Maturitas 72 (2012) 203–205

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Maturitas
journal homepage: www.elsevier.com/locate/maturitas

Review

Reminiscence therapy in dementia: A review

Maria Cotelli ∗ , Rosa Manenti, Orazio Zanetti ∗∗
IRCCS Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, 25125 Brescia, Italy

a r t i c l e i n f o a b s t r a c t

Article history: Dementia is a progressive disorder that impacts several cognitive functions. However, some aspects of
Received 16 April 2012 cognitive function are preserved until late in the disease and can therefore be the targets of specific inter-
Accepted 21 April 2012 ventions. The rehabilitation of cognitive function disorders represents an expanding area of neurological
rehabilitation, and it has recently attracted growing political, social and ethical attention. Here, we review
the efficacy of reminiscence therapy to improve cognitive functions and/or mood. Available studies sug-
Keywords:
gest that reminiscence therapy can improve mood and some cognitive abilities. Further studies, based
Mood
on larger patient samples including placebo and control conditions, should be conducted to identify the
Cognition
AD
optimal conditions for such treatment protocols.
Rehabilitation © 2012 Published by Elsevier Ireland Ltd.

Contents

1. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Competing interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Provenance and peer review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Dementia results in a slowly progressive attack of cognitive dementia and their caregivers [4,5]. Reminiscence is a psychosocial
functions. The behavioural and functional impairment that accom- intervention that is commonly used in dementia treatment.
panies dementia constitutes one of the major causes of disability Reminiscence therapy (RT) is one of the most popular psychoso-
worldwide, and it has a significant impact on the lives of affected cial interventions in dementia care. It was introduced in the 1980s,
individuals and on the quality of life of their families. and it is based on evocation and discussion with another person or a
It is now well known that the effectiveness of pharmacolog- group about past activities, events and experiences, using a variety
ical treatments is limited (donepezil, rivastigmine, galantamine of supporting materials. This treatment [6] is based on the assump-
and memantine), and such treatments have symptomatic effects in tion that remote memory remains intact until the later stages of
only a small portion of patients. Therefore, non-pharmacological dementia and may be used as a form of communication with the
interventions for dementia patients have gained attention in patient. RT includes the recall of past events with the use of music,
recent years, and there are currently many different approaches photographs and other aids, often prepared with the involvement
under study, ranging from multi-strategy approaches to psychoso- of caregivers. The most recent Cochrane Review [7] reports that
cial interventions to cognitive training [1,2]. Non-pharmacological no firm conclusion could be reached regarding the effectiveness of
interventions may play a role in planning multidimensional models RT for dementia. A similar procedure is life review therapy (LRT),
for dementia care by treating the cognitive, functional, behavioural which addresses issues regarding unresolved conflicts, guilt and
and affective aspects of dementia [3]. Psychosocial interventions resentment that a patient has particular difficulty in reviewing
have the potential to improve the quality of life of people with independently. Although the procedures are different, both RT and
LRT involve the recollection of past experiences (events, emotions
and relationships).
∗ Corresponding author. Tel.: +39 0303501457; fax: +39 0303533513.
The present review provides an overview of the use of these psy-
∗∗ Corresponding author. Tel.: +39 0303501358; fax: +39 0303533513. chosocial interventions. We included only randomised controlled
E-mail addresses: mcotelli@fatebenefratelli.it (M. Cotelli), trials that investigated the effects of RT on cognitive functions
ozanetti@fatebenefratelli.it (O. Zanetti). and/or mood in patients with dementia. In spite of the relative

0378-5122/$ – see front matter © 2012 Published by Elsevier Ireland Ltd.

http://dx.doi.org/10.1016/j.maturitas.2012.04.008
204 M. Cotelli et al. / Maturitas 72 (2012) 203–205

RC: randomised controlled study, FU: follow up after treatment end, II: individual intervention, GI: group intervention, DP: dementia patients, RT: reminiscence therapy, ROT: reality orientation therapy, CAPE: Clifton assessment
procedures for the elderly; HCS: Holden communication scale, LSI: life satisfaction index, ADL: activity of daily living, BDI: Beck depression inventory, MMSE: mini mental state examination, CDR: clinical dementia rating
scale, GDS: geriatric depression scale, AMI: autobiographical memory interview, QOL-AD: quality of life-Alzheimer disease, GHQ-12: general health questionnaire, RSS: relative stress care, SES: social engagement scale, WIB:
notoriety of RT, only a few studies are available which are discussed

well-being/ill-being scale, MDS-ADL: a self-care rating scale, ABMI: agitation behaviour mapping instrument, IS: interact scale, HR: heart rate, BRSE: activities for the behaviour rating scale for the elderly and ↑: improvement.
RT: ↑ WIB at the end,
ROT followed by RT:

RT plus ROT: ↑ BRSE

in this review (Table 1).

