Retrogenisis Theory

analesde psicologia
O Copyright 2006: Sericio de
ISSN edici6u irnpresa:
20Q6,vol 22, n" 2 (diciembre),260-266
Retrogenesis
theoryin Alzheimer'sdisease:Evidence
Heather Rogersnnl, andJuan Cados Arango Las
'Unifbmetl
zl)tpannent
de Ia Univenidad de Murcia. Murcia (Espaffa)
ISSN edici6n rveb (ww.um.e s/arales ps): 7695-2294
clinical implications*
2
Seruices
UtiuniE of tlte.l-.tuttlt Scienas.lhtltxda, Maryland
ol Plgsitat.Medicineail Reltabilitation,Uriuniry of Metlicireanr)Dntisrry of Nw
I6skrMedicul Re/tabilitationRuunb and EducationCorporctkn, ll/est )ruagq
T'eoriadc la retrog6nesisen la enfermedad Alzheimer: Evidencia e implicaciones clinicas.
Resumen: l,a enFermedad de Alzheimcr @,A) es una de las principales
causasde muerte en el munclo. Lrllbaio indice de natalidad, la mejota en las
condiciones sanitarias y sociales y, como consecuencia, el aumento en la
esperanzade vida, han hecho que el n(rnero dc personasmayores de 65
aros aumente ctdu vez m6s, Hste aumento en Ia expectativa de vida ha llevado a que el nlimero de casosnuevos de peffionasque ptesentan IJA se
haya incrementando de manera &arnitica en los riltimos afios. I)iferentes
cstudios han demostrado quc confor,ne va evolucionandola enfermedad
de Alzheirner, se sueleproducir ura repgesi6nde las capacidadescognitivas, ftrncionalesy fisicas a estadiosevolutivos ptevios dcl desarrollo.lj,i
presente articulo tienc con:ro objetivo rcoilzztrwa rcvisi6n de la evidencia
que apoya el concepto dc tetro-g6nesiscn la Enfermedad de Alzheimer, a
la luz de Ia teoria del desauollo evolutivo dc Piaget. Se exarninru6 la teoria
de la tetto-g6nesistanto desdeuna perspectivaclinica,cognitiva,funcional,
ueurol6gica y neutopatol6gica.Finalmentc, se discutird las implicaciones
que la tcoria de la retro-g6nesispuedc rcner en la creaci6ne implementaci6n dc programa de rehabilitaci6npala personascon dernencia.
Palabras clave: Linferrnedadde Alzhimer;
rehabilitaci6l,
Inuoduction
Nanrk, NevJenel
krffv
Abstract: Alzheimer's
(AD) is a one of the top leading causes
death in the wodd. In
tJnited Statesalone,over 4.5 million.Americans
'Ihe
had Alzheimer's in the
2()00.
annu.d number of tew casesis increasingdramaticaliy
year as people begin to r:eacholdet ages in
which the prcvalenceof
is higher and as peoplc sr.rvive lotger with
the disease.Anecdotal
ations of inclividuals with AD ftom familv
members and/or caregi
indicate how suffers become "childlike" as the
diseaseprogresses.
researchsuggestsdrat the prog'ressionof Al)
occursin reverseorder nonlal hlnnan development. 'Ihe present article
reviews the evidence
porring this theoly of retrogenesis.Cognitive,
frrnctional, neurologic
neuropatholog/cprogressionof.AD will be examined and compared
acquisition in each area. Potential
implications of the
ris theory on rehabilitation program devclopment and i
for individuals with dementia wili bc discusscd.
Key wordsl Alzheimer's
retrogenesistheory; relubilitation.
with severe brain da
Although the progression of the
n to person, patients with AD live
after diagnosis, but can live f<rr up to
According to 2002 census data, Alzheimer's disease(AD)
2004). The term dementia teferc ^
ranks as the eighth leading causeof death in the United Sta- 20 yeats S,arson, et
loss of intellectual pacity tha;t interferes with everyday
tes and caused59000 deathsin that year alone (Centersfor
of a specific disease or condition
Disease Control and Prevention, 2005). Over 4.5 rnilLion functioning as
s disease is the most commofl
Arnedcans were estimatedto be suffering with this disease flMeiner, 2003).
