Cognitive therapy with a speech therapist for mild dementia

JCB3

Can anyone explain what should be happening in a therapy session? I finally convinced my husband to attend a virtual visit. The therapist started with a lengthy list of general questions regarding memory that have been asked/answered at several prior medical apptments within the same network. She then said she'd like to focus on specific memory issues that my husband has been having. We mentioned a) forgetting laundry in the washer; and b) forgetting scheduled appointments and what they are scheduled for. She mentioned about setting a timer on his phone and/or a timer on our stove or microwave. (She never assessed his familiarity with electronics or gadgets….both of which my husband is averse to..). And then suggested writing appointments down on a calendar that is visible, with notes. (Both of which we are already doing) At this point, my husband (who was only doing the apptment at my insistence) decided that this was "bs" and we ended the apptment. I thought it would be exercises/skills to try to play on existing strengths and possible enhancement of skill. If there is anyone with knowledge of what should be occurring in a session, can you let me know. Or were my expectations unreasonable? I came away from the apptment feeling that any memory enhancements (timers, lists, notes, etc) are up to me……….which is what has been going on. Not complaining, just clarifying if there was something else that was supposed to be included?

SDianeL

My DH has Alzheimer's and has been seen by 2 Speech Therapists which did nothing but agitate him. I think if he had been having trouble finding words they might have helped but that wasn't what was happening. He is now in Late Stage 6 in a Memory Care Facility. Their Speech Therapist did have a few sessions with him but called me to say they weren't helping. At least she was honest. She recently evaluated him for being able to swallow. So they must do other things other than speech. No therapy has helped my DH. Speech, PT, OT, etc.

M1

Welcome to the forum jCB3. This has come up before and i think your husband is right: mostly BS. The idea of "cognitive behavioral therapy" for someone with impaired cognition is an oxymoron. For another thread i looked into whether there was any solid research that validates this approach aS beneficial and there wasn't.

money better spent is therapy for the caregiver to help them cope.

don't intend to sound negative or suspicious, but i have to wonder about any practitioner who recommended this- kickback scheme perhaps or mutually beneficial some other way? I find it borderline unethical.

JeriLynn66

My 98 year old FIL in AL was sent OT and Speech to "help him adjust to AL'….

um, how do you do that since his short term memory is 2 minutes???

Iris L.

Welcome JCB. There is cognitive rehabilitation therapy available via a Speech and Language therapy department. But this is primarily directed towards stroke snd head trauma patients, who might have a chance of regaining cognitive function as their injuries heal over time. But PWDs will never heal, they will only DECLINE. Caregivers can learn accommodations, which we call work-arounds. The members discuss these a lot.

PWDs need to be kept active on their level. They need failure free activities.

I don't know if the referral was unethical but it certainly was clueless. I wonder about the referring doctor's grasp of your DH's condition. It will help you to have a knowledgeable PCP, because you will be seeking medical attention often. How to approach serious illnesses in the PWD is discussed a lot. Also, learn about silent UTIs when behavior changes rapidly.

Iris

Quilting brings calm

One of the therapists at my mom’s AL does this type of stuff. She will work with mom on orientation to time and date, or playing games on the iPad meant to stimulate her brain. I don’t think it’s meant to improve as much as slow down the decline. Similar to the so called memory medications. I don’t see how it would work as a virtual appointment though

harshedbuzz

@JCB3

Hi and welcome. I am sorry for your reason to be here but pleased you found this place.

I'd save my money for respite care down the line. In addition to memory loss, early dementia brings significant losses in empathy, self-awareness and executive function that would be needed for successful CBT.

Your DH likely doesn't have the skills needed to accurately assess a situation and recognize when to use the kinds of strategies that are the basis of CBT. He probably wouldn't appreciate when his role in a situation was the problem, nor be able to executive the best strategy for the situation if he could even recall what he's been taught in therapy.

Psychoactive medication can be very effective for depression, anxiety, agitation, aggression, delusions and hallucinations. I'd seek guidance from his neurologist or find a good geriatric psychiatrist.

HB

H1235

My mom did see a therapist for problems swallowing. She was probably stage 4. Suggestions were common sense. Smaller bites, chew more… I could have made most of the same suggestions, but mom would have never listened to me(she would just say you’re not a doctor how would you know). She did pt because she had had a few falls. The suggestions were good but common sense. She also suggested some light exercises to build strength. Mom didn’t mind the visits. I’m not sure how much she remembers of it and don’t think she ever really tried to put any of it into practice.

JCB3

Thank you everyone for your helpful comments and sharing of experiences. It was his neuro that initially referred him for "cognitive therapy" with a speech therapist (not CBT, which I am very much aware of and knew that would have no benefit). He made it seem that this was something different, specifically geared to enhancing memory function and that the research indicated that this was at least as effective as current medications. I have also been reading about "cognitive stimulation therapy" which seems to be a thing in great britain. It seems to use games, activities and socialization techniques to help with engagement, etc. I am wondering if my health insurance group has decided to just try to throw something at this and assigned it to an already existing department cuz they really didn't do their homework on it…….But you all have confirmed my suspicions that, basically, any prompts, timers, helpful noted and reminders are up to me.

harshedbuzz

@JCB3

I'm sorry. Reading fail on my part. It's been a week.

My dad did do some cognitive stimulation therapy while in rehab not long after he was diagnosed. I think he was getting 30 minutes daily 1:1 with a speech therapist for about 7 weeks.

Dad's situation was a little different than most here. He had 2 kinds of dementia Alzheimer's (about stage 4) and Wernicke-Korsakoff's (which was somewhat reversable and for which he was being treated). The CT gave us data around the efficacy of his treatment/nest steps, and it helped justify his admission so we could get him moved closer to me. The SLP was personable and cute; he enjoyed the attention.

I don't think anything she did with him "stuck". It sounds like many of the strategies offered are pretty garden variety supports and accommodations that border on common sense. That said, be aware that for some PWD these kinds of "reminders" can become triggers that ramp up anxiety and that they'll become less useful as he progresses.

HB

Chammer

I saw a YouTube video within the last year of a presentation by a renowned FTD researcher/physician and he did address that speech therapy has proven to be beneficial for FTD, but it was specifically for FTD and I think even more specific to early aphasia. I will see if I can find the link.

This highlights though that research is very specific and just having "research shows dementia patients benefit from speech therapy" may be misleading unless you delve into the specifics.