Implications for Nursing Research and Practice
Nurses and nurse researchers are in key positions to educate, detect and refer, intervene, and create new strategies for those at risk of developing cognitive impairment. As health educators, nurses can talk to patients, family members, and communities about ways to promote successful cognitive aging. Preventive health strategies to recommend include avoiding substance use, exercising, and eating well (Vance & Crowe, 2006; Vance et al., 2005), as well as staying cognitively viable through educational pursuits, mentally stimulating activities, and cognitive remediation therapy. A point to stress regarding mental stimulation is that such activities must be novel and challenging. Novelty encourages neural plasticity, which results in maintaining or improving cognitive reserve. The mental stimulation must make participants' "brains sweat"—a corollary to physical exercise. Nurses should encourage older adults to use a variety of cognitive strategies; relying on the same type of stimulation, such as crossword puzzles, is not mentally stimulating if this is the only type of cognitive exercise in which one engages.
Gerontological or adult nurses frequently see older adults in the primary care setting. To detect and refer patients who may be at risk for cognitive impairment, nurses need to assess patients for telltale signs of cognitive decline at each visit. Patients who forget their physician appointments or who are socially isolated and lack mental stimulation and those who comment about mental problems are at risk. Nurses can inquire about signs of decline and help initiate referrals to psychologists, psychiatrists, and neurologists. Vance, Farr, and Struzick (2008) designed a flowchart to educate nurses on how to detect and refer adults who are experiencing cognitive problems.
Nurses also can introduce simple approaches that can help patients compensate for cognitive decline. As suggested in Table 1 and Figure 1, spaced retrieval, external cues, and chunking are just a few of the strategies that nurses can teach to patients. These strategies can be combined and implemented on an individualized basis to make them more accessible and user-friendly for older patients. Such techniques can help older adults compensate for age-related cognitive losses, which can improve quality of life.
Finally, nurses can create and examine new strategies to improve or maintain cognitive functioning and compensate for cognitive impairment. New cognitive remediation strategies are in the works. Noice, Noice, and Staines (2004) developed a cognitive remediation therapy in which older participants were engaged in nine 90-minute drama sessions during which they were taught how to act, memorize a script, respond emotionally, and spatially orient on stage. This training allowed for participation in the full continuum of the physical, cognitive, and affective components of a drama. Older adults who took part in this training experienced significant improvement on a number of cognitive domains compared to older adults assigned to visual art training and a no-treatment control group. Other training paradigms, especially those that do not require a professional trainer, are needed to facilitate cognitive remediation therapy. Computer gaming as a strategy to improve cognitive functioning represents a novel area for exploration (Goldstein et al., 1997; Riesenhuber, 2004).
J Neurosci Nurs. 2008;40(4):241-249. © 2008 American Association of Neuroscience Nurses
Cite this: Mental Stimulation, Neural Plasticity, and Aging: Directions for Nursing Research and Practice - Medscape - Aug 01, 2008.