Neurocognitive Rehabilitation in Dementia of the Alzheimer type Wilver Janampa B

arrios
Federico Villarreal National University School of Psychology
Alzheimer disease (AD)
Neurodegenerative disorder, cortical, progressive and irreversible.
Dementia of Alzheimer type (DAT)

Neuropsychological progressive clinical syndrome of persistent cognitive and fun

ctional impairment. It affects the social-laboralacadémica autonomy.
Clinical Manifestations
Cognitive: memory, attention, language, orientation, perception, praxis, executi
ve functions. Psychological: depression, aggression, apathy, agitation, anidam
ia, hyperactivity, pictures pseudopsiquiátricos. Neurological: agrafestesia, f
ret. olfactory, Sind. extrapyramidal fret. dream, alt. Cerebellar, alt. Running

Clinical course
Phase I: Pre Clinical Mild cognitive impairment: forgetfulness, anomia, neglect,
possible disorientation. Even normal life and activities. Phase II: Minor Impai
rment obvious: decreased intellectual performance, forgetfulness, acalculia, any
faults in the autonomy sociallaboral but bearable with supervision. Phase III:
Mild cognitive impairment and functional anterograde amnesia, retrograde, low ve
rbal fluency, disorientation, hallucinations, aggressiveness. significant proble
ms with the environment. Failures incapacitating social and work autonomy (aband
onment). Stage IV: Severe Loss of higher functions, loss of communication, myocl
onus, incontinence, dysphagia, hypersomnia, postramiento, death.
Epidemiology

World: 25.54 million people suffer from DTA (Fundació ACE, 2003) Peru: 15% of th
e population over age 65 have some form of dementia, 50% are DTA (Sanchez, 2006)
. The DTA appears after age 65, and its probability increases with advanced age,
among other risk factors.

What to do?
Diagnostic Phase
RMF TAC ERM Neurology, PET, EEG, hormonal profile CBC Metabolic profile analysis
Neuropsychology LCR mental state: MMSE CI: Memory WAIS-R: Benton, King, Wechsle
r, WAIS Note: strikethrough, Stroop, cancellation Language: Boston, My Alfa, Tok
en gnosis test: Figure King, Benton, WAIS, Popperleuter Praxias: Fig Rey, Kohs c
ubes, Strikethrough, Puzzles, Executive functions: WAIS similarities, PM-38, Wis
consin Card Sorting Test, Stroop Test Psychological: Zung, Hamilton Functional S
cale : Blessend, Hutchinski.
There is no instrument which
determine the accurate diagnosis of ASD.
However, the exploratory phase
establishes the fundamental neuropsychological profile for his presumption and t
he design of rehabilitation.
The exploratory phase is a simple
rehabilitation component.
Therapeutic Phase
Neurology Neuropsychology
Pharmacological symptomatic and neuroprotective T. Cognitive: nootropics, muscar
inic agonist, ACh protectors, T. neuropeptidérgicos behavior: antidepressants, a
nxiolytics, antipsychotics, neuroleptics, Prevention: Vitamin E
Neurocognitive Rehabilitation (RNC) Process continent of techniques and strategi
es aimed at improving cognitive and functional performance of the patient in ord
er to procure better adaptation and quality of life. Neuronal Plasticity scienti
fic basis of learning capacity
Objectives of the RNC
Initial goals To stimulate and maintain mental abilities. Avoid disconnectio
n from the environment and strengthen social relationships. Provide certainty
and increase patient autonomy Encourage self-identity and self-esteem: Interme
diate Objectives dignify Improving cognitive performance and functional To i
ncrease personal autonomy in daily activities To improve the health and sense
of ultimate objectives Improve quality of life of patients and their environme
nt.
RNC Techniques
Therapy Reality Orientation (TOR) The information provides the patient repeatedl
y over time, space and human environment. It is aimed at patients with disorient
ation, confusion and memory loss. Objectives Avoid disconnect the patient
Increase the autonomy arrangements within 24 hours TOR TOR sessions
Reminiscence therapy
Is to maintain the memory functions remotely over the facts or present stimuli.
Objective - To preserve the recent and remote memory. - Improve social integrati
on. Evoking ancient learning mode by presenting current stimuli such as photos,
songs, letters, etc. of which recount experiences
Music Therapy
Music therapy involves the application of music and dance to eventually help res
tore mental health and / or physical. It is based on the stimulation of brain wa
ves. Objective - To improve cognitive functioning and functional - improve the m
ood, hearing, language, motor skills, rhythm. - Check the tension and anxiety.€M
odalities - Relaxation - Dance - Free Expression
RNC Programs

They are a set of activities and exercises integrated, systematized and adapted
to the neuropsychological profile of patients with DTA. These programs include a
n application protocol, materials and warnings about its use. These programs are
customized, adjustable and flexible. Always under the guidance specialist.

