Western New York’s Dementia Resource
Adult Cognitive Disorders
Buffalo Occupational Therapy
Dementia and Alzheimer’s | Buffalo NY | Buffalo OT
Michelle Eliason, MS, OTR/L, C.DS., CKTS
Prevalence of Adult Cognitive Disorders in the United States
By 2050, the United States is expected to experience rapid growth of the old and old-old population. America’s oldest generation (85 years and above) is expected to quadruple in size and reach over an 8 million person census. Adult cognitive disorders are under stated in the United States. This statistic projection is likely a key factor in the discovery of increased adults living with cognitive disorders. In 2000, there were 4.5 million people diagnosed and living with Alzheimer’s disease, by 2050 this number is set to reach 13.2 million in the United States (2). Alzheimer’s disease and other related dementias (ADRD) is one of the top diagnoses associated with adult cognitive disorders and occupational therapists are emerging in the community to address the critical needs required to maintain independence and quality of life throughout one’s lifespan despite being diagnosed with an adult cognitive disorder.
Cognition, Functional Cognition, and Occupational Therapy
Cognition is an umbrella under which many brain functions can be found. The ability to acquire, store, manipulate, and later retrieve this information appropriately are all aspects of cognitive function (1). In other words, memory, attention span, self-awareness, problem solving, self-monitoring—all of these abilities are powered by an individual’s cognition. Functional cognition is the cognitive processes required to carry out activities of daily living (ADLs), instrumental activities of daily living (IADLs), and community living skills (3). With coursework including Neuroscience, Neuroanatomy, Neuro- rehabilitation, Applied Neuro-physiology, Applied Geriatrics, and Assistive Technology, Occupational therapists are experts in addressing functional cognition. By designing interventions to include environmental context, functional performance skills, and cognitive skills, an occupational therapist is a strategical expert in aging with independence.
Examples of Adult Cognitive Disorders
Adult cognitive disorders can be a result of many ailments and/or diseases. Some of the major influencers include the following:
- learning disability
- developmental disorders
- traumatic brain injury such as accident or stroke
- Alzheimer’s disease or other related dementias (ADRD)
- mental illness
- excessive stress
- environmental factors (3)
Regardless of the source of cognitive disorder, occupational therapists are a key solution to aging in place (aging in the place of your choice) and productive aging (4). By establishing cognitive and functional profiles through programs such as The Independent Senior Living Collaborative, occupational therapy can collaborate with the patient, primary physicians, and specialty community services to best meet an individual’s needs throughout the progression of an individuals cognitive disorder (if any) (5).
Occupational Therapy Cognitive Rehabilitation Approaches
There are also many cognitive rehabilitation approaches taken by an occupational therapist addressing adult cognitive disorders. A few of them include the following:
Environmental Press Model
Occupational therapy practitioners offers a holistic approach to rehabilitation which means an occupational therapist includes the personal perspective of the client, the environment, and the occupation (meaningful activity) being effected in all treatment approaches- also known as the P-E-O Model (6). By using this type of approach, an occupational therapist can utilize the correct environmental press. Environmental press can also be referred to as the “just right challenge”. When approaching aging in place independently when an individual has an adult cognitive disorder, finding the “just right challenge” is critical to long term independence. Too much challenge and a cognitive decline may result because an individual is pressed beyond the ability to function, too little challenge and the individual acquires learned helplessness causing decline due to lack of cognitive use. Occupational therapists are skilled in making this determination.
Global Strategy Learning and Awareness Approaches
- Client and caregiver education through all stages
- Group processing and development
- Occupational therapist acts as a third party guide as client and caregiver determine compensatory methods (3)
Domain Specific Strategy Training
- Determine what activities/areas of life being effected by the cognitive disorder and determine specific solutions for that area (3)
Cognitive Retraining in approach and functional activities
- Learn how to “work around” the specific symptoms of the cognitive disorder
- Use approaches such as Montessori-based activities, Space-Retrieval Therapy, and Errorless Approach
- Specific repetitive training in activity of daily living (ADL) or Instrumental Activity of Daily Living (IADL) being effected. (3,7,8)
Environmental Modification and Assisted Technology Training
- Home assessments
- What Is Cognition & Cognitive Behaviour – Cambridge Cognition. (n.d.). Retrieved January 22, 2019, from http://www.cambridgecognition.com/blog/entry/what-is-cognition
- Herbert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer’s disease in the U.S. population: Prevalence estimates using the 2000 census. Archives of Neurology 2003;60:1119–1122.
- The Role of Occupational Therapy in Adult Cognitive Disorders. (n.d.). Retrieved January 22, 2019, from https://www.aota.org/About-Occupational-Therapy/Professionals/PA/Facts/Adult-Cognitive-Disorders.aspx
- Eliason, M. C. (2019, January 21). Productive Aging Specialists | Occupational Therapists emerge as Leaders in Community Practice | Buffalo Occupational Therapy. Retrieved January 22, 2019, from https://www.agingwithpurpose.org/2019/01/21/productive-aging-specialists-occupational-therapists-emerge-as-leaders-in-community-practice-buffalo-occupational-therapy/
- Eliason, M. (2019, January 03). WNY Independent Senior Living Collaborative |Buffalo Occupational Therapy. Retrieved from https://www.agingwithpurpose.org/2019/01/03/wny-independent-senior-living-collaborative-buffalo-occupational-therapy/
- Eliason, M. C. (2019, January 03). LIFE SPACE and PERSON ENVIRONMENT FIT | Occupational Therapy. Retrieved from https://www.agingwithpurpose.org/2018/09/14/life-space-and-person-environment-fit-occupational-therapy/
- Femia, E. E. (2006, October). EVALUATION OF THE MONTESSORI-BASED ACTIVITIES PROGRAM OF THE ALZHEIMER’S AWARENESS AND CARE PROGRAM (United States, National Alzheimer’s Association, The D.C. Office on Aging And Home Care Partners). Retrieved January 19, 2019, from https://www.alz.org/national/documents/aoagrant_tools_montessori.pdf
- Goal-oriented Cognitive Rehabilitation in Early-stage Alzheimer’s and Related Dementias: Multi-centre Single-blind Randomised Controlled Trial – Protocol Version 5. (2019, January 18). Reading presented at GREAT Living Well with Memory Deficits. Retrieved from file:///Users/Michelle.Eliason/Downloads/3007132.pdf
Michelle Eliason, MS, OTR/L, C.D.S, CKTS is both an occupational therapist and CARES Dementia Specialist. She has been an elder care professional for 7+ years. Working in various aspects of the elder care industry has given her a generalist skill set and a broad knowledge base of elder care approaches and resources. Michelle is passionate about influencing the elder care industry advocating against nursing home negligence and elder abuse, and working with older adults to enable them to live in their own homes throughout the aging process.