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The Home-Based Memory Rehabilitation Programme (for persons with mild Alzheimer’s disease and other dementias) Mary McGrathAdvanced Clinical Specialist Occupational Therapist Memory Clinic, Belfast City Hospital Contact: - www.COT.org.uk

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Outline• Introduction• Background• Memory Rehabilitation• Care Pathway• Memory Rehabilitation Programme• Evaluation www.COT.org.uk

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Introduction• Dementia – used to describe a collection of symptoms that cause failure or loss of mental powers• Alzheimer’s disease – most common form in persons over 65 years (Cummings, 2004) www.COT.org.uk

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• Other forms of dementia – Vascular dementia – Fronto-temperal dementia (under 65) – Lewy body dementia• 700,000 in UK• £17 billion per year (Alzheimer’s Society, 2007)• 19,000 in NI (NI Dementia Strategy, 2011) www.COT.org.uk

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Alzheimer’s Disease (AD)• Progressive, neurodegenerative condition caused by structural and chemical changes in the brain• Causes impairment in: – Recent memory – Language (anomia) – Behaviour (apathy, agitation, depression, disinhibition) – Executive function• AChEIs (donepezil, galantamine, rivastigmine and memantine) (NICE technology appraisal 217, 2011) www.COT.org.uk

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Background• Memory Clinic established in 1994• For people experiencing memory difficulties in everyday life• Centre of excellence• Tertiary referral service• No cognitive rehabilitation• RCT of effectiveness of MRP (UUJ, 2006)• Launch of MRP, January 2007 www.COT.org.uk

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Memory Rehabilitation• Part of cognitive rehabilitation approach (Wilson, 2002)• Core Principles: Compensation: – compensation strategies include: • Use of external memory aids (Aides Memoir) Environmental Adaptation: • Minor adaptations to the home environment to support these strategies (Wilson and Hughes, 1997) www.COT.org.uk

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Care Pathway REHABILITATIONwww.COT.org.uk

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Checklist of everyday memory problems Yes No1. Do you forget what you did yesterday?  1. Do you put items, e.g. your glasses or keys down and forget where you have left them?  1. Do you have difficulty remembering appointments?  1. Do you have difficulty remembering what people have told you?   Repetition of questions: Yes: No:  1. Do you forget people’s names?  1. Do you lose your way when you are out?   www.COT.org.uk INSIGHT

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Home-based Memory RehabilitationProgramme (MRP) mild, early-stage dementia• 1 visit per week for 5-6 weeks as required• Home-based• Customised• Involvement of caregiver• Compensation strategies• Environmental adaptation• On-going support www.COT.org.uk

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MRP - compensation strategies• Weeks 1&2 – Customised Medication Checklist – Memory Book (A5 wire-backed) – Tip Sheet “Remember where you have put something” www.COT.org.uk 11

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Medication Checklist / / TIME DRUG DOSAGE SUN MON TUE WED THUR FRI SAT Before Zoton 1 Tablet Breakfast (for stomach) Aricept 1 Tablet (Memory) Eye Drops As required After Supper Quinine Sulphate 1 Tablet (restless legs) Eye Drops As requiredINSTRUCTIONS:  Take each tablet as shown on checklist  Each day tick the box after each tablet is takenTAKE & TICK www.COT.org.uk

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Week 3– Prompt card and notebook by phone– Pocket notebook– Tip Sheet“Remember what people have told you” www.COT.org.uk

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Prompt Card for taking telephone messages Write all messages down Tell the caller that you are writing the message down Read the message back to the caller www.COT.org.uk

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Weeks 3-5 – Memory board – Post-its – Alarm clock – Calendar – Daily schedule – Safety Checklist – Tip Sheet “Remember what you have to do” Week 6 – Revision and consolidation www.COT.org.uk

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DAILY SCHEDULEMonday:Morning:  Take in the KERBIE binsAfternoon:  Visit Doris in Nursing Home  Go for a walkTuesday:  Do food plan/shopping listWednesday:Morning:  Go to Tesco for shoppingAfternoon:  May go to visit Doris in Nursing HomeEvening:  Put out binsThursday:Morning:  Take in bins  HouseworkAfternoon:  May go for a walkFriday:Morning:  HouseworkSaturday:Morning:  Go shoppingSunday:  May do housework  RestEvening:  Speak to Robert on the phone www.COT.org.uk

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SAFETY CHECKLISTLiving Room:  Turn off TV with Zapper  Turn off wall switches  Turn off gas fire  Check all candles are blown outHall:  Check outside front door is locked  Check the inside door is lockedKitchen:  Check back door is locked  Check microwave and radio are turned off  Check cooker is offEach night:  Close all doors in case of fire  Take shoulder bag upstairs to bed www.COT.org.uk

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Support and communication• Three monthly follow-up• Liaison with: – Consultants – GP – Community OT – Specialist Dementia Nurse – Family members – CPN – Social Worker• Open-line communication www.COT.org.uk

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Evaluation Percentage of patients still using compensation strategies at their post MRP reviews100908070605040302010 0 3 m ths 6m ths 9m ths 12m ths 15m ts 18m ts 21m ts 24m ts fig. 2 Follow -up www.COT.org.uk

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24 Month Audit• 50% of patients reviewed 24 months following completion of the MRP were still using strategies taught to them to compensate for their memory deficits, which demonstrates that new learning took place during the MRP and has been maintained over time (McGrath and Passmore, 2009) www.COT.org.uk

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References• Cummings, JL. Long-Term Treatment for Patients with Alzheimer’s Disease. Alzheimer’s Disease and Associated Disorders. 2004; 18 (Suppl 1): S1-S8.• Department of Health and Social Services and Public Safety. Improving Dementia Services in Northern Ireland; A Regional Strategy, 2011.• McGrath, M, Passmore, P. Home-based Memory Rehabilitation Programme for persons with mild dementia. Irish Journal of Medical Science. 2009; 178 (suppl 8); S330.• The Rising Cost of Dementia in the UK, Alzheimer’s Society, 2007.• Wilson, BA, JC, Hughes, E. Coping with Amnesia: The Natural History of a Compensatory Memory System. Neuropsychological Rehabilitation. 1997; 7: 43-56.• Wilson, BA. Towards a comprehensive model of cognitive rehabilitation. Neuropsychological Rehabilitation. 2002; 12 (2): 97-110.• www.nice.org.uk/guidance/TA217 www.COT.org.uk mary.mcgrath@belfa sttrust.hscni.net