Therapeutic Interventions for Cognitive Decline

Cognitive decline has an adverse effect on occupational performance.

It hinders a person’s ability to engage in activities of daily living, work, education, and leisure, which is why therapeutic interventions for cognitive decline are critical. According to a 2022 article, 1 in 10 Americans over 65 have dementia. However, dementia is not the only cause of cognitive decline. Cognitive decline can result from acute health conditions or progressive diseases such as: 

Signs and symptoms of cognitive decline include: 

Related: Navigating the Maze: An Overview of Dementia 

Therapeutic interventions to address cognitive decline 

A randomized trial examined the relative effectiveness of primarily compensatory and primarily restorative cognitive interventions in a group of study participants who were experiencing early psychosis. The 56 study participants received either Cognitive Adaptation Training (CAT), the compensatory intervention, or Action Based Cognitive Remediation (ABCR), the restorative intervention for four months.  

The CAT intervention used environmental supports and weekly home visits to increase community function and provide compensatory strategies for cognitive difficulties. The ABCR involved computerized cognitive drills, practice exercises, goal setting, simulations, and behavioral activation. This study concluded that both CAT and ABCR hold promise as interventions for early intervention psychosis populations. Researchers felt more work is needed to identify illness severity, subtype, and contextual considerations that might emphasize more compensatory versus more restorative cognitive interventions. 

Compensatory strategies for older adults with mild cognitive decline 

Another research study involved 125 older adults. The older adults who had normal cognition, mild cognitive impairment, or dementia underwent neuropsychological testing. Information was gathered from the participants through questionnaires that provided information about everyday compensation and cognitive and functional abilities. 

The study results showed that older adults with cognitively normal and mild cognitive impairment used compensation more frequently than those with dementia. Higher levels of neuropsychological functioning were associated with more frequent compensation use. Most importantly, greater frequency of compensation strategy use was associated with higher levels of independence in everyday function, even after accounting for cognition. 

The use of compensation strategies is associated with higher levels of functioning in daily life among older adults. These findings provide a strong rationale for developing interventions targeting such a strategy. 

Traumatic brain injuries and compensatory strategies 

Therapeutic interventions using compensatory strategies are also effective for people who have a traumatic brain injury. Compensatory strategies include: 

Remediation for older adults with depression and mild cognitive impairment 

A study published in JAMA Psychiatry showed cognitive remediation coupled with transcranial direct current stimulation effectively slows cognitive decline in older adults at risk of cognitive decline. These remediation techniques were found to be effective in older adults with remitted major depressive disorder (with or without a mild cognitive impairment) and those at low genetic risk for Alzheimer's disease. The effects were more prominent in the remitted major depressive disorder (with or without mild cognitive impairment) than in the mild cognitive impairment without remitted major depressive disorder group. 

Cognitive decline: Challenges and opportunities 

Cognitive decline poses significant challenges. It also presents opportunities for innovation and collaboration among healthcare professionals. Determining occupation engagement that supports cognitive strengths and provides opportunities to engage in activities to address cognitive decline. Therapeutic interventions for cognitive decline encompass strategies to support engagement in meaningful activities.