↑ CAPE, ↑ HCS, ↑ LSI

RT and Snoezelen:
In an early study, Baines et al. [8] included 15 subjects with

no effects at FU
No significant
moderate to severe impairment of cognitive functioning who were

HR, ↑ ABMI
RT: ↑ AMI
randomly assigned to 3 groups according to the following treat-
RT: ↑ BDI

changes
Results

ments: RT followed by reality orientation therapy (ROT), ROT

followed by RT and no treatment. Intervention (RT and ROT) was
for 30 min, 5 times a week for 4 weeks. RT sessions were group ses-
sions that included the use of audio/slide programmes designed to
Follow-up

6 weeks

6 weeks

6 weeks
facilitate reminiscence, old photographs, books, magazines, news-
None

None

None

None
papers and domestic articles. After 4 weeks, the RT and ROT groups
crossed over to receive the alternate therapy, whilst the ‘no treat-
CDR, MMSE, ABMI, IS, HR ment’ group continued without a specific treatment. The results
showed that the group that received ROT followed by RT showed
MMSE, QOL-AD, CAPE,

improvement in cognitive and behavioural measures (such as life

HCS, GHQ-12, RSS

MMSE, GDS, BRSE

MMSE, SES, WIB,

satisfaction index), which was not found in the other two groups.
ADL, BDI, MMSE
CAPE, HCS, LSI

GDS, LSI, AMI

The authors suggested that it may be important to use a reality ori-

entation technique with confused patients before involving them
MDS-ADL
Outcome

in a reminiscence group.
In the same year, Goldwasser et al. [9] recruited 30 subjects
with clinical diagnoses of dementia and randomly assigned them
to 3 groups: RT, social support and no treatment. Intervention (RT
Three 40-min sessions over two weeks

and social support) was for 30 min, twice a week for 5 weeks.
Twenty 30-min sessions (5/week)

Twelve 60-min sessions (1/week)

Reminiscence topics included food, family, early memories, adjust-

Ten 30-min sessions (2/week)

Six 30-min sessions (1/week)

ments, losses, jobs and music, whereas the social support group
Eighteen sessions (1/week)

focused on present and future events. The self-reported level of

Twelve sessions (1/week)

depression in the RT group was positively affected compared with

Frequency/duration

participants in the supportive therapy and control groups, but no

significant effects were found for cognitive or other behavioural
functioning.
More recently, some studies tried to deepen these data. Mor-
gan [10] included 17 patients with a mild to moderate degree
of dementia on the clinical dementia rating scale (CDR) [11]. Life
review therapy (LRT) was used in the treatment group. The life
Study design

review group received an average of 12 individual weekly sessions.

A life story book was developed for each person in the intervention
group; this book incorporated the person’s own words accompa-
RC

RC

RC
RC

RC

RC

RC

nied by appropriate pictures, and the focus of the sessions was

life review. The comparison condition was a ‘no treatment’ con-
trol group. The results showed an improvement in autobiographical
15 DP (5 RT followed by ROT,

24 DP (12 RT plus ROT vs. 12

17 DP (8 RT, 9 no treatment)
11 DP (7 RT, 4 no treatment)
5 ROT followed by RT, 5 no

support, 10 no treatment)

memory selectively in the RT group, which suggests the usefulness

contact, 30 no treatment)
101 DP (36 RT, 35 social
30 DP (10 RT, 10 social

of this treatment in patients with dementia.

20 DP (RT followed by
Snoezelen, Snoezelen

Subsequently, Thorgrimsen et al. [12] reported an evaluation of

followed by RT)

supportive care

an RT protocol that involves individuals with dementia and fam-

ily caregivers (18 weekly training sessions for care-givers, with
Participants

treatment)

7 of these sessions also attended by the person with dementia).