ine for 50 to 70ohof all forms of
in the year 2000,a two-folcl increasefrom the 1980 estimates form of dementia,
Hofman, 2000). The cognitive and
(Herbert, et a/.,2003). Herbert and colleagues(2003) were dementia pauner
functional
impact
o
the
diseaseis often tefered to as de*
ptedict
able to
the prevalenceof A-l) in 2050; they report
mentia of the Alzhei
s type, or DAT.
that 73.2 to 16 million Americans will have the diseaseif
Family members nd caregivets of individuals suffering
curfent population ftends continue and no pfeventive treatthat these individuals tended to
ments for Alzheimer's diseaseemerge.The annual number from DAT often
the diseaseprogressed (Arango &
of new caseswill begin to dimb shaqply around the year become "childlike"
'Iwo
2040, when all the baby boomers will be over 65.
fac* Rogers,2003). Crure feseafchhas been focused on elucitots contribute to this change:(1) an increasein the nui:nber dating this process f "returning to childhood" that has
nted to occur in patients with deand ptoportiofl of people who survive to the oldest ages been anecdotally
t'!i t14)e and vascular dementia. This
whete AD is more frequent, afid Q) an increase in suryival mentia of the
reseafch suggests
. degenerative mechanisms reverse the
ratesof peoplewith the disease.
order
in normal hr.rman development. Tlhe
of
acquisition
Flowever, AD is not a normal part of agrng. It is a slow
sis (R.eisberg,
et a/., 1.999a)and
disease, starting with mild memory problems and ending processis known as
irevolves functional,
avioral, cognitive, and neurologic
degeneratioq as well
to the neuropathologic changes that
x The opinior-rsand asserrions contained herein are the private views of
occur furAD.
the authors and are not to be consh'uedas being official or as reflecting
This processof
is is so robust that the stages
disease varies from
an ^vetuge of 5
the views of the Uniformed Sewices University of dre I'Iealth Sciences,
or the f)eparftnent of Defense.
*+Cortespondence address
[Direccidnpara cotrespondencia]:I)r. Juan
Car'losArango Lasprilla.Neuropsychology& NeuroscienceLaboratory.
Kessler JVledical Rehabilitation ltesealch and llducation Corp. 1199
Pleasant Valley Way. West Otange, New Jersey 07052. l:, mail:
of AD can be
ages(DAs). This is
tient's curtent
pfopflate
tinues to affect a
260 -
d into conesponding developmental
t because an awateness of a paage can asslsl 1Ir provlolflg
ap-
and care. As Alzheimer's disease conpercentage of the population, tllis
Retrogenesis theory in Alzheitner's disease: Eridence and clinicdl imt)lications
line of researchalso naturally extends to the development of
innovative interventions to prevent decline and improve
cognitive, social and behavioraloutcomes in these patients.
For example, an intergeneraaonaLprogram that pairs individuals with AD and preschool-aged children with similar
DAs could be irnplemented that meets the developmental
needs of both parties involved so that young children and
the older adults with dementia can benefit from the interaction. After examining the stagesof AD and providing evidence to support the retrogenesis phenomenon in the progressionof Alzheimer's disease,we will discusspotential impJications of this retr:ogenesistheory for rehabilitation professionalswith a specifi.cemphasis on involving young childten in rehabi-litation programs and designing activities that
^te ^pptopn^te to the developmental age of the older adult
withAD.
General Stagesof Alzheimefs Disease
The development of A-lzheimer's diseasebegrns in the entothinal cortex an area near the hippocampus. Next, it
spreadsto the hippocampus,which is essentialto the formation of short-term and long-term memories.'Ihese affected
regions begin to atrophy. The brain changes are thought
start 10 to 20 years before any visible signs and symptoms
appear. Forgetfulness, or problems with shot term (workis the fust visible sign of the undedying disI?".*.*"*,
As the diseasebeginsto affect the cerebralcortex, memory loss continues and changesin other cognitive abilities
emerge.The clinical diagnosis of AD is usually made during
this stage.Signsof mild .AD can include: memory loss, confusion in unfamiliar places,difficulty with finances, impaired
judgment, loss of spontaneity and senseof initiative, and
mood and perconality chaoges,including increased arxiety.
In the brain, amyloid plaques and neuro{ibrillar tangles (the
halknarksof Alzheimer's disease)first damageareasof btain
that control filemory, language, and reasoning. Physical/funcaond, abilities do not decline until later in the disease(Arango,2004).
