The Home-Based Memory Rehabilitation Programme (for persons with mild Alzheimer’s disease and other dementias) Mary McGrath, Advanced Clinical Specialist Occupational Therapist Memory Clinic, Belfast City Hospital

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

2. Outline
• Introduction
• Background
• Memory Rehabilitation
• Care Pathway
• Memory Rehabilitation Programme
• Evaluation
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3. 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)
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4. • 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)
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5. 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

6. 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

7. 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

8. Care Pathway
REHABILITATION
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9. Checklist of everyday
memory problems
Yes No
1. 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

10. Home-based Memory Rehabilitation
Programme (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

11. 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

12. 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 required
INSTRUCTIONS:  Take each tablet as shown on checklist
 Each day tick the box after each tablet is taken
TAKE & TICK
www.COT.org.uk

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

14. 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
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15. 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

16. DAILY SCHEDULE
Monday:
Morning:  Take in the KERBIE bins
Afternoon:  Visit Doris in Nursing Home
 Go for a walk
Tuesday:
 Do food plan/shopping list
Wednesday:
Morning:  Go to Tesco for shopping
Afternoon:  May go to visit Doris in Nursing Home
Evening:  Put out bins
Thursday:
Morning:  Take in bins
 Housework
Afternoon:  May go for a walk
Friday:
Morning:  Housework
Saturday:
Morning:  Go shopping
Sunday:
 May do housework
 Rest
Evening:  Speak to Robert on the phone
www.COT.org.uk

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

18. 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

19. Evaluation
Percentage of patients still using
compensation strategies at their post
MRP reviews
100
90
80
70
60
50
40
30
20
10
0
3 m ths 6m ths 9m ths 12m ths 15m ts 18m ts 21m ts 24m ts
fig. 2
Follow -up
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20. 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

21. 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