3.4 Therapies to help memory and thinking

Therapies for managing memory and thinking difficulties focus on: 

a) improving memory and thinking (e.g., medications, brain training), or  

b) helping to reduce the impact of problems with memory and thinking in daily life (e.g., cognitive rehabilitation) 

Medications

In Canada there are four approved medications for dementia. Donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon) are approved for people with mild–to moderate Alzheimer’s disease, while memantine (Ebixa), is approved for people with moderate to severe Alzheimer’s disease.  

These medications work by increasing or balancing the levels of certain chemicals in the brain that are responsible transmitting memory between brain cells. In some people with Alzheimer’s disease and Lewy body dementia, these medications have been shown to improve or maintain memory and thinking for about a year.  

However, like all medications there are side effects. You can read more about these medications and their side effects here.

If you are interested, make an appointment with your family doctor or nurse practitioner to discuss whether these medications would work for you. 

Cholinesterase inhibitors, including donepezil, galantamine and rivastigmine are more commonly known by their brand names (Aricept, Reminyl and Exelon). They are approved for people with mild-to-moderate Alzheimer’s disease. They work by decreasing the breakdown of a certain chemical in the brain called acetylcholine. This results in increased levels of acetylcholine in the brain, which is important for memory. These medications have been shown to temporarily improve or maintain memory and thinking for about a year and result in slower decline in some people with Alzheimer’s disease and Lewy body dementia. 

The NMDA receptor antagonist, memantine (brand name Ebixa) is approved for people with moderate to severe Alzheimer’s disease and may slow an individual’s rate of decline in thinking abilities and function. However, it should be noted that none of these medications provide a cure for dementia and their effects are modest. Just as acetaminophen does not cure an infection but may relieve a fever, these drugs are all aim to reduce symptoms. Read more about these medications including their side effects here. 

Brain Training

Brain training involves mental exercises to improve different aspects of memory and thinking. In research studies, mental exercises are usually presented on a computer, sometimes in the form of a game. It is not clear whether brain training helps people with dementia. Some studies found that it improves memory and thinking, while others have not. Doing intensive brain training (i.e., more frequently each week) may have a greater effect. As well, people may only improve on the tasks they train on (e.g., if you practice remembering shopping lists, this will improve, but your word finding may not). 

Some people with dementia who practice brain training feel it helps them. If you are interested in computerized brain training, some companies offer tailored brain training programs online. However, there is no evidence that these programs improve memory and thinking for people with dementia and we do not specifically endorse them. You can try some for free, but ongoing access requires a monthly payment or the purchase of a lifetime package. 

• NeuroNation 
• Luminosity 
• Elevate App 

Cognitive Stimulation Therapy

Cognitive stimulation therapy is a program of activities which encourage people with dementia to use different parts of their brain. The activities may include conversations or mental or physical games. They are usually run by a health provider in small groups over six to eight weeks.  Many research studies have consistently shown cognitive stimulation therapy improves memory and thinking, and people who partake in the activities usually enjoy them. 

Unfortunately, despite the research evidence and clinical recommendations behind cognitive stimulation therapy, programs are rarely offered in Canada. You may be lucky to find a group in your area. The research suggests that regularly doing a variety of mentally challenging activities in a group can improve memory and thinking for people with dementia (see section 4 iv on boosting your brain health). 

There is some research being done on brain training through Baycrest. To learn more, visit this link.  

Cognitive Rehabilitation

Cognitive rehabilitation is individual therapy usually delivered at home to people with dementia. A therapist, usually an occupational therapist, talks to the person and their care partner about their goals (e.g., to keep cooking for themselves, or to be able to walk to the store alone), and makes a plan to help them meet those goals. The plan may include: 

• setting up the house to make activities easier (e.g., organizing and labelling things in the kitchen)  
• practicing strategies (e.g., walking to the store together and seeing where the person might have difficulty, cooking a recipe a few times) and  
• showing carers how they can be supportive without taking over (e.g., making sure the person has their wallet, phone and keys when they leave for the store). 

Research shows that cognitive rehabilitation helps people with dementia to better manage their activities in daily life, but it does not improve memory or thinking. Cognitive rehabilitation programs for people with dementia are rare in Canada. Contact an experienced occupational therapist or psychologist and ask if they can provide you with cognitive rehabilitation.  See section 5.2 Put your life plan into action.