The participants, randomly assigned to RT treatment or no treat-
ment, were 11 people with a diagnosis of dementia and 11 informal
family caregivers. Sessions with caregivers alone were intended to
train them to use reminiscence methods. In joint sessions, topics
GI: RT vs. social support

II: RT vs. social contact

II: RT vs. no treatment
GI: RT (with caregiver

included ‘school days’, ‘the world of work’ and ‘dressing up and

GI: RT vs. ROT vs. no

involvement) vs. no

II: RT vs. Snoezelen

GI: RT plus ROT vs.

looking good’, accompanied by slides, enlarged photographs, music

Reminiscence therapy in patients with dementia.

vs. no treatment.

vs. no treatment

supportive care

and drama to bring their memories to life. The results indicated pos-
Intervention

itive trends (not significant) in support of the effectiveness of RT as

treatment

treatment

a valuable therapeutic intervention for people with dementia and

their caregivers.
A randomised controlled trial has been conducted by Lai et al.
[13] on a larger group. The authors included 101 nursing home
residents, including 36 participants receiving individual RT, 35 in
Thorgrimsen et al. [12]

a social contact comparison group and 30 without any treatment.

Goldwasser et al. [9]

Akanuma et al. [15]

Sessions lasting 30 min were conducted by two staff members and

Baillon et al. [14]
Baines et al. [8]

held once per week for six weeks. Participants were diagnosed with
Lai et al. [13]
Morgan [10]

