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Section 6
Cognitive Training

Question 6 | Test | Table of Contents

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In the last section, we discussed care for the caregiver.  wo important aspects of care for the caregiver are mandatory self care and warning signs of emotional overload. We also discussed the COPE technique. The COPE technique can be used to help remind a caregiver of his or her daily needs.

In this section, we will discuss cognitive retraining. There are three basic steps to the application of cognitive retraining techniques. These three steps are to acknowledge the cognitive deficit, base interventions on relatively well preserved skills, enhance the encoding and retrieval memory processes. 

♦ Application of Cognitive Retraining Techniques
First, we’ll discuss the application of cognitive retraining. Cognitive retraining focuses on maintaining the remaining abilities of a client through reinforcing and expanding on those skills. For Edgar and Thelma, cognitive retraining was a tool to lengthen Edgar’s periods of independence. Thelma found that it was fairly easy to get her husband, Edgar, age 79, to comb his own hair. Edgar was in the middle stage of Alzheimer’s disease. Usually, Thelma handed Edgar a comb after he got dressed and told him to comb his hair. However, if Thelma did not prompt Edgar to stop, he would just keep combing his hair.

Clearly, for aging clients like Edgar, simple, autonomic tasks are easier than combining multiple tasks. The purpose of cognitive retraining is to provide short term help to the client by targeting remaining abilities with cognitive remediation. There are three basic steps to the application of cognitive retraining techniques.  These three steps are to acknowledge the cognitive deficit, base interventions on relatively well preserved skills, and enhance the encoding and retrieval memory processes.cognitive retraining techniques.

Cognitive Retraining Technique, 3 Step

♦ Step #1 - Acknowledge the Cognitive Deficit
The first step in the application of cognitive retraining techniques for Edgar was to acknowledge his cognitive deficit by discussing thought process limitations. As I explained to Thelma, raising the subject of Edgar’s memory problems in public may not be acceptable. However, Edgar may benefit from an open discussion with a healthcare professional in a non-threatening environment.  Acknowledging Edgar’s cognitive deficit may be productive, especially if he is frightened by the changes. Do you agree?

♦ Step #2 - Base Interventions on Relatively Well Preserved Skills
The second step in the application of cognitive retraining techniques is to base interventions on relatively well preserved skills. As you know, the purpose of cognitive retraining is to maintain as high a level of function as possible. I explained to Thelma that improvement in the ability to maintain independence and in the quality of Edgar’s life were the primary goals.

Thelma summarized by stating, "So we’re going to choose realistic tasks instead of ones that require a lot of effort."  By basing interventions on relatively well preserved skills, do you find that the attention span of individuals with dementia can be increased? Later in this section, we will discuss a technique I used with Edgar which reflects this concept. 

♦ Step #3 - Enhance the Encoding and Retrieval Processes of Memory
In addition to acknowledge the cognitive deficit and base interventions on relatively well preserved skills, the third step in the application of cognitive retraining techniques for Edgar was to enhance the encoding and retrieval processes of memory. Essentially, the cognitive strategies used with Edgar were based on attempts to either enhance the encoding and retention of new information, or aid in the retrieval of previously stored materials.

The following visual imagery technique worked well for Edgar to enhance the encoding processes of his memory. Are you treating a client with dementia who could benefit from this technique?  If so, you might consider discussing how to implement visual imagery with the caregiver of your client.

♦ Technique:  Visual Imagery and Verbal Elaborations
Visual imagery uses interesting, humorous, or even absurd mental pictures to make something easier to remember. For example, to help Edgar remember his dentist’s name, Thelma used visual imagery. The dentist’s name was Dr. Hertz. Edgar imagined the dentist with a comically enormous pair of pliers aimed at someone’s open mouth. The humor in imagining a dentist with a name that sounds like ‘hurts’ made it easier for Edgar to remember. 

In addition to visual imagery, verbal elaborations are another technique which can aid in enhancing the encoding processes of memory. Verbal elaborations are word based equivalents of visual imagery. Examples may include rhymes or mnemonics.

♦ Technique: Spaced Retrieval
Finally, to enhance the retrieval processes of Edgar’s memory, I used the spaced retrieval technique.  This technique also implements the second step in the application of cognitive retraining techniques which is to base interventions on relatively well preserved skills. Originally, this technique was used with patients with brain injury but later adapted for use with clients who have Alzheimer’s.

The information to be learned is presented, and then retrieved through questioning. The interval between presentation and questioning is increased as the client becomes more successful in retaining the information. For example, from 5 seconds to 10, then 20, 30, 40, and 60 seconds, and then by 30 second intervals. If the client cannot retrieve the information after an increase in the interval, the interval is reduced back to the level at which the client had been successful.

For Edgar, who enjoyed woodworking, I researched various wood tools and how they were used as well as standardized sizes of woodcuts and dowels. By using the spaced retrieval technique and basing the  intervention on relatively well preserved skills, I was able to increase the interval in which Edgar could retain and retrieve information. Once Edgar become somewhat proficient, we moved to other topics, such as sports and his medications. 

By starting with a favorite past time and then working toward activities of daily living, I find clients tend to be more cooperative.

Think of your Edgar. Could your client enhance his or her memory retrieval processes by using the spaced retrieval technique? Could the application of other cognitive retraining techniques benefit your client?

In this section, we have discussed cognitive retraining. There are three basic steps to the application of cognitive retraining techniques. These three steps are to acknowledge the cognitive deficit, base interventions on relatively well preserved skills, and enhance the encoding and retrieval memory processes. 

In the next section, we will discuss validation or non reality based communication. Understanding the five tenets and six domains of non reality based communication is an integral part of implementing this approach. 
Reviewed 2023  

Peer-Reviewed Journal Article References:
Basak, C., Qin, S., & O'Connell, M. A. (2020). Differential effects of cognitive training modules in healthy aging and mild cognitive impairment: A comprehensive meta-analysis of randomized controlled trials. Psychology and Aging, 35(2), 220–249.

Batthyány, A., & Greyson, B. (2021). Spontaneous remission of dementia before death: Results from a study on paradoxical lucidity. Psychology of Consciousness: Theory, Research, and Practice, 8(1), 1–8.

De Lucia, N., Grossi, D., Milan, G., & Trojano, L. (2020). The closing-in phenomenon in constructional tasks in dementia and mild cognitive impairment. Neuropsychology, 34(2), 168–175.

Di Nuovo, S., De Beni, R., Borella, E., Marková, H., Laczó, J., & Vyhnálek, M. (2020). Cognitive impairment in old age: Is the shift from healthy to pathological aging responsive to prevention? European Psychologist, 25(3), 174–185. 

Smith, G. E. (2016). Healthy cognitive aging and dementia prevention. American Psychologist, 71(4), 268–275.

Wiedl, K. H., Schöttke, H., & Garcia, M. D. C. (2001). Dynamic assessment of cognitive rehabilitation potential in schizophrenic persons and in elderly persons with and without dementia. European Journal of Psychological Assessment, 17(2), 112–119.

QUESTION 6
What are three basic steps to the application of cognitive retraining techniques? To select and enter your answer go to Test.

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