Cognitive Retention Therapy (CSA Journal)

Building Bridges to Memory

Newtreatment options for those diagnosed with Alzheimer’s disease (AD) are rare despite the considerable research and resources committed to finding a treatment or a cure. A new therapy that is proving very beneficial for AD is Cognitive Retention Therapy (CRT). The program was recently reviewed by the University of Calgary and received a very strong endorsement by the research community.

CRT is a structured program of text- and activities-based memory and thinking exercises. Utilizing each individual’s own life story as the focus of the program, participants rebuild the paths to older and well-established memories (memory bridges).

The rapidly increasing number of seniors being diagnosed with dementia and particularly Alzheimer’s disease has been called an epidemic. The number of persons diagnosed with this progressive and ultimately fatal disease in North America is more than 5 million and growing every day, and research into treatment options and new medications is substantial. This article will review what every CSA should know about Alzheimer’s disease, plus a new treatment option that can improve the quality of life for those diagnosed. CSAs have an excellent opportunity to direct clients and their loved ones to seek further evaluation and treatment of dementia symptoms when appropriate.

Dementia Is Not Just One Disease

You may often hear the term dementia used inter-changeably with Alzheimer’s disease. However, they are not exactly the same thing. Dementia is a more general term that describes a group of symptoms that can result from a variety of different causes. In fact, a number of disease processes and illnesses cause dementia. Further, dementias are categorized as reversible and irreversible types. For example, a reversible dementia can result from an infection in another part of the body. The elderly are particularly prone to this. As a rule, a reversible dementia will clear up when the underlying cause is resolved.


The Rising Tide of Alzheimer`s Disease

Of the irreversible dementias, Alzheimer’s disease is the most common. Accounting for 64 percent of all diagnosed dementias, it is characterized by a loss of memory that affects day-to-day functioning, increased difficultly performing familiar tasks, poor judgment-making ability, changes in personality, and cognitive decline. It is estimated that the incidence of the disease is quite high, doubling every five years after age 65.

While the causes of Alzheimer’s are unknown, scientists have identified a set of risk factors that may be associated with the increased chance of an individual developing the disease. These risk factors include:

  • Age: This is the single biggest factor in 90 to95 percent of AD cases.
  • Genetics/family history: Genetics play acertain role in only 5 to 10 percent of AD cases; in the other 90 to 95 percent, a family history of AD is a risk factor but is neither necessary nor sufficient for AD to develop. Scientists are still exploring the role heredity plays in AD.
  • Education: Individuals with less than sixyears of formal education are at a higher risk of developing AD.
  • Head Injury: People who have suffered a head injury–especially with the loss of consciousness–have an increased chance of developing AD.
  • Stroke/depression: Strokes not onlyincrease risk for vascular dementia but also for AD. Several studies have pointed to depression prior to diagnosis as a risk.
  • Mild cognitive impairment (NCI): Peoplewith MCI have a much greater chance of developing AD. Some studies have shown that those with MCI will progress to AD at a rate of 10 to 15 percent per year; another study showed this rate to be only 5 to 6 percent per year. The subject of MCI as a risk factor–and possibilities for preventive treatment–is an area of intense research.
  • Smoking: The evidence is mixed–somestudies have shown an increased risk for Alzheimer's disease while others have not.


Following the Numbers

Table 1 provides an estimate of the total U.S. population and specifically the senior population for 2004. This table also indicates the five most heavily populated senior states. While the number of seniors is growing rapidly, it's important to remember that with the growing senior population there is also a growing incidence of Alzheimer's disease.


Senior Population Compared to U.S. Population in Five Top Senior States



Total pop.

Total pop.




65 Years


Total %

Geographic Area


and Over


pop. 65-85

United States















New York















Total of 5 states





Source: Adapted from Table 1-RES: Estimates of the Resident Population by Selected Age Groups for the United States, July 1, 2004 (SCEST2004-01-RES), Population Division, U.S. Census Bureau, released February 25, 2005.

As of 2004, 12.4 percent (approximately 36.3 million) of the U.S. population belonged to the senior segment (age 65 or older). Of this number, 87 percent were between 65 and 85 years of age. This average is in line with the percentage of seniors living in each state, with Texas having the largest proportion (89 percent), followed by California and Florida, both with 87 percent, New York with 86 percent, and finally, Pennsylvania with 85 percent. In total, this age group, 65 to 80 years, in these five states accounts for just over one-third (31.9 percent) of the total senior population in the United States.

If we look only at the numbers of those affected in the United States, the growing trend is staggering. The U.S. Alzheimer's Association has estimated that 4.5 million people have the disease. Given that age is a large factor, a 44 percent increase in the number of dementia sufferers is expected by 2025. However, since age is a major risk factor for AD, and the seniors population is expected to double in the next twenty-five years (growing to 70 million by 2030), the occurrence of AD could rise as high as 70 percent to an estimated 7.7 million by 2030. Current estimates are that one in ten individuals over 65 are affected by dementia, and nearly half (approximately 45 percent) are over the age of 85.

