The number of people living with dementia increases dramatically each year

There are an estimated 35.6 million people affected by dementia globally, a number expected to almost double every 20 years. According to ASHA, people with dementia represent the third-largest caseload for speech language pathologists working in U.S. healthcare. 

Here, we will help you recognize symptoms of dementia, understand the goals of therapy, and identify the Constant Therapy tasks that our data shows is used to exercise those with dementia most often.

Dementia is not a specific disease. It’s an umbrella term, describing a wide range of symptoms, and there are multiple types of dementia, including Alzheimer’s disease, frontotemporal dementia, primary progressive aphasia, and vascular dementia. Dementia is a clinical syndrome characterized by persistent progressive deterioration. It usually affects people older than 65 years of age. 

The symptoms of dementia may cause individuals to withdraw from activities and relationships

Dementia affects a variety of cognitive functions including attention, memory, communication & speech, reasoning, and visual perception, and can also result in:

• Apathy & Depression
• Impaired Judgment
• Disorientation
• Behavioral Changes

Due to these symptoms, dementia can cause individuals to withdraw from activities, family and friends. However, maintaining these activities and relationships are the very things that may reduce the effects of cognitive impairment. Therefore, it appears beneficial for people with dementia (PWD) to explore treatments that may provide some relief of symptoms and help maintain a level of independence longer. 

The goal of cognitive therapy: stimulate cognitive areas as they relate to activities of daily living

The jury is still out on how well cognitive therapy or training can help people with dementia. Research has examined different types of therapy approaches for cognition and communication, and the findings show promise, but are preliminary. Further well-designed studies of cognitive training and cognitive rehabilitation are required to provide more definitive evidence.

In the meantime, people living with dementia often receive rehabilitation services including physical therapy, occupational therapy, and speech-language therapy. In speech-language therapy, exercises often target dysphagia (swallowing problems), cognition, and communication. There are different approaches in cognitive-communication treatment, which can involve stimulating cognitive areas through activity, specific training for the underlying cognitive domain, and treating affected behaviors and skills as it relates to activities of daily living.

Analysis: how is Constant Therapy being used with this population?

A recent analysis of Constant Therapy users took a look at individuals using the app, who identified as living with dementia, and what tasks are assigned to them most frequently by their clinicians.

We looked at data on 30,200 users who identified with a diagnosis of dementia at sign-up. This group of users completed an average of 218 tasks each, for a total of 6.5 million tasks.

The Constant Therapy tasks listed below are the 10 most frequently assigned by clinicians for their clients with dementia. 

The top 10 Constant Therapy exercises assigned by clinicians to their clients with dementia

1. Match pictures: In this working memory task, the patient must recall the location of everyday pictures. 
Individuals Assigned: 14,327 Percent of Users Identified As Living With Dementia: 47%

 2. Find the same symbols: Targets a variety of skills often affected by dementia, including attention, visuospatial processing, and executive functioning. With 10 levels of difficulty, higher levels provide an increased challenge by adding more symbols in the grid and more distractions.
Individuals Assigned: 13,810 Percent of Users Identified As Living With Dementia: 46%

3. Put steps in order: Sequencing steps to daily activities often affect people living with dementia. In this executive functioning task, you are presented with the steps to daily activities and must drag these steps into the correct order. 
Individuals Assigned: 13,633 Percent of Users Identified As Living With Dementia: 45%

4. Do clock math: Dementia can affect an individual’s ability to do daily tasks such as reading a clock or calculating time. This task target skills in visuospatial processing, memory, and calculations. Do clock math has 3 levels of difficulty where individuals must calculate the time (e.g. what time will it be in a half hour). 
Individuals Assigned: 10,091 Percent of Users Identified As Living With Dementia: 33%

5. Remember pictures in order (N-back): This memory exercises is specifically targeting an aspect of working memory called updating. There are 3 levels of difficulty. In Level 1, you must remember the order of the pictures from 1 picture ago. In level 3 you must recall 3 pictures ago. 
Individuals Assigned: 9,555 Percent of Users Identified As Living With Dementia: 32%

6. Follow instructions you hear: Follow instructions you hear works on auditory memory and auditory comprehension through following directions. There are 10 levels of difficulty.  Level 1 starts with 1-step directions, and upper levels become more challenging with longer directions, temporal instructions, and increased demands on working memory.
Individuals Assigned: 9,245 Percent of Users Identified As Living With Dementia: 31%

7. Repeat a pattern: This task works on attention, visual working memory, and visuospatial skills. There are 12 levels of difficulty with Level 1 requiring a recall of a 4-item pattern in a small grid, and Level 12 requiring recall of a 10-item pattern in a large grid. 
Individuals Assigned: 7,869 Percent of Users Identified As Living With Dementia: 26%

8. Remember the right card: This task works on attention, disinhibition, and processing speed. The patient is presented with a playing card to remember and tap on that card whenever it is presented in a series of cards. There are 3 levels, which each level increasing in speed.
Individuals Assigned: 7,806 Percent of Users Identified As Living With Dementia: 26%

9. Read a clock: This task helps people with cognitive, speech, or language disorders improve daily living skills by reading an analog clock and answering questions about the time. 
Individuals Assigned: 7,293 Percent of Users Identified As Living With Dementia: 24%

10. Read a calendar: This task helps people with cognitive, speech, or language disorders improve their skills in interpreting, planning, and managing daily activities within a calendar.
Individuals Assigned: 6,279 Percent of Users Identified As Living With Dementia: 21%

If you are looking for Constant Therapy tasks to assign to your patients with dementia, consider starting by leveraging the expertise of the clinicians who came before you. After all, Constant Therapy is created by clinicians, for clinicians. 

References:

• Prince. M., and Bryce, R. (2013). The global prevalence of dementia: A systematic review and metaanalysis, Alzheimer’s & Dementia 9 (2013) 63–75.
• Swan, K., Hopper, M., and Wenke, R. (2018). Interventions for communication in moderate–severe dementia, American Journal of Speech-Language Pathology, 27, 836–852. 
• Postman, Whitney A. (2016). Computer-Mediated Cognitive-Communicative Intervention for Residents with Dementia in a Special Care Unit: An Exploratory Investigation, Perspectives of the ASHA Special Interest Groups, October 2016, Vol. 1 (SIG 15), 68-78. 
• Treatment for Dementia, ASHA.org.