Articles

Movement with Meaning: A Multisensory Program for Individuals in Early-Stage Alzheimer's Disease

Those of us in the field of dementia care are reexamining our philosophical beliefs and exploring practical, hands-on approaches in our relationships with individuals living with Alzheimer's disease. We are creating innovative programs and developing a new framework for preserving the emotional health, autonomy, and dignity of those who need us to walk hand in hand with them, witnessing the process of their experiences with empathy and respect.

I recently reported on a study showing how the gestures people made in describing how they solved a problem (the Tower of Hanoi) changed the way they remembered the game. These findings add to other research demonstrating that gestures make thought concrete and can help us understand and remember abstract concepts better.

I’ve discussed on a number of occasions the effects that stereotypes can have on our cognitive performance. Women, when subtly reminded that females are supposedly worse at math, do more poorly on math tests; African-Americans, when subtly reminded of racial stereotypes, perform more poorly on academic tests. And beliefs about the effect of aging similarly affect memory and cognition in older adults.

Introduction

In 1997, the U.S. Congress asked the Director of the National Institute of Child Health and Human Development (NICHD) at the National Institutes of Health, in consultation with the Secretary of Education, to convene a national panel to assess the effectiveness of different approaches used to teach children to read. For over two years, the National Reading Panel reviewed research-based knowledge on reading instruction and held open panel meetings in Washington, DC, and regional meetings across the United States.

The thing to remember about Ericsson’s famous expertise research, showing us the vital importance of deliberate practice in making an expert, is that it was challenging the long-dominant view that natural-born talent is all-important. But Gladwell’s popularizing of Ericsson’s “10,000 hours” overstates the case, and of course people are only too keen to believe that any height is achievable if you just work hard enough.

The much more believable story is that, yes, practice is vital — a great deal of the right sort of practice — but we can’t disavow “natural” abilities entirely.

Brain autopsies have revealed that a significant number of people die with Alzheimer’s disease evident in their brain, although in life their cognition wasn’t obviously impaired. From this, the idea of a “cognitive reserve” has arisen — the idea that brains with a higher level of neuroplasticity can continue to work apparently normally in the presence of (sometimes quite extensive) brain damage.

Most mnemonic strategies use visual images. But as I say in The myth of imagery, while there is no doubt that imagery can be an effective tool, there is nothing particularly special about it. The advantage of imagery is that it provides an easy way of connecting information that is not otherwise readily connected. However, providing verbal links can be equally effective.

Back in 2010, I read a charming article in the New York Times about a bunch of neuroscientists bravely disentangling themselves from their technology (email, cellphones, laptops, …) and going into the wilderness (rafting down the San Juan River) in order to get a better understanding of how heavy use of digital technology might change the way we think, and whether we can reverse the problem by immersing ourselves in nature.

K. Anders Ericsson, the guru of research into expertise, makes a very convincing case for the absolutely critical importance of what he terms “deliberate practice”, and the minimal role of what is commonly termed “talent”. I have written about this question of talent and also about the principles of expertise. Here I would like to talk briefly about Ericsson’s concept of deliberate practice.

Brain tissue is divided into two types: gray matter and white matter. These names derive very simply from their appearance to the naked eye. Gray matter is made up of the cell bodies of nerve cells. White matter is made up of the long filaments that extend from the cell bodies - the "telephone wires" of the neuronal network, transmitting the electrical signals that carry the messages between neurons.

The volume of gray matter tissue - a measure you will see cited in various reports - is a measure of the density of brain cells in a particular region.