Table 2 estimates the number of dementia-related cases in the United States as a whole, as well as in the five most senior-populated states as of 2005.


Estimated Cases of Dementia in the Five Highest Senior-Populated U.S. States



% 65-85




Total Estimated



of Total

85 Years


Dementia 85

Dementia Cases

Geographic Area

years by %


and Over

65-85 Years

Years and Older

65 and Older

United States





















New York





















Total of 5 states







Source: Adapted from Table titled Estimates by Selected Age Groups for the United States, July 1, 2004 (SCEST2004-01-RES), Population Division, U.S. Census Bureau, released February 25, 2005.

Who, Me?

Ask seniors what they worry about the most and you will often hear the same answers: “out-living my money,” “falling and breaking a hip,” and “being diagnosed with Alzheimer’s disease.” Of these three very real concerns, a diagnosis of Alzheimer’s disease perhaps should be the greatest.

The insidious, slow progression of symptoms and the possible effect they have on the individual’s judgment can mean the person with Alzheimer’s disease may not even realize there is a problem. Often seniors simply attribute memory problems to “getting old.” And while it’s true that we often are not as sharp at 70 as we were at 30, frequent forgetting isn’t necessarily a sign of regular aging.

Unfortunately, our clients don’t always realize there is a problem. Or because of their fear that they may have Alzheimer’s disease, they avoid seeing a doctor altogether. Whatever the reason, the best course of action would be to seek proper evaluation by a qualified clinician. While the prospect of a diagnosis of Alzheimer’s disease is frightening, not getting treatment should be considered even worse.

Treatment Options

Medications are certainly one choice of treatment, and your clients should be advised to see their doctor if they wish to pursue this option. About five or six drugs are currently available for those diagnosed with AD, and more are in clinical trials. It is important to note that none of the drugs currently being prescribed affect the progression of the disease itself, but only delay the progression of the more problematic symptoms. So while medications may help the client function better for longer, the disease process continues unabated. The medications only work for a relatively short period of time, and not everyone can take them. For many, adverse side effects such as nausea, diarrhea, and stomach upset result in discontinuation of the medications.

There is also a growing segment of the population that would much rather be actively engaged in their own care plan. Simply taking a few pills every day isn’t really “doing something” about their illness. Remaining engaged in activities of daily living and participating in a cognitive therapy program ad described here may be exactly what the doctor ordered.


What Is Cognitive Retention Therapy?

Cognitive Retention Therapy is a structured, supportive, and stimulating therapeutic program designed to slow the progression of Alzheimer’s symptoms. By reviewing each person’s life story, we gain insight into which activities that person finds the most familiar and enjoyable. Cognitive exercise “modules” are made up of both general information and client-specific questions designed to stimulate and reinforce neural path-ways in the brain. It is the process of searching for the correct answer and using reasoning that is stimulating to the human brain.

Each and every time the client finds the correct answer (and they always will), a positive connection to that person’s life is reinforced, perhaps re-establishing or building a pathway that was failing in the brain. We have known for years that not stimulating the brain results in the loss of cognitive abilities over time, including diminished memory function and the slowing of reasoning ability. For those with AD, this loss of cognitive functioning can be particularly devastating.


How CRT Works

If you have ever tried to remember a piece of information but could not–the “it’s on the tip of my tongue” phenomenon–then you have experienced something that a person with Alzheimer’s disease experiences increasingly every day. You know the information is there in your head somewhere, but you can’t find it. In the early to middle stages of Alzheimer’s disease, something very similar happens: the information that makes up your memories largely remains intact, while the neural pathways–or bridges that connect the dots–are lost to the disease.

Research on the human brain tells us that our memories are not stored in a very orderly way but are instead broken up into pieces. An example of this can be illustrated if you think about a lemon. The taste of the lemon is stored in one area of the brain, while the shape, size, color, smell, and texture of the lemon are all stored in different areas of your brain. When you are remembering a lemon, you are actually “assembling” the memory from a number of different areas of your brain.

For early to mid-stage Alzheimer’s patients, CRT uses the odd way we break up our memories to great advantage by stimulating the process of locating the information that makes up our memories. Training the brain to build memory bridges, the program uses a person-centered, university-researched program of structured cognitive exercises.

By starting CRT as soon as possible after diagnosis, participants and therapists can maximize the positive benefits of the program. Like most other serious diseases, the earlier treatment starts, the better. CRT is not invasive. No pills are needed, no adverse drug effects to worry about. For those patients who cannot or do not take dementia drugs, CRT has been proven to offer benefits on par with medications.

CRT can be used in conjunction with prescribed Alzheimer’s medications, and results from the combination of the two types of therapy are often exceptional. The best results in treatment are very likely a mix of medication and directed psychological forms of therapy such as CRT. The biggest issue concerning newer forms of treatment is that the public and the medical community may not be aware of them so those needing the treatment may miss out.

As CSAs are often in a position to offer resources and information to their clients, they can have a very positive impact on their client’s lives by keeping up on the latest treatment options and passing on their valuable knowledge when the need presents itself. Persons interested in finding out more about this program can visit

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