By this moderate stage AD, damagehas spread further
to the areasof the cerebralcortex that control language,reasoning, sensoryprocessing,and consciousthought. Affected
tegions continue to aftophy and signs and symptoms of the
diseasebecomemore pronounced and widespread.Behavior
problems, such as wandering and agitation,can occur. More
intensivesuperwisionand caxebecomenecessary.Symptoms
of this stage can incl,udeenhancedmemory loss and languageproblems, shortened attention span, difficulties recognztng famitat faces, language problems, difficulty otganizing thoughts and thinking logically, occrrrence of repetitive
statementsor movemerit, pfesence of hallucinations or dehr-
261
sions, appearanceof suspiciousnessor paranoia,irdtability,
loss of impulse control, and perceptual-motor problems
(Arango & Fernandez, 2003; All;Lngo& Rogers, 2002).
In the last stage of AD, known as severeAD, plaques
and tangles are widespread t}roughout the brain and areas
of the bmin have atrophied further. Patients cari{rot recogntze famitar loved ones and are unable to communicate.
Symptoms during this stage cap include: weight loss, seizrres, skin infections, difficulry swallowing, groaning, moaning, or grunting, somnolence, and udnary and fecal incontinence. At the end, patients may be in bed much or all of the
time. It is common for most people with AD to die from
other illnesses.
Cognitive Retogenesis
Ajr-rtiaguerraand Tissot (1968) were the first researchersto
take an empidcal apptoach to the study of retrogenesis.
They obsewed that the decline of certain capacities in dementia appearedto reverse Piaget's developmental stages.
Jean Piaget'stheory of intellectualdevelopment(1952)identified four major stagesand emphasized the interactive telationship befween intemal operations and the envkonment i:r
the acquisition of knowledge. Cognition and behavior development in childrcn and loss in people with DAT we found
to be rematkably sinrilar O4atteson,Linton, and Barnes,
1996) (see fable 1), Patients with dementia of the Alzheimer's type do indeed appear.to "go backwards" through
the sensorimotor,preoperational,concrete operational,and
fotmal operational stagesdefined by Piaget.
Piaget'sdevelopmentaltleory also assistedresearchersin
the assessmentof residual cognitive capacities of older
adults with dementia in the more severe stages.These patients often had severely impaired ftrnction and were previously considered"untestabld'. A Piagetiantest battery (the
Uzgitis and l-Iunt Ordinal Scalesof Psychological Development - OSPD) tlat was origina[y designed to assessan infant's level of sensodmotor development from birth to age2
was adapted for the AD population. There were five subscalesin this new version of the OSPD: (1) visual pursuit
and object permaflence,i.e., tracking an object through an
atc of 180 degtees,(2) means-ends,i.e., reachingout for an
object, (3) causality,i.e., appropriatelyresponding (e.g.,with
a smile) to an event, (4) spatial telations, i.e., glancing between two visually presented objects/persons, and (5)
schemes,i.e.,visuallyinspectingan object held in hands.The
scale is hierarchical and the highest rated task perforrned is
the raw scote for each individual subscale.The sum of the
subscaleswas tle total score,ranging from 0 to 55. Cognitive decline using this measure was highly correlated vrith
functional declinein latet stagesof AD (Aue4 eta/.,1994).
anales de psicologla, 2006,vol.22,n" 2 (dicimbrc)
262
Table
HeatherRogers,aruIJuan CarlosArango Lasprilla
s
Levels and
of Alzheimer's l)isease.
