Nonpharmacological Treatment of Memory Loss, Alzheimer’s Disease, and Dementia

Helpful Habits

Using a system that can become a habit is critically important when teaching a patient with memory loss new skills. Habits do not depend upon the episodic memory system—the memory system that is affected by Alzheimer’s disease and most other disorders of memory. Habits depend upon a different kind of memory, procedural memory. Procedural memory is the type of memory we use when riding a bike, touch typing, playing the violin, and typing with our thumbs on our phone. It is due to procedural memory that, when we are not paying attention to where we are driving, we may make turns toward a familiar location—but not necessarily the one we had intended to go to! Procedural memory is quite well preserved in Alzheimer’s disease until quite late in the disease. This preservation of procedural memory allows us to teach the patient with Alzheimer’s new functional skills even when their episodic memory is devastated. Teaching by doing is the key to learning with procedural memory. Think again about learning to ride a bike; it is not learning verbally with words. See Appendix C for more on the different types of memory systems in the brain.

Here is an example. The wife of a patient with mild Alzheimer’s disease has just bought a new wall calendar that she is keeping all of their appointments on. Although they had not previously used a wall calendar, she is very pleased with her new system, which works very well for her. She reports to us, however, that it is not working for her husband. He is continually asking her what they are doing for the day. Although she has told him a thousand times to go look at the calendar, he never goes on his own; he will go to it, however, after she tells him to. We then explained to her that she needs to actually lead him to the calendar each time he asks what they are doing for the day, so that “his feet can learn where to go.” At first it seems like no progress is being made. But over the course of a few weeks of her leading him to the calendar every time he asks, he begins to go to look at the calendar automatically.

External Memory Aids

Almost all of us use external devices to augment our memory. These include traditional simple items, such as a list, calendar, or organizer, as well as electronic devices including smartphones and tablets to store names, addresses, phone numbers, appointments, and other information. Before their illness, most patients with memory problems also used such devices to a greater or lesser extent. Not surprisingly, patients who always depended upon external devices are, in general, able to continue using them early on in the disorder to compensate for their declining memory. Patients who, by contrast, always depended upon their memory to keep themselves organized tend to suffer more swift and severe functional impairment as their memory declines, because they do not automatically reach for external devices to compensate for their impaired memory. As their illness progresses, however, almost all patients would benefit from additional use of external devices to compensate for their memory problems. What follows are some of the simple ways that a number of our patients have found functional improvement in the face of memory impairment.