by Laura N. Gitlin, Tracey Vause Earland by the Center for International Rehabilitation Research Information by the for, Exchange (CIRRIE).

Dementia is a neurodegenerative, progressive clinical syndrome characterized by a decline or loss of memory and other cognitive abilities. The most common type of dementia is Alzheimer's disease, which accounts for up to 80% of the cases. Other types of dementia include vascular dementia, Parkinson dementia, mixed dementia, Frontotemporal dementia and Creutzfeldt-Jakob's disease. The most important goals of rehabilitation for individuals with dementia are to help the individual achieve and maintain function to the maximum level possible, to restore or compensate for functional decline, and to provide caregivers with education to provide a supportive environment where the individual can function optimally. Rehabilitation is focused on habilitative, compensatory, nonpharmacologic approaches that modify behaviors and the physical environment so that individuals can participate in activities of daily living to the maximum extent for as long as possible. These approaches focus on the preserved abilities of the patient to help them achieve quality of life regardless of their cognitive abilities. Some of the symptoms observed in patients with dementia include memory impairments, difficulty performing daily activities, anxiety, fatigue, depression, hallucinations, reduced visual acuity, hearing loss, medical conditions such as infections, difficulty in communication, and aggression. Behavioral symptoms may arise due to a physical environment that is cluttered, distracting, unfamiliar and difficult to navigate, and communication patterns that are complex and confusing. Some of the nonpharmacologic approaches used in the treatment of dementia include cognitive rehabilitation, environmental redesign, memory retraining, activity engagement, cognitive behavioral therapy, and caregiver training. Cognitive rehabilitation identifies strategies for dealing with difficulties in activities that arise due to impairments in memory or cognitive abilities, thus enabling individuals to engage in activities. Environmental redesign involves environmental modifications so that an individual can function optimally within the environment. Environmental modification may include simplifying the environment, removing clutter, color coding, visual cueing, and placing objects strategically. Cognitive behavioral therapy is used to address anxiety and includes such components as awareness training, breathing skills, coping self-statements, and sleep skills. Caregiver training focuses on providing families and caregivers with knowledge about dementia and other strategies such as problem solving techniques, communication techniques, environmental modification methods, and coping techniques. The use of activities in a therapeutic context has been found to provide positive effects for individuals with dementia. Research suggests that engagement in activities provides meaning, a sense of involvement and belonging, and a positive emotional outlet for patients. Engagement in activities can also be used to achieve physical goals in rehabilitation.