Social Lives
Authors: Cassandra Dinius, Carmen Pocknell, Richard Roche, Department of Psychology & Assisting Living and Learning (ALL) Institute, Maynooth University
Remember those life moments that you think are unforgettable and yet, are already blurred one year later. Our precious memories are fragile and can evaporate as rapidly as a blink of an eye. Memory loss has taken so many dreams away.
Keeping our brains active – especially our memories – can be life changing, and is comparable to revisiting our favourite, faded old book: by reading it again and again, we keep the moments alive…
Dementia is the form of neurodegeneration we hear the most about, a condition which progressively touches specific brain regions. The term ‘dementia’ includes a large range of conditions such as Alzheimer’s dementia, frontotemporal dementia, and unfortunately, many more. It affects various cognitive functions (e.g. memory, language). In the long-term, this degeneration can interfere with daily activities, and can cause disability and dependence. In fact, more than 55 million people currently live with this condition, and researchers estimate over 131 million worldwide by 2050. In Ireland, according to the Alzheimer’s Society of Ireland, more than 64,000 people are living with dementia today and an additional 180,000 people provide care to someone living with the disease. Alzheimer’s dementia is one of the most common dementias, representing between 60-70% of cases.
Each dementia journey is unique, which creates a real challenge to find a suitable treatment. Today, the dramatic increase and irreversible characteristics of dementia present a major public health concern, both nationally and internationally. As a cure for dementia is not yet available, non-pharmacological approaches – such as physical activity, social engagement, cognitive stimulation – represent a promising avenue of research to focus on, in an attempt to help reduce the humanitarian, social and economic burden of new cases.
Overall, adults and dementia patients have a tendency to preserve older, “remote” episodic memories (i.e. memories for events) instead of more recent memories. For this reason, Reminiscence Therapy is an ideal form of intervention which seeks to activate and engage remote memories, encouraging people to recall, recount and relive specific events from their earlier years.
Reminiscence Therapy is identified as discussion of lived past experiences with individuals, or in a group, with the help of triggers, such as music, or photos (see here for further information). Reminiscence Therapy appears to have beneficial effects on general cognition in dementia patients (such as improved mood, well-being, and cognitive function). Along with this, cognitive stimulation, combined with exercise and social interaction, has shown to be more favourable than some pharmacological interventions, helping psychological wellbeing, throughout the patients’ dementia journey.
Another powerful factor is physical exercise, which strongly enhances cognitive performance (e.g. memory, attention) and mental wellbeing (e.g. mood). Importantly, when practised early and maintained later-in-life, physical exercise is strongly associated with lower risk of developing Alzheimer’s Disease.
The links between reminiscence and exercise are poorly investigated to-date, yet healthy older adults and those in early-stage dementia may benefit from these activities. In the long-term, this investigation is critical as it could enable the moderation, and/or decrease of cognitive impairments and neurodegenerative disorders in the population, worldwide.
In 2019, we established a two-year project, the Recall Initiative, funded by the IRC New Horizons funding scheme. We focused on the potential benefits of reminiscence therapy on memory and wellbeing for healthy older adults living in the community, and people in the early stages of dementia. The initial study incorporated pre- and post-reminiscence testing of processes including memory, attention and executive function, as well as psychological variables – anxiety, depression, quality-of-life and social engagement. A small sub-group also took part in functional MRI brain scanning at Trinity College Institute of Neuroscience to test for structural and functional brain changes as a result of the intervention. During the group sessions, we recorded audio (with permission) of the stories and memories that our participants recalled, with these recordings hosted in a designated section of the Digital Repository of Ireland).
In the next exciting step of this research programme, our AIM-WARM (Age-Inclusive Maynooth: Walk and Recall Memories) project will investigate the potential impact of combining the physical exercise of walking, with social engagement and reminiscence therapy, in early Alzheimer’s disease groups. We will measure the potential benefits of this combination on autobiographical memory, cognitive abilities and psychological wellbeing, in this population.
Our previous projects have emphasized that this work is conducted with older adults, and for them, as well as about them. This ethos of participant-centred engagement was at the centre of the Recall Initiative and will continue at the heart of our new projects. This is an opportunity for older adults to move throughout the town of Maynooth and engage with others while having a face-to-face, social connection each week. Participants are active people age 60+ living with early-stage Alzheimer’s in the Maynooth area. Recruitment will take place throughout the town and through “Team Up for Dementia Research”via the Alzheimer’s Society of Ireland.
A unique component of this project is the central tenet of Person Public Involvement (PPI). PPI consultants are embedded throughout the project – from early-stage design and methodology through participant recruitment and data collection, to interpretation and dissemination of the results. This requires input from people living with dementia as well as their spouses, carers and families. Their contributions will influence the substantive content of the intervention and will teach us the most effective, useful, and practical ways to deploy this study.
PPI contributors come from the Dementia Research Advisory Team (DRAT) and include people living with dementia, as well as their carers and families, offering an invaluable and unique perspective. We are seeking two rounds of PPI input. The first will provide initial feedback on study design and consideration. Our second one will be for specific feedback about local landmarks and walking routes in the Maynooth area.
During one-on-one consultations, PPI contributors will be asked to help us consider the walking routes to be employed, the content of reminiscence sessions and the types of cues and objects to be used to facilitate reminiscence. We feel that there is so much to learn from the experts in experience (e.g. route distance, time of the day). Contributing members will be acknowledged and appreciated, just as any consulting expert would be. With their permission, we will provide their name in our dissemination of the work (e.g., presentations, publications).
Results from the AIM-WARM initiative will shape the future of our next project, Tailored Reminiscence Interventions for Ageing and Dementias in Community Settings (TRIADICS). This project, funded by IRC Coalesce, will assess the benefits to cognition and psychological health using tailored, co-created interventions. These may include exercise, meditation, breathwork and group reminiscence meetings for older adults and people living with dementias, including Alzheimer’s disease and Semantic Dementia.
We will continue to call on a Patient and Public Involvement (PPI) approach to co-create these tailored therapeutic reminiscence interventions with representatives from each of the four groups of interest: community-dwelling older adults, people living with Alzheimer’s Disease, people living with Semantic Dementia, and older people living in prisons. This project will also utilize functional MRI to obtain neuroanatomical data to provide insight into relevant brain mechanisms and structures that may be engaged in reminiscence therapy and throughout this intervention.
Using an iterative process, these Reminiscence Therapy interventions are being refined with the intent to deploy this service on a larger, public scale and disseminate this approach to the broader public. The project will develop, refine and pilot-test a set of tailored interventions and then validate them through a series of pre-post mixed-methods studies. Subsequently, this regime can be rolled-out in larger-scale initiatives via links with Age-Friendly Ireland (AFI) and Meath County Council, the national contact point for age-friendly communities in Ireland. Finally, recalled memories and stories elicited during the programme will be recorded, archived, anonymised and made available to the public as part of our existing, bespoke section of the Digital Repository of Ireland (DRI).
By keeping the individual, and their lived experience at the heart of these reminiscence-based interventions, we hope to improve not only the cognitive and psychological health of our participants, but also to help preserve their important memories and experiences, not only for themselves, but for their families, friends and society as a whole.
Acknowledgements:
This work was supported by a grant from the Irish Research Council and in collaboration with the Alzheimer’s Society of Ireland. Sincere thanks to Prof Sean Commins (MU), Prof Ronan Foley (MU), Ciara O’Reilly (ASI), and the Dementia Research Advisory Team for their valuable input.