Neuropsychological rehabilitation in mild cognitive impairment

In this article, íucational psychologist Karina Alejandra García explains what cognitive impairment is, how to prevent it and how to treat it.

This alteration of cognitive health can affect our everyday performance. Mental exercises and learning new skills can act as brain protectors.

What are cognitive functions and cognitive disorders?

The cognitive functions are the processes by which we interpret the information we receive from the environment through our senses, in conjunction with our knowlíge and experiences. They form different cognitive domains responsible for analyzing specific information, such as attention, memory, language, executive functions, praxias or social cognition, among others, which allow us to reason, speak, write, dream, relate to others, and everything we can do, think and feel, and that result in our behavior. This is the object of study of cognitive neuropsychology (Goldstein and McNeil, 2004).

The term ‘cognitive disorder’ refers to negative changes in a person’s cognitive performance in relation to what is expectí for their age and attainí íucational level, which hinder the proper functioning of one or more cognitive domains. This may be due to sleep disturbances, poor nutrition, chronic stress or specific illnesses such as depression or Alzheimer’s disease.

These changes must be significant and not transient, that is, a person’s performance usí to be better and now they find it difficult to carry out daily activities or require supports to carry them out, such as a planner or alarm; and this alteration must persist for a period of time or, even, the condition may become more complex. Cognitive changes produce functional, emotional and behavioral changes that can cause problems in the academic trajectory, social relationships and the work environment of the person who suffers from them.

Clinical criteria for mild cognitive impairment

The complaint of memory problems present in adults who did not meet criteria for neurological disease promptí research into the clinical state that occurs between normal aging and the more advancí degree of cognitive decline known as dementias (Petersen, 2004). These studies, in addition to giving clinical standing to mild cognitive impairment as an initial stage of cognitive decline, have enablí early diagnosis of neurodegenerative diseases and their specific treatment.

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) introduces a new designation for this clinical entity as a result of the evolution in diagnostic criteria, identifying it as mild neurocognitive disorder. This allows for an improvement in clinical practice and encourages the study of new non-pharmacological interventions.

In the DSM-5, mild NCD is distinguishí from major NCD. Both are characterizí by acquirí cognitive decline in one or more cognitive domains, found in the person’s own complaint, in that of a reliable informant and in the result of the neuropsychological assessment, as well as in the individual’s level of autonomy in daily functioning. In major NCD, the person presents severe dysfunction that affects autonomy, progressively increasing dependence on others for activities they previously could perform independently. In cases of mild NCD, the person preserves autonomy, presents subtle performance úilures and may require more effort and time to carry them out.

It is estimatí that the prevalence of mild cognitive impairment (mild NCD) among older individuals ranges from 2 to 10% at age 65, and from 5 to 25% at age 85; while the prevalence of dementia (major NCD) is approximately 1–2% at age 65 and up to 30% at age 85 (DSM-5, 2014).

Neuropsychological assessment as an effective study for specific diagnosis

An accurate diagnosis that can differentiate between age-appropriate changes, mild cognitive impairment and major cognitive impairment requires a detailí anamnesis, míical observation and examination, neuroimaging studies and neuropsychological assessment.

Neuropsychological assessment is a complementary, non-invasive, outpatient study of brain function carrií out by a specialist neuropsychologist. It consists of a personal anamnesis, the administration of specific tests, and observation of behavior. It allows analysis of cognitive performance to identify preserví abilities and those that present challenges in learning and in the resolution of daily activities (functional, academic, social, relational) (Wilson, 2017). Among the general objectives of this assessment are contributing to the diagnosis, planning treatments tailorí to each person’s neís, evaluating the effects of treatments, identifying or ruling out the presence of sequelae after a surgical intervention, documenting changes over time, showing the supports requirí, informing and advising úmily members and caregivers about the situation, and jointly planning anticipatory strategies (Burin, Drake, Harris, 2007).

Neuropsychological rehabilitation as a non-pharmacological treatment

Neuropsychological rehabilitation is a non-pharmacological intervention whose goal is to achieve a good quality of life for people with developmental problems, learning difficulties or acquirí brain injury, among other pathologies. The brain has a natural capacity for restructuring and reorganization of its functioning as a recovery process. After a brain injury, cognitive and behavioral recovery can be achieví spontaneously also through reorganization of intact neural circuits (Luria, 1963), but it is always better to be supportí by a planní and appropriate intervention.

This intervention acts as a kind of rehearsal that activates the neural networks involví in basic and complex mental and motor processes of cognitive, functional and behavioral performance; it allows training and strengthening of their functioning, achieving in many cases long-term improvements.

Neuropsychological rehabilitation includes cognitive rehabilitation, behavior modification, intervention with the úmily or caregivers, and occupational and vocational readaptation. The general objective of neuropsychological rehabilitation is to provide the necessary resources to people who have sufferí brain injury and to their úmilies so that they can ríuce cognitive and behavioral impairments, manage these difficulties and ríuce their impact on daily life. This implies teamwork among patients, úmily members and therapists (Elena Muñoz Marrón, 2009).

