Rementia: is it possible to reverse the symptoms of early-stage dementia?

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By Jackie Pool

From recalling names to relearning how to make tea, occupational therapists can help people with dementia regain functions

As we get better at living longer, the number of people living with dementia rises. Globally, an estimated 46.8 million people live with the condition.

But dementia has not always been understood in the way it is today. For a long time, it was thought of as a mental health disease and an inevitable consequence of ageing. During the 20th century, however, advances in medicine and research meant that dementia came to be understood as a set of cognitive and functional symptoms, caused not only by neurological conditions, but also by the physical, social and psychological experience of the individual.
The latest thinking in the field of dementia care, to which I have devoted my career, is the new understanding that while we can support individuals to maintain their current abilities for longer, we can also – in some cases – work to restore lost functions.

When I first worked as an occupational therapy assistant in the 1980s, I was shocked by the treatment of those living with dementia. Too often, people had simply been given up on.

This was not because of any negligence by individual care workers – the whole culture was different then. Hospital services were described starkly as “psycho-geriatric”, and the overriding purpose of dementia care was to keep people safe, secure and occupied – essentially appeasing them with entertainment, rather than stimulating them and helping them retain functions wherever possible.

In recent years, this approach has had a radical overhaul. The understanding of dementia as a neurological issue and a combination of many different causes has been adopted by the mainstream. Pioneers, such as Prof Tom Kitwood, have shown that the symptoms of dementia are determined by people’s specific neurological impairments, by their own personality and life history and, crucially, by social psychology: how we treat those living with dementia.

This was a huge wake-up call for the field in the 1990s, and a formative moment for those, such as myself, who specialise in dementia care. Once we better understood what dementia is and the many factors that can cause it, researchers began to explore “rementia” – the possible reversal of some of the symptoms.

Central to this approach is the use of occupational therapy. In practice, occupational therapists work with those with early-stage dementia to understand each individual’s set of symptoms and where they would like to improve and regain functions. Some, for example, may want to learn how to use a mobile phone, some may want to relearn how to make a cup of tea, and others may be desperate to recall the names of their grandchildren.

The therapist will then help each individual break down the specific activity into its component parts, analyse them, and put them back together to relearn them. Making a cup of tea, for example, is an incredibly complex task when broken down into each tiny movement and decision required: reaching for the kettle, gripping the handle, deciding how much water to use.

Underlying the practice are the latest developments in neuroscience, which explores how functions can be regained by enabling new links between neurons to work in place of the damaged ones. This phenomenon of rewiring the brain is well understood but has not yet been applied widely to dementia care, where it has huge potential to help people in the early stages of the condition.

Several studies I have been engaged in are now working to bring the “rementia” model and the use of occupational therapy into the dementia care mainstream, and ensure that the benefits of this revolution in dementia care reach as many people as possible.

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