Piaget Developmental Level
Alzheimer's Disease Stage
7. Sensodmotor Period (Birth *ASt 2)
Severc stageAD
Substage1: Use ofreflexes
Speechand motor dysfunction
Few words spoken
Inconlinence
unable to walk or eat
Substage2: Primary Circuiar Reaction (PCR)
Substage3: SecondaryCircular Reaction(SCR)
Substage4: Coordination of SCRs
Substage5: T'ertiary Cir.cularllcactions (I'CR)
Substage6: Invention of new meansthtnugh deduction
Moderate stageA-D
Recentmemory loss
Itemote memoly preserved
Unawareof surroundings
Personaihygieneproblems
Agitation, wandering, obsessivesymptoms
Difficulty counting to 10
2, Preopetational Period (Age2-7)
Mild stageAD
Stage1: l?reconceptualStage
Difficulty choosingpropcr cft>thing
Bathes only with coaxing
Cannot subtract3 repeatedlystartingat 20
Stage2: Perceptual or Intuitive Stage
Early stage AD
3. Conuete Operational Stage (Age 7-U)
I)ecreased ability to pcrform in job
Incr:easeddifficulty in social interactions
f)eficit in mcmoty and c<>nccnftation
f)ifficulty with countins uo bv 7
Prcclinical
4. Formal Operational Stage (Age U+)
Nonnal forgctfulness- No impairment
Possiblesubjectiveworry about memory loss
Matteson,Linton & Banrcs (1
Functional Rettogenesis
The Frurctional AssessmentStaging (FAST) procedrlre descfibes 16 successivefunctional stagesand substagesofloss
of capacity(R-eisbetg,
1988).As the diseaseprogresses,indivtduals with AD lose the following sequence of abilities.
First, they lose theit ability to hold a job (FAST stage3), and
then become unable to manage their finances (FAST stage
4). They cannot selectappropdateclothing for the occasion
(FAST stage 5), put on clothes without he$ (FAST stage
6a), showet without help (FAST stage 6b), or toilet without
help (FAST stage 6c). They become unable to control theit
urine (FAST stage 6d) and their bowels (FAST stage6e). At
later stagesin the disease,they can <lnly speak only five to
six words (FAST stage7a), then just one word (FAST stage
7b). They have lost all other abilities and ate only able to
walk (FAST stage 7c), then simply sit up (FAST stage 7d),
anales de psicologla,
2006, vol. 22, n.2 (diciembre)
then only smile (FAST stage 7e), and finafiy only hold up
one's headwithout assistance(FAST stage7$.
It is readily ^pparcrrt tlat the FAST progression in revetse describes the capacities that an rnfant gains over the
course of human development. At one to three morrths,
helshe can hold up his,/het head without help. At rwo to
f<l:r months he/she can srnile.By six to ten months, he/she
can sit up. By one yerhe/she can walk and speakone word.
By 15 months, his/her vocabula(y grows to five to six
'words.At agetwo or three, he/she leams
to conftol his/her
bowels and, at age three to forx and ahalf, her urine. By age
four, he/she can toilet unaided and shower unaided. At age
five, he/she c4n dressherself. Betweenthe agesof five and
seven,shelearnsto selectthe proper clothes.At ageeight to
twelve, she begins to handle simple finances, and between
ages12 and 18 she holds het fi.rst job. The functional deterioration sequencedby a person with AD reversesthe order
of acquisition of the same functions in human deveiopment.
Iletrcgenesis theory in Alzheimer's disease: Eyidence and clinical implicotions
Each FAST stage can be heuustically translatedinto a
cortespondiflg developmental age (DA), or the age at which
each ability is acquired (Reisbetg et a/., 1998). Due to individual differences, tJrere is some vanability in the ptecise
tempotal and ordinal sequenceof acquisition of firnctional
abilities in children. Coincidentalln the variability in the loss
of these samefunctions in the person vith AD is of sirnilar
magnitude (Sclan& Reisberg 1,992).In addition, the time it
takes a child to acquire each ability or set of abilities is apptoximately the same amount of time needed for a person
with Alzheimer's diseaseto lose the same capacity(Reisberg
eta/.,2002).
The FAST was found to be strongly cotrelated with
othet measlres of dementia, such as the Mini-Mental State
Examination, however the final six to eight FAST stages
produced fl.oot effects using this measure(n"eisberg,1984).
Post-mortem examination of the btains of individuals with
AD showed that deterioration, as measuredby the FAST,
was stongly correlated with neruopathological changes,including hippocampalvolume loss, cell loss, and neurofibdllary changesS-eisberg 2002),
The Bdef Cognitive Ratirg Scale (BCRS) is another instrumefit that describessequencesof progtessivelossesi:n
Alzheimet's disease.Some of its subscalescan be ttanslated
into developmental ages (DA$, for example the geomettic
figute drawing and the food preparation and self-feeding
subscales(Reisberg 1998). Many emotional changesin AD
ate also explainable,in part, on the basisofthe corresponding DAs. Thus, if a developmental age can be obtained, that
DA can be used to anticipatethe loss of other abfities, as
well as identify general management needs and activity preferences.These AD-DA correspondenceshave been formd
to be valid despite clifferences between AD patients and infants in physical size,life history, societaland self expectations, concurrent morbidity, and other factors (Reisberg,
2002).
