Occupational therapy key to early dementia diagnosis and support

Dementia is a condition that affects nearly a million Canadians and their families – a number that is expected to double by 2030.

While there is no effective drug treatment for the progressive disease, much progress has been made over the last decade on interventions to prevent or delay dementia in people at risk. But what if we could recognize the symptoms earlier? 

This is the focus of research by Shlomit Rotenberg, an assistant professor in the department of occupational science and occupational therapy with the Temerty Faculty of Medicine. Rotenberg studies those at risk of developing dementia and aims to help them stay engaged in meaningful activities that can improve their well-being here-and-now and support their cognitive health in the long term. 

Brain health through social and leisure activities: occupational therapy for dementia prevention 

One of the early risk factors associated with dementia is subjective cognitive decline, which appears in otherwise healthy individuals who may begin noticing subtle changes in their daily functioning – like forgetting to pay a bill – but these symptoms are too mild to be detected in a cognitive screening test. 

Not everyone who experiences subjective cognitive decline will develop full dementia, but some will continue this trajectory of cognitive and functional decline, which can make it challenging to complete basic activities and carry on with daily living. 

With an occupational therapy lens, Rotenberg explores everyday functioning in people with subjective cognitive decline in depth. Because the two key components of a dementia diagnosis are significant cognitive decline and decreased independence in everyday functioning, it is important that both aspects are explored in people at risk for dementia. 

Rotenberg’s latest study, a scoping review, finds that the body of research on everyday functioning in older adults with subjective cognitive decline is small and tends to focus on their ability to manage their finances and health, manage a household and use technology, while overlooking their participation in social and leisure activities. 

“While older adults with subjective cognitive decline are, by definition, independent, we found that they withdrew from many of their social and leisure activities. This is concerning because participation in social and leisure activities is linked with better cognition functioning, better physical health, and greater well-being, and may delay the onset of dementia,” says Rotenberg. “To be more effective in preventing dementia, we need to be proactive in asking older adults about their daily functioning, including social and leisure activities.”

Rotenberg says that withdrawing from everyday activities can begin a vicious cycle. “Being engaged in social and leisure activities is proven to delay dementia by several years. It is especially important that we have early interventions to keep people engaged.” 

Occupational therapists can play a key role in breaking this cycle. “Occupational therapists can recognize the functional decline earlier and help people compensate for challenges in everyday functioning so they can maintain their independence and stay engaged in social and leisure activities to support their health,” says Rotenberg. 

Working with Deirdre Dawson, professor emeritus in the department of occupational science and occupational therapy, Rotenberg and her team conducted a study on how people perform a complex shopping test in a shopping centre. The results of this experiment revealed cognitive problems in participants that a standard cognitive test did not. “Lab tests tend to focus on one specific cognitive domain in a controlled environment” she explains, “but real-life is much more complex. If you need to plan your route in a mall, budget, prioritize, and problem solve unforeseen events, the cognitive load is huge, and lab tests don’t fully capture that.” 

Rotenberg’s next challenge is to develop a training program that builds on the lessons learned to help older adults at risk for dementia stay engaged in activities that enhance their cognitive health over time.