Mind active
Peña-Casanova (2005) proposes to exercise the patient with techniques and specif
ic exercises to improve specific cognitive functions. Technical TOR, Reminiscenc
e, Music Therapy, Cognitive Therapy Validation Workbooks with exercises designed
to train damaged functions: memory, language, gnosis, attention, calculation, r
easoning Activities Workshops significant occupational, recreational and product
ive work adaptation of the physical environment Modifi- physical (home) to impro
ve alignment and safety.
Integral Program psychostimulation
Tárraga and Boada (1993) is based on neuroplasticity and cognitive psychostimula
tion "Brain Gym." Intervention includes three workshops: Workshop exercises psyc
hostimulation-specifically stimulates cognitive functions. Use workbooks with ex
ercises sorted and graded according to performance. Psicoexpresión Workshop Acti
vities to promote emotional health through music therapy, physical activity, rel
axation, to improve the coord. motor body schema, spontaneity, social integratio
n. Occupational workshop seeks to maintain productive recreational and household
activities: cooking, sewing, painting, garden, decoration, fabrics, etc..
Computer Support
Since 1990, computer science and neuroscience transcends NeuroRehabilitation. To
day there are programs that encourage interactive, multimedia learning channels.
- GRADIOR (Franco, 1998) - Abse (Cuba Neuroscience Center, 1999) - Teachware (C
uba Neuroscience Center, 1999) - Smartbrain (ACE Foundation, 2006) Aims - Active
Prevention - Treatment and Rehabilitation
Psychological intervention in the DTA
The family also receives a social impact
economic and emotional (depression, anxiety, guilt, aggression, grief, etc.) syn
drome disabling symptom complex caregiver for the caregiver (stress, depression,
abandonment, illness, addiction, legal, social isolation, cognitive impairment)
.
What to do?
The psychologist will design a treatment plan unique to the patient's environmen
t. Objectives To provide human support to improve stress coping prevent major ps
ychological disorders Improving the Quality of Life Self-Help Groups Other resou
rces Bibliotherapy Geriatric Day Care Centers Clinics
Conclusions

The DTA is an amnesic syndrome, mixed and permanent afasoapraxoagnósico unknown

etiology There are no instruments for the accurate diagnosis of DAT. The scienti
fic basis of the RNC is the neuroplasticity and learning ability The RNC seeks t
o slow the degenerative process and improve the quality of life of patients and
their environment. The DTA impacts the primary support group, the same exclusive
psychotherapeutic attention it deserves. The RNC comprises an interdisciplinary
work (neurologists, neuropsychologists, physiotherapists, occupational therapis
ts, nurses, speech therapists, social worker) for better chances of recovery.

Recommendations
Promote the study, research on dementias nationwide. Proposals and prevention pr
ogram of DAT in populations at risk. Training of health personnel involved in de
mentia patients in rehabilitation techniques. Propose the establishment of speci
alized care centers and interdisciplinary intervention by the DTA.

"The true madness may not be anything other than the very wisdom that, tired of
discovering the nakedness of the world, has taken the wise decision of going cra
zy." Heinrich Heine (1797-1856)
THANK YOU
Barrios Janampa Wilver Lima - Peru 2006
Rehabilitation
"Rehabilitation is defined as the coordinated set of medical, social, educationa
l and health professionals aimed at fostering the patient's functional recovery
and reintegration into their daily life activities with the greatest possible ca
pacity and independence" (WHO, 2006).
Variety of denominations
Psycho-stimulation neurocognitive rehabilitation cognitive rehabilitation Cognit
ive training psicocognoscitiva cognitive stimulation
All have a equifinality: slow the degenerative process and improve the quality o
f life.
PATHOLOGY
Dementia.
Under 65
Alcoholic dementia
Dementia with Lewy Bodies Other
Over 65
Vascular dementia Alzheimer's Disease
COMMUNICATIONS

Author: Mr. Ps. Barrios Janampa Wilver Institution: Kayra Clinic. -Mail Address:
Javier Prado Falls Q-19. Lima 03, Peru Email: wilber_jb@hotmail.com * Summary t
aken from the book: "neurocognitive rehabilitation IN DEMENTIA OF ALZHEIMER TYPE
" of Mr. Ps. Janampa WILVER Barrios.