By Trish Bogucki
I have normal pressure hydrocephalus (NPH) and have suffered from cognitive impairment. Unfortunately, I was so focused on my balance and gait issues that I did not seek treatment for my memory problems until after I underwent surgery and many months of Physical Therapy. In fact it was only when my neurosurgeon said that he didn’t need to see me for a year that I said “Wait a minute – I’m not fixed yet!”
I told him that I was having a lot of trouble remembering meetings at work, people’s names, tasks that I needed to do, passwords – the list went on and on. That’s when he told me about Cognitive Therapy and referred me to a local therapist, and my life definitely changed for the better. I was very fortunate to be referred to a terrific speech and cognitive therapist with whom I had an immediate rapport; I really enjoyed her energy, curiosity and optimism. What follows is a description of what cognitive therapy consisted of and some of the tips I have for others who might be in the same boat I was in. The first tip is probably the most important.
Tip #1: Seek help for cognitive issues as soon as you become aware of them. Ask your primary care physician, neurologist or neurosurgeon for a referral to a cognitive therapist or neuropsychologist for an evaluation if you have any issues with memory.
What is Cognitive Therapy (CT) all about? Like Physical Therapy (PT), it starts with an initial assessment meeting to determine the degree of impairment, whether Cognitive Therapy is needed, and the frequency of the therapy sessions. Also similar to PT, Cognitive Therapy is comprised of exercises and tools to help stimulate and strengthen – in this case your cognition is being strengthened and made more resilient.
Tip #2: Find a therapist you will enjoy seeing each week. You should look forward to your sessions and leave each one feeling more on top of things than when you went in.
What do you do at CT? At each appointment there are exercises done in the office: for example, memorizing simple flashcard images and being able to repeat a series of four, five or six images in order. Or looking at a picture of a complex scene and being able to answer questions about its contents. Another exercise involved reading a one-page newspaper article and then turning it over and being able to list facts contained in the article. At first you may be able to list only a few facts, but as you practice your list will grow.
Cognitive therapy is not limited to your office visits: there is homework for in between appointments. One recurring assignment was to work on brain games each day. There are several commercial web sites and mobile apps that feature brain training exercise designed by cognitive scientists. These sites/apps strengthen your cognitive skills in several areas: memory for sure, but also attention, flexibility, vocabulary, speed and problem solving. Some are free and some require an annual subscription fee.
Tip #3: Find a brain training website or app that you enjoy (and can afford) and challenge yourself to use it daily for up to a month. If you’re not hooked after a month then look for a different app, but find one that you like.
Cognitive therapy isn’t all fun and games. Your therapist may ask you to discuss any issues you faced since your last visit and offer strategies for avoiding “meltdowns” in the future. Some of the strategies are simple – like putting your keys in a bowl by the door whenever you come home so you are not searching madly for them when it’s time to go. One strategy that works well for many is the “bag for every occasion” approach: designate a tote bag for work, another for class, another for therapy/gym, etc. Put things you will need in the bag when you think of it instead of waiting till you’re running out the door.
Tip #4: Act on a thought (like putting things in one of your bags) when you have it instead of trying to remember it later. If you’re not in a place where that’s feasible then write it down in a notebook or smartphone that you keep with you.
Other strategies involve technology – like making regular use of the calendar function on your phone or computer to remind you of appointments or tasks and then making it a regular practice to check your calendar at least every morning, afternoon and evening. Another is keeping a small notebook or a smartphone with you for capturing To Dos for later. You may not be able to cure your memory loss, but these strategies will help you deal with it. There are several components to cognition: memory for sure, but also attention, flexibility, vocabulary, speed and problem solving. I learned that a lot of the issues attributed to poor memory are actually caused by a lack of attention.
Tip #5: Find brain exercises and games that work on attention as well as memory.
How do you know when you are done with therapy? Once you stop seeing dramatic improvement after each visit and start seeing more consistent performance then it may be time to end formal therapy. Of course sometimes your insurance runs out first, but that’s something you should discuss up front with your therapist.
Tip #6: Plan how long your therapy can/should last with your therapist and develop a list of exercises and strategies that you will employ after you’re done seeing the therapist.
I recently attended a talk at a local library on cognitive health for seniors and was happy to get reinforcement of the importance of keeping your brain challenged. They distributed a long list of websites and apps that offer brain exercises and they stressed the importance of trying new learning challenges and not relying on just one or two activities.
Tip #7: Don’t stop working on your cognition! Take a course at your local high school or community college or try a new hobby – these can be fun learning experiences that will help challenge your cognition (as well as opportunities to meet new people).
It’s important for all of us as we get older to keep our brains challenged with learning new skills, but I think NPH patients may not need so much convincing of that. Cognitive therapy improved my quality of life considerably, and I am very grateful to my wonderful therapist for all the strategies she taught me. I wish you similar success in your therapy!