Management of memory impairment in older people with dementia

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Abstract
The applicability to older people with dementia of a number of strategies designed to enhance memory function is considered. Environmental adaptations and external memory aids appear to hold most promise in this population. Internal strategies and general memory exercises are probably of little value. Reminiscence therapy, in dementia at least, seems to be most effective as a way of facilitating communication; cognitive effects have not been identified. Reality Orientation has been shown to have a fairly consistent, although small, effect on cognitive function, particularly verbal orientation. Some examples of well-implemented RO programmes have demonstrated behavioural change, for example in the person's ability to find locations around the ward or home. To maximize the probability of a positive outcome, programmes need to be individualized, based on a careful assessment of the nature of the person's difficulties and strengths, using retained abilities wherever possible to compensate for those that are lost. Turning the focus away from conscious, effortful strategies towards more automatic processes is helpful. When working with family care-givers on memory management it is important to recognize that their sense of strain may limit their cooperation. Finally, non-cognitive factors, such as anxiety and depression may reduce memory function further in people with dementia; addressing these may also bring cognitive benefits.

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