dementia according to DSM-IV criteria. Significant differences in

Reference

the well-being/ill-being scale (WIB) were observed in the RT group

Table 1

at the end of the treatment compared with the baseline assessment,

suggesting a significant improvement in psychosocial well-being
 M. Cotelli et al. / Maturitas 72 (2012) 203–205
induced by RT, which provides support for the effectiveness of RT
in patients with dementia.
A relevant study investigated the effect of RT on behavioural
disturbance in dementia patients, which is a common feature of
dementia that causes significant distress for caregivers. Baillon et al.
[14] performed a crossover controlled study that evaluated the
effect of Snoezelen therapy (ST) and RT on the mood, behaviour
and heart rate of patients with dementia. ST for the elderly works
by directly stimulating the senses. ST originated in the Netherlands
in the field of learning disabilities and usually takes place in a
dedicated room where patients may experience visual, auditory,
olfactory and tactile stimuli [16] with the aim of creating a feel-
ing of safety, novelty and stimulation under the user’s control. The
aim of ST is to increase the patient’s well-being and communica-
tion by involving the person with dementia in an enjoyable process
that they can understand through their senses. ST does not require
memory function and emphasises the preferences of the patient
with dementia, thus promoting autonomy and the ability to tai-
lor the intervention to the likes of the individual or group. Twenty
patients with dementia and significantly agitated behaviour were
randomised to one of two groups (ST followed by RT vs. RT fol-
lowed by ST). Each patient received three individual sessions of ST
and RT over a two-week period, with at least one week of wash-
out between treatments. RT was selected as the control therapy
as it is has been already accepted as an appropriate treatment for
these patients. The results of this study showed that both inter-
ventions had a positive effect on agitated behaviour and heart
rate, which suggests the relevance of these treatments in dementia
patients.
Finally, a recent study [15] combined RT and reality orienta-
tion (ROT) with imaging to assess the functional changes linked to
these therapies. Twenty-four patients with vascular dementia were
enrolled and divided into two groups: RT plus ROT vs. supportive
care. With regards to behavioural improvement, the RT plus ROT
group showed a greater improvement in social/communication and
activity, and this change was linked to a significant increase of
cerebral metabolism in the anterior cingulate [15]. The authors’
findings suggested that the reminiscence approach combined with
the reality orientation approach stimulated the anterior cingu-
late and had a positive effect on social interaction. The direct link
between behavioural effects and functional changes paves the way
to more in-depth investigations of these therapies and their under-
lying mechanisms.
1. Conclusion
Available studies suggest that reminiscence therapy can
improve mood and some cognitive abilities. The reviewed studies
have highlighted some beneficial effects of RT on mood, well-
being and behaviour in patients with dementia. Furthermore, an
improvement of autobiographical memory has been described.
Nevertheless, there is little evidence for the use of reminiscence
therapy. The number of trials remains very small and their quality
is often poor. Overall, the included trials have important method-
ological weaknesses, particularly in relation to small sample sizes,
the heterogeneity of the patient groups (i.e., dementia of several
aetiologies) and difficulties in carrying out post-treatment assess-
ments ‘blind’ to treatment condition. Furthermore, only one study
[13] attempted to evaluate adherence to the treatment, indicating
205
that there were no significant differences between those patients
who had completed and those who had not completed the proto-
col. Although all of the investigators report randomisation, details
of the methods used are lacking. Further studies, based on larger
patient samples including placebo and control conditions, should
be conducted to identify the optimal conditions for such therapeu-
tic tools.
Contributors
Cotelli, Manenti and Zanetti contributed to the study concept
and design, drafting of the manuscript, critical revision of the
manuscript and study supervision.
Competing interest
None declared.
Provenance and peer review
Commissioned, not externally peer reviewed.
References
[1] Olazaran J, Reisberg B, Clare L, et al. Nonpharmacological therapies in
Alzheimer’s disease: a systematic review of efficacy. Dementia and Geriatric
Cognitive Disorders 2010;30(2):161–78.
[2] Buschert V, Bokde AL, Hampel H. Cognitive intervention in Alzheimer disease.
Nature Reviews Neurology 2010;6(9):508–17.
[3] Cotelli M, Calabria M, Zanetti O. Cognitive rehabilitation in Alzheimer’s disease.
Aging Clinical and Experimental Research 2006;18(2):141–3.
[4] Moniz-Cook E, Vernooij-Dassen M, Woods B, Orrell M. Psychosocial interven-
tions in dementia care research: the INTERDEM manifesto. Aging and Mental
Health 2011;15(3):283–90.
[5] O’Shea E, Devane D, Murphy K, et al. Effectiveness of a structured education
reminiscence-based programme for staff on the quality of life of residents with
dementia in long-stay units: a study protocol for a cluster randomised trial.
Trials 2011;12(1):41.
[6] Norris A. Reminiscence with elderly people. London: Winslow; 1986.
[7] Woods B, Spector A, Jones C, Orrell M, Davies S. Reminiscence therapy for
dementia. Cochrane Database of Systematic Reviews 2005;(2):CD001120.
[8] Baines S, Saxby P, Ehlert K. Reality orientation and reminiscence therapy. A con-
trolled cross-over study of elderly confused people. British Journal of Psychiatry
1987;151:222–31.
[9] Goldwasser AN, Auerbach SM, Harkins SW. Cognitive, affective, and behav-
ioral effects of reminiscence group therapy on demented elderly. International
Journal of Aging and Human Development 1987;25(3):209–22.
[10] Morgan S. The impact of a structured life review process on people with
memory problems living in care homes. Bangor: University of Wales;
2000.
[11] Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for
the staging of dementia. British Journal of Psychiatry 1982;140:566–72.
[12] Thorgrimsen L, Schweitzer P, Orrell M. Evaluating reminiscence for people with
dementia: a pilot study. The Arts in Psychotherapy 2002;29:93–7.
[13] Lai CK, Chi I, Kayser-Jones J. A randomized controlled trial of a specific remi-
niscence approach to promote the well-being of nursing home residents with
dementia. International Psychogeriatrics 2004;16(1):33–49.
[14] Baillon S, Van Diepen E, Prettyman R, Redman J, Rooke N, Campbell R. A com-
parison of the effects of Snoezelen and reminiscence therapy on the agitated
behaviour of patients with dementia. International Journal of Geriatric Psychi-
atry 2004;19(11):1047–52.
[15] Akanuma K, Meguro K, Meguro M, et al. Improved social interaction and
increased anterior cingulate metabolism after group reminiscence with
reality orientation approach for vascular dementia. Psychiatry Research
2011;192(3):183–7.
[16] Baker R, Dowling Z, Wareing LA, Dawson J, Assey J. Snoezelen: its long-term
and short-term effects on older people with dementia. British Journal of Occu-
pational Therapy 1997;60(5):213–8.