Neurologic Retrogenesis
Studies have shown that "pdrnitive reflexes" or "developmental reflexes" (such as the sucking teflex, the hand and
foot graspreflexes,the rooting reflex and the Babinski plantar extension reflex) that disappear in the fust few years of
life re-appearin people vrith advancedstageAlzheimer's disease.Interestingly, these reflexes appear to emerge at approximately the samepoint in the processof AD deterioration as might be anticipated by the cortesponding DA. For
example, Franssenand colleagues(1997) grouped AD patients according to their FAST stage score and then calculated the percentageof each gtoup manifesting one or more
of tlrese developmental reflexes. Less than 1,ohof the normal
or mildly impaired (FAST stages1-3) individuals were found
to have any of these reflexes, The developmental age at this
stage coffesponds to the period of adolescenceto adulthood in which the reflexes are oot rypically observed. Developmentalreflexeswere also uncommon (ess than 5%) tn
263
the mild to moderate AD gtoup (FAST stages4 - 5). In a
similar vein, these developmental teflexes are highly unlikely
to be observed in a gtoup of five- to twelve-year-old children. However, in the severestagesof A,lzheimer,sdisease
(FAST stages7a and 7b and stages 7c arLd7d), 85% and
97% of eachgtoup respectivelymanifest at least one developmental reflex. Notably, these are the developmental stages
in infancy of 12-15 months and newbom to 12 months in
which the sucking reflex, the hand and foot grasp reflexes,
the rooting reflex and the Babinski plantar efieflsion reflex
ate much mote likely to appear.
Neuropathologic Retrogenesis
In the study of bmin development, the disappearanceof
pdmitive reflexes in infants has been telated to the progressive myelination of neurons in the brain. The patteffi of
myelination in the pattem has also been related to the progtession of neuropathologiclossesobservedin Alzheimer's
disease.Specifi.cally,ateasof the brain that arc the last to be
myelinatedare the most vulnerableto death and decreased
glucosemetabolismin AD (McGee4 et a/.,1990). tsmak and
Braal<(L99L) studied neurofibdllar pathology and noted that
the stagesofchange in AD reversethe pattern and sequencing of myelination in normal development as measrued by
the Fleshing stages of progressive developmental myelination. Moreover, non-human primate tesearchin this areahas
even shown that cognitive decline in a Rhesus monkey is
conelated'nith increasedmyellr degeneration(Peters,et a/.,
1996). This fi"di*g is consistent vzith the theory of retrogenesisand suggestsa link between newopathologrcal detedoration in AD and progtessively wotsening cognitive and
functional abilities. These changes as a group ffien corespond to a specific developmental age.
Implications of Retrogenesis and DevelopmentalAge onAD Care
Hurnans of all ages have needs, including movement, socializa;t16r., love, and digfity. Unfortunately,
these firndamental needs are not always well understood in persons with
Alzheimer's disease. Accordin.g to the str:dies examined in
the ptevious sections, an understanding of the phenomenon
of retrogenesis can provide insight into a person's true developmental age. Armed with a DA for each individual with
Alzheimer's disease, a tehabilitation professional can engage
the person in developmentally appropdate tasks that foster a
sense of accomplishment and self-worth while maintaining
&gtuty. As the disease progresses, just like an infant, the person with AD needs continued love, praise, acceptance, and
opportunities for socialization. Even in the most severe
stages of the disease, individuals maintain the capacity to
remember, think, learn, and influence their environment
within the context of their developmental age. Thus the
amount and type of cate required for a petson with AD de-
anales de psicologla,
2006, vol. 22, n" 2 (dicicmbre)
264
Heather RogeN, and Jtan Catlos Arango Lasprilla
pends on his or her DA (R.eisbetg,at al., 1.999b)and the
kinds of activities enjoyed by a person with AD at a palitcular DA are miuored by the types of activities enjoyed by
children at the sameDA.
