Managing anxiety and other emotional sequelae resulting from impaired cognition

Anxiety and depression are frequently seen in memory-impaired people. Kopelman and Crawford (29> found depression in over 40 per cent of 200 consecutive referrals to a memory clinic. Evans and Wilson (39 found anxiety to be common in attenders of a weekly memory group. Dealing with these emotional problems should be an integral part of memory rehabilitation. Obviously, listening, trying to understand, and providing information are key factors in encouraging families to cope with their difficulties. Wearing(31 provides a helpful reference on the problems faced by families of memory-impaired people, and makes suggestions as to what can be done to help. Providing information or explanations is one very simple and therapeutic strategy that can help reduce the fear and anxiety accompanying memory impairment. Written information is best, as most people, whether memory impaired or not, are unlikely to have good recall of information at times of stress. Memory Problems After Head Injury,(32> written for the National Head Injuries Association; Managing Your Memory,(33) and Coping With Memory Problem(34) are all useful publications to have available for patients and their relatives.

In addition to providing information, it may be necessary to offer therapy for anxiety and depression. Relaxation therapy can be helpful in reducing anxiety, even if memory problems are severe enough to prevent a participant from remembering the actual therapy sessions. Depression, too, may exacerbate difficulties in people with organic memory impairment. It is possible that cognitive behavioural therapy approaches such as those employed by Beck (35> might be appropriate for those with depression associated with organic memory impairment, although no studies appear to have been reported. Psycho-therapy, on the other hand, is a well-established intervention for patients with neurological damage. Prigatano et al/36> firmly believe in group and individual psychotherapy with brain-injured clients. Jackson and Gouvier(37> provide descriptions and guidelines for group psychotherapy with brain-injured adults and their families.

Other groups for memory-impaired people can be useful in reducing social isolation, which is also common in people with memory problems. (31) Wilson and Moffat(38) describe several kinds of groups for patients. Moffat (39> reports on a relative' memory group for people with dementia, and Wearing (31 offers suggestions for setting up self -help groups. Evans and Wilson ^ point out the social value of memory groups as well as their effect in reducing anxiety.

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