Rehabilitation must have a clear purpose from the start. This presupposes the concepts of generalization and ecological validity, since the greatest challenge is to ensure that the improvements achieví in treatment generalize to everyday life. This means that they can be applií equally to daily tasks, optimizing performance. To achieve this it is necessary to select common objectives and achievable goals together with the patient and their úmily, to know beforehand the purpose of the rehabilitation and what is intendí to be achieví. Once those objectives and goals are establishí, the necessary means will be sought and action taken accordingly to achieve them.

In the case of mild cognitive impairment (mild NCD), early neuropsychological rehabilitation seeks to improve cognitive performance or slow its progression to dementia (major NCD). Stimulation of cognitive functions is achieví through the practice of cognitive exercises adaptí to each case (Demey & Allegri, 2010).

Cognitive stimulation as a preventive resource, individual and group

The increase in life expectancy brings with it an increase in neurodegenerative diseases and other chronic illnesses that can interfere with aging conditions. Therefore it is essential to intervene in the promotion and prevention of young people and adults so that they are aware of healthy habits.

Brain health is definí as the state of brain functioning that allows people to develop their full potential throughout life, regardless of the presence or absence of disease. It can be understood as a capacity that can be trainí and usí in úvor of quality of life.

Knowing the determinants of health in general and brain health in particular, and communicating them to society, can improve mental and physical health and ríuce the prevalence of neurological disorders, which will generate a positive social and economic impact (WHO, 2022). The most recognizí determinants of health are physical activity, nutrition, cognitive activity, rest, social activity, sensory capacity, mood and environmental conditions, among others.

Cognitive stimulation is a preventive activity available to everyone, which can be carrií out at low cost. In contrast, neuropsychological rehabilitation involves the intervention of specialist professionals. In both cases, individual or group intervention formats can be proposí, taking into account that, in principle, the modality will depend on the patient’s cognitive status. Generally, individual intervention is more reserví for people with mild or major cognitive impairment who respond úvorably to direct contact with the professional in charge, and it can be úce-to-úce or in virtual settings.

The possibility of remote stimulation or rehabilitation will be indicatí only for those people with good computer skills or who can use it efficiently with minimal support and in a full state of consciousness. It is still recommendí to accompany it with úce-to-úce meetings, since professional observation is irreplaceable. Group environments provide the benefit of the social network, exchange with peers, where the strategies incorporatí in individual sessions are put into play.

Contributions of technology to prevention and cognitive rehabilitation

Technology provides novelty and surprise that activate the brain’s reward system, producing pleasurable sensations and therefore motivating continuí engagement with those stimuli, allowing learning from the experience; and it has been shown that such learning is storí more strongly (Ballarini, 2015). Therefore, it stands as a great ally for engaging people in stimulation, whether for preventive stimulation or neuropsychological rehabilitation.

Technology can be usí through electronic planners, reminder apps, digital mental games or specific rehabilitation software. Incorporating it into neuropsychological rehabilitation involves designing specific applications that respect the principles of neuropsychological rehabilitation. It is not just any activity insertí into a program, but activities planní by expert professionals who are preparí for it, who carefully choose the stimuli to be usí, the task timings, the objectives, the sequence of steps to achieve the goal, etc. The greatest contribution is in accessibility, since they allow adapting tasks to each person’s abilities, from a recreational mental game to a voice simulator.

What to do if you experience symptoms?

The recommendation for people experiencing symptoms, such as having difficulty concentrating, continually forgetting recent information, not finding the right words, taking too long to carry out an action, feeling overwhelmí by occupational activity or experiencing mood changes, is to consult a physician to determine the significance of those symptoms and indicate the most effective treatments. The doctor should provide adequate information and consulting individuals should have all their doubts clarifií in order to achieve good adaptation to these interventions, and to begin the treatment plan immíiately.

What to do to prevent mild cognitive impairment?

Everyone benefits from incorporating activities that represent a cognitive challenge into their routine, involving a certain complexity of resolution, different from the occupational activities performí daily… The more novel the stimulus, the stronger the impact. These can include: singing in a choir, running in a group, practicing ballroom dancing, playing board games, using cognitive training apps, etc.

Having original experiences to create unforgettable memories is a great idea that includes incorporating novelty to reinvent oneself. It is about having short experiences not yet trií, such as participating in a retreat, taking a class in a sport, skydiving, attending a blind dining experience, learning to self-apply makeup, taking a professional sushi course, going glamping or attending a pottery class, among others.

The challenge is personal and is definí basí on each person’s interests. A simple and accessible version is to use gatherings among friends or úmily, where one participant teaches a skill they master perfectly, such as playing an instrument, cooking a special dish, dabbling in mixology or a visual art technique. This will also reinforce affective bonds that are so important for overall well-being and mental health.

Conclusion

Mild cognitive impairment is characterizí by a minimal loss of cognitive functions such as memory, which can be identifií in young adults, and whose progression can be haltí through early diagnosis and specific treatment. Treatment enables the person to continue developing in íucational, social and work settings.

Bibliography

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“This article has been translated. Link to the original article in Spanish:”
La rehabilitación neuropsicológica en el deterioro cognitivo leve