The neuropsychologist, Claudia Mayza, tells us about her experience in the center Caldevid Geriatric in neuropsychological rehabilitation in older adults with dementia. This text aims to promote research and the use of new technologies in the approach to dementia.

In recent years, there has been an increase in both the population pyramid and the life expectancy of older adults, leading to a closer look at lifestyle, related diseases, and the scope of the healthcare system.

The World Health Organization estimates that worldwide, between 5% and 8% of the population over 60 years old have been diagnosed with dementia. In 2015, at least 47 million people suffered from dementia, and statistical projections indicate that this disease will affect 75 million people by 2030 and 131 million people by 2050.

According to the Pan American Health Organization (PAHO) (2020), the majority of people with dementia are taken care of at home, increasing mortality rates for both individuals with dementia and their caregivers and/or family members.

In addition, many countries lack adequate care in long-term care facilities or institutions, which generates an economic impact.

In 2010, the estimated cost of treating and caring for people with dementia was $604 billion worldwide and $235.8 billion in the countries of the Americas, with a significant portion of this economic burden being shouldered by families.

What is neuropsychological rehabilitation?

Neuropsychological rehabilitation is defined as a structured set of therapeutic activities specially designed to retrain the skills of individuals who have suffered some form of cognitive deficit following an injury or illness.

In an integral concept, it refers to an intervention that aims to enable patients and their families to live with, manage, prevent, reduce, or cope with these alterations. In the case of dementia, it focuses on improving the quality of life, promoting independence, slowing down the level of deterioration, and optimizing overall cognitive functionality and performance.

Neuropsychological rehabilitation in dementia

Currently, there is an integral management of neuropsychological rehabilitation that allows for various evidence-based strategies using cognitive methods, techniques, therapies, or psychosocial interventions. The focus is mainly on maintaining the functionality and quality of life of older adults and their family members and/or caregivers.

Any intervention must be adapted to the difficulty, with permanent supervision by a specialist, focusing on a degree of representativeness and transferability in daily activities.

Highlighting the importance of neuropsychological assessment as a starting point for appropriate approaches and knowledge of both cognitive reserve and preserved and/or impaired functions.

The use of new technologies and the digital era

According to statistics from the Economic Commission for Latin America and the Caribbean (ECLAC) (2019), the elderly population is the most isolated in the use of digital technologies, revealing a deep digital divide and the challenge of promoting inclusion.

It is important to mention that the pandemic and post-pandemic context have highlighted the need to use technology as a resource for maintaining communication, socialization, medical assistance, rehabilitation, entertainment, and learning for older adults.

There are various studies recommending the use of new technologies (ICT) as a method to improve the quality of life for older adults with neurodegenerative diseases, neurological conditions, cognitive impairment, depression, among other diseases.

Resources such as “wiitherapy,” applications, platforms, virtual and augmented reality, RGS, robotics, among others, are the most commonly used.

Neurorehabilitation: Experience with NeuronUP

Neurorehabilitation can be focused on two types of processes: short-term and long-term.

Short-term process

In the first case, it must be specific, measurable, adaptable, realistic, and with a defined time frame.

Long-term process

In the second case, the goal is to help recover and/or minimize, compensate for and/or substitute for impaired or diminished functions, helping to regain maximum potential, functionality, and independence, and then maintain and/or slow down the process. This is applicable in cases where cognitive impairment and/or dementia are present.

Evidence-based alternative

From our experience in private care and at the Caldevid Center, the NeuronUP platform has allowed us to provide a digital evidence-based alternative with cognitive techniques such as:

Errorless learning (EL), Spaced retrieval (SR), Fading cues (FC), Attention Process Training (APT), metacognitive strategies, acronyms, trial and error, visualization, association, approximation repetition, modeling, self-instructions, among others, that complement the comprehensive approach we provide to older adults and their families.

Types of intervention

We also provide various types of neuropsychological rehabilitation interventions:

• In-person: Individual and group.
• Tele-rehabilitation: Facilitated by a specialist and screen-shared.
• Home-based: Individual.

Platform complementing other activities

The NeuronUP platform is used in all modalities, complementing other activities that we offer at the day center, such as paper exercises, therapeutic games, virtual reality, dynamic and psychostimulation activities, geriatric gymnastics, functional physical therapy, social and recreational activities, art therapy, gerolympics, art exhibitions, among others.

NeuronUP is user-friendly, adapted to difficulty, age, and educational level, and has resources that promote motivation and treatment adherence.

It contains digital activities, which are organized according to intervention areas and cognitive functions (attention, memory, language, executive functions, gnosis, praxis, visuospatial skills, social cognition) and occupation areas (basic and instrumental activities of daily living, among others). It allows managing patients and performance results.

Group work with NeuronUP

In September 2022, a digital mini gerolympics was held using the NeuronUP platform.

The activity was scheduled in 2 moments:

1. Pre-gerolympics training, reinforcing the use of digital activities for both older adults and their families, lasting 2 weeks with a frequency of 2 times per week.
2. The actual activity involved forming groups of two people (an older adult and a companion) according to schedules and characteristics.

This allowed working on different cognitive and occupational functions, as well as fostering motivation, autonomy, identity, a sense of belonging, and competitiveness in new challenges.

Conclusion

• It is important to consider that the use of technology will not be accessible in some cases, either due to economic, social, degree of disease deterioration, or related deficits.
• The neuropsychological approach is broad, with diverse techniques and strategies that will be adapted according to the case, always including the family, both in the participation of the sessions and in psychoeducation and emotional support.
• Encourage research and training on updates in neurorehabilitation and other neuropsychological rehabilitation strategies.

In Peru, access to the use of new technologies and neurorehabilitation techniques for older people suffering from cognitive deficits or dementia is limited. However, there is an effort made by many professionals from different areas, including care, research, and training.

Nothing is unique, it is not just one resource, dementia intervention is broad, so it is important to use tools that show evidence, since the shared purpose is to provide quality of life for older adults and their families.

Bibliography

• Custodio, N., García, A., Montesinos, R., Escobar, J., Bendezú, L. Prevalencia de demencia en una población urbana de Lima-Perú: Un estudio puerta a puerta. An Fac med. 2008; 69(4): 233-238.
• León-Sarmiento, FE, Bayona, E., & Bayona-Prieto, J. (2009). Neurorrehabilitación: La otra revolución del siglo XXI. Acta médica colombiana, 34 (2), 88-92.
• Prevalence of Dementia and Associated Factors among Older Adults in Latin America during the COVID-19 Pandemic Soto-Añari M, Camargo L, […] López N Dementia and Geriatric Cognitive Disorders Extra (2021) 11(3) 213-221
• Sunkel G, Ullmann H, Las personas mayores de América Latina en la era digital: superación de la brecha digital, Revista de la CEPAL, 2019.
• Wilson. B, Winegardner.J, Van Heugten. C., Ownsworth., T, (2017), Rehabilitación neuropsicológica. Manual internacional, Editorial El Manual Moderno S.A de C.V.
• Zurique Sánchez C, Cadena Sanabria MO, Zurique Sánchez M, Camacho López PA, Sánchez Sanabria M, Hernandez Hernandez S, et al. [Prevalence of dementia in the elderly in Latin America: a systematic review]. Rev Esp Geriatr Gerontol. 2019;54(6):346–55. Spanish.

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