Decisions

Using the seven-step cycle will be important if you want to make good decisions. The first step will be to figure out what the problem is. The important thing is to find a good way to improve how dementia patients are treated (Abdel-Basset et al., 2019). For example, the cognitive training method is one of a number of methods that have been shown to work in research. After figuring out the problem and how to measure it, the next step should be to get the information you need. For example, if cognitive training is suggested, research articles and recommendations should be looked for to see if the decision will work. When it comes to nursing, evidence from relevant sources will be very important. So, literature and other sources of evidence should be used to figure out what the solution is and how well it works. The third step should be to find other options and compare how well they might work. For example, the team should compare both drug-based and non-drug-based treatments that might help solve the problem (Abdel-Basset et al., 2019). The fourth step should be to weigh the evidence to determine from the information which alternative will be more effective. For instance, it is important to know the most effective measure between pharmacology, cognitive training, and cognitive stimulation among others. Next, the best alternative should be picked and implemented. After implementation, the measure must be monitored to ensure that it is effective (Abdel-Basset et al., 2019). If cognitive training fails to cause desired results, it should be replaced with a more suitable measure.

Bargaining Concepts

While the decision may not affect all patients and stakeholders, it must be accepted by stakeholders that will be impacted. Therefore, nurses must find ways of bargaining to cause desired outcomes. For instance, the nurse may use a collaborative strategy for bargaining (Twelvetree et al., 2022). They may inform other stakeholders of their findings on the use of cognitive training and encourage change while seeking contributions from their peers. Negotiations are important because patient care involves various professionals working together. Hence, changes in treatment modalities should be decided by teams rather than individuals (Twelvetree et al., 2022). While collaborating in decision-making will be important, to bargain effectively, the nurse suggesting should research to ensure that they can support their argument for the use of cognitive training rather than the alternatives.

Conclusion

The treatment of dementia patients requires that nurses implement effective measures like cognitive training as part of the measures to improve the patient’s independence. Cognitive training aims to use patients’ neuroplasticity and cognitive reserve to help them preserve their current functions while learning new functions. The alternatives that may be used include using medication and cognitive stimulation among others. However, evidence supports cognitive training as a way of improving patients’ lives. The seven steps decision-making model and effective collaborative bargaining may help improve the planning and implementation of the changes.

References

Abdel-Basset, M., Manogaran, G., Gamal, A., & Smarandache, F. (2019). A group decision-making framework based on neutrosophic TOPSIS approach for smart medical device selection. Journal of Medical Systems, 43(2), 1-13. https://doi.org/10.1007/s10916-019-1156-1

Bahar‐Fuchs, A., Martyr, A., Goh, A. M., Sabates, J., & Clare, L. (2019). Cognitive training for people with mild to moderate dementia. Cochrane Database of Systematic Reviews, (3). Doi: 10.1002/14651858.CD013069

Chan, J. Y., Chan, T. K., Kwok, T. C., Wong, S. Y., Lee, A. T., & Tsoi, K. K. (2020). Cognitive training interventions and depression in mild cognitive impairment and dementia: A systematic review and meta-analysis of randomized controlled trials. Age and Ageing, 49(5), 738-747. https://doi.org/10.1093/ageing/afaa063

Irazoki, E., Contreras-Somoza, L. M., Toribio-Guzmán, J. M., Jenaro-Río, C., Van der Roest, H., & Franco-Martín, M. A. (2020). Technologies for cognitive training and cognitive rehabilitation for people with mild cognitive impairment and dementia. A systematic review. Frontiers in Psychology, 11, 648. https://doi.org/10.3389/fpsyg.2020.00648

Twelvetree, T., Suckley, J., Booth, N., Thomas, D., & Stanford, P. (2022). Developing sustainable nursing and allied health professional research capacity. Nurse Researcher, 30(2). Doi: 10.7748/nr. 2019.e1618.

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