Reminiscence interventions have been studied for decades, with some evidence of benefit for cognition, mental health, and overall well-being in older adults. But should structured reminiscence programs have a place in long-term care facilities and in the treatment of individuals with cognitive impairment? Investigators conducting a small study in Portugal have reported that “simple reminiscence” directed to positive life events may improve autobiographical memory in nursing home residents with cognitive impairment and may be helpful for maintaining or improving cognitive function as well as decreasing anxiety and depressive symptoms. “Caring for persons with cognitive decline offers the chance to develop a broad range of interventions that go well beyond medicinal therapies,” wrote Teresa Silveira Lopes, PhD, and her colleagues from the University of Porto in Portugal. “Reminiscence therapy can be one of those interventions.” Forty-one individuals living in four nursing homes were randomly assigned to a program of five individual weekly reminiscence sessions of 30 to 40 minutes each, or to a control group without exposure to any intervention (Arch Gerontol Geriatr 2016;66:183–92). The first reminiscence session was the most structured. With the help of a therapist, each resident built a sort of temporal grid or time scale, collecting and illustrating general positive memories (such as friends, family, and hobbies) with photos, clippings, and other visual elements. In subsequent sessions the tool would assist residents in retrieving and conversing about specific memories; these sessions were more unstructured than the first, with the therapist stimulating the resident to retrieve specific memories but not suggesting themes or chronological recall. Development of the visual reminiscence tool was “a dynamic process” that continued throughout the sessions, Dr. Lopes told Caring. Psychologists, nurses, and family members contributed data and autobiographical information and materials up front, which helped ensure that the documented events were positive events that would promote positive feelings, she said. The outcomes were measured by independent researchers 2 weeks before the program and 2 weeks afterward using a variety of assessments: the Montreal Cognitive Assessment (MoCA) and the Autobiographical Memory Test (AMT) for cognition; the Alzheimer Disease Assessment Subscale Non-Cog (ADAS Non-Cog) for behavior; and the Cornell Scale for Depression in Dementia (CSDD), the Geriatric Depression Scale (GDS-5), and the Geriatric Anxiety Inventory for emotional status. In considering the outcome differences or the changes in assessment scores between the intervention and control groups, the researchers found statistically significant differences in cognition, anxiety, self-reported depression through the GDS-5 and all autobiographical memory measures. For instance, the mean MoCA score in the intervention group went from 14.35 before the test to 15.60 after, whereas in the control group it changed from 13.62 before the test to 11.95 after. The AMT evaluates the ability to recover specific autobiographical memories in a limited time upon presentation of a stimulus word. Participants in the intervention group improved significantly in all elements of the test, from the number of recalled events retrieved to the specificity and positive valence. Depressive symptoms as measured by the CSDD and altered behavior as measured by the ADAS Non-Cog improved in the intervention group, but neither the level of change in this group nor the differences between the two groups were statistically significant. The Portuguese study, however, lacked a placebo intervention in the form of some sort of activity that enhances social contact. One of the challenges in evaluating reminiscence interventions lies in separating its potential benefits from the advantages of broader social interactions or recreational activities — or in the case of this study, the benefits of interacting with a single individual. Most research published thus far on reminiscence therapy for older individuals, and for older individuals with cognitive impairment or dementia, has involved small studies of group interventions rather than individual programs. Several published meta-analyses indicate that reminiscence therapy is “a promising non-pharmacological approach” to improve depressive symptoms and other indicators of mental health in the elderly, but there have been few if any controlled studies to determine its benefits as compared with generic social interactions, according to Andrea Gaggioli, PhD, of the Universita Cattolica di Milano. Dr. Gaggioli is currently analyzing the results from a randomized, controlled trial of group reminiscence for institutionalized elderly adults (Trials 2014;15:408). There also are questions of the appropriateness and effectiveness of reminiscence for patients with cognitive impairment. Residents who participated in the Portuguese study had mean MoCA scores that fell within the range — as set for the Portuguese population — for mild dementia (a score between 16 and 12). Michi Yukawa, MD, the medical director of the Community Living Center at the San Francisco Veterans Administration Medical Center, told Caring that reminiscence can be a good practice overall for skilled nursing facilities so long as it focuses on positive past events and the promotion of positive feelings (the principles of “simple reminiscence”). “Staff have to know what subjects to talk about and what to avoid,” said Dr. Yukawa, who is also an associate clinical professor of geriatrics at the University of California–San Francisco (UCSF) School of Medicine. A program at her facility engages residents with dementia in regular group discussions that involve “a fair amount of reminiscence,” she noted, but the staff know the residents well and the residents have dementia that is not too advanced. Dr. Louise Aronson, MD, professor of geriatrics at the UCSF School of Medicine, said that autobiographical memory can serve as a good topic of conversation in the earlier phases of Alzheimer’s disease and dementia, when distant memory is usually stronger than recent memory. “It taps into a strength and also helps humanize the person to their caregivers,” Dr. Aronson told Caring. “When the disease is more advanced, if [residents] want to discuss their autobiography and it gives them pleasure, then it’s terrific. But I see no need otherwise to go there.” Efforts to work with these residents “in the present,” with in-the moment sounds and smells and touch can be just as, if not more, important for engagement. “What engages a person with dementia will vary widely,” Dr. Aronson said. “The key is to do and discuss whatever allays anxiety and brings pleasure and meaning to their lives. There’s no one-size-fits-all approach to achieving that goal.” Christine Kilgore is a freelance writer based in Falls Church, VA. Pre-registration for the AMDA – the Society for Post-Acute and Long-Term Care Medicine 2017 Annual Conference, closes Feb. 23. Save and secure your spot now! If you are a Society member, you can receive the discounted member registration rate as well as receive all the benefits of Society membership from now through Dec. 31, 2017. If you 3are not currently a member, visit www.paltc.org/membership for details on benefits and dues before registering. The Annual Conference takes place from March 16–19 at the Phoenix Convention Center. Visit www.paltc.org/phoenix-2017 now to register for the meeting and book your hotel.