One caveatto note i.sthe lach of physicalreftogenesis.It
is possiblethat the physicalcapacities(e.g.,lacing butroning,
slipping oo clothing) of a person wirh AD at a particular de*
velopmental ^ge tL y exceedthose of DA-comparable childten. In addition, the grasp reflex can be mr.tchstronger in
the individual with AD as a consequenceof theit size and
strength compared to an infant, It is also impotant to recogntze thf those vrith AD have a longer attention span and
bettet concentration than infants or children at the correspondingDA (X"eisberg,
2002),
functional abilities.Jatott and Bmno (2003)used scoreson
the Nlini-Mental State Examination, a scale designed to assesscognitive function in dementia, to group individuals as
severe,modetately, or mddly impaired. They found that cogrutive rmpainaeflt was not prchlbitre of paticipation in
IGPs, provided that the activities were carefrrlly planned.
Those adults who parricipated were more likely to experience positive affect and engagein behaviors that supported
personhood (i.e.,eating, crafts, or sensorystimulation).The
researchersoote that high activity consistency and high frequency opportunities for participation rnay be especiallyimportant to individuals with dementia.
A few goups of researchershave recently begun to employ a vadety of Montessori-based activities for individuals
'Ihey
with dementia.
have found that, for the individuals
Findings ftom Intergenerational Ptogram In- with Alzheimer's disease,such activitiesincreasedconstructive (active engagement)and decreasedin problem behaviors
terventions
Iike agitation, aggressiveness,and withdrawal (|udge, Camp,
& Orsulic-Jeras,2000), as well as elicited gleater pleasure
Although some mufual benefits fot participants of intergenand lower levels of feat and anxiety (Orsulic-Jeras,Judge, &
etational programs (IGP$ have been identified, adults with
Camp, 2000), Camp and colleagues(1997) use Montessori
dementia ^re not often targeted to work with chil&en and
adolescents.Young preschool-agedchildren may even pose techniques within the context of an IGP for older adults
specialproblems in this type of program. Indeed, eady re- with dementia and preschool-aged children. All parricipants
searchby Seefeldt(1987)reported a negativeimpact on pre- were asked to perform Montessori tasks as baselinemeasschoolersafter their visit to a nrusing home; Short-DeGraff ures of cognitive, moto!, and sensory functioning. They
and Diamond (1996)concludedthat the cogrritivedisabilities were then scored on their ability to complete each activity
of oldet adults with dementia seem to prevent effective cotrectly with minimat cuing. All paticipants became familiar with Montessori-basedactivitiesand procedures beforeany
IGPs targetingthesetwo groups.
intergenerational
contact took place.
Griff and colleagues(1996)sought to deterrrine successEach
adult
was
then paired with a child who was not yet
fril and unsuccessfi;l IGP activities for preschool and elder.ly
at
the
adult's
ability
for specific activities. Older adults with
pairs who were either frail, livrng in the community or had
Alzheimer's disease.Unfortunateh the majority of the ac- dementiawere assignedto be the mentors. They practiced
presenting the activity with staff before teaching the lesson
tivities wete unsuccessfi.rl
fot the pteschool-AD dyads.The
researcherschoseto canceltheit secondcycleprogramrning, to the child. There were no instances of disengagementand
no aggtessive, disruptive, confused, ot anxious behavior
but there were a number of lessonsto be leamed. The unwhile
with the children. The stflrctwe of the activities was
successfirl activities required abilities that were beyond the
important to the successof this program. The older adult
developmental age of the individual with AD, i,e. blowing
with dementia did not have to temember the task that was
bubbles.Thesetasksresultedin frustration and distress.The
children becameconfusedand upset by the behaviorsof the taking place. The materials on dle table served as extetnal
older adults with AD. Moreover, becauseof the mismatch memory aids to see what steps had been completed. This
between older adult and preschooler developmental ages, form of extemal compensation fot memory and executive
the aclultswith AD did not have to follow the samerules as fi.rnctioning deficits allowed the older adults to use tleir
abilitiesthat remainedin tact, such as ,o6lal slcillsand longthe children and this double standard caused additional
problems. On the other hand, the successfulactivitieswere term memoties, to guide their interaction vrith the preschoolers.
developmentally appropnate and included tashs that relied
on long-term memory (which is pteserved until very late in
Conclusions and Future Directions
the progressionof AD), movemerit,and music.
Floweve{, positive effects of IGPs for older adults with
This reseatch offers numerous recofirmendations for the de*
dementia and preschoolershave also been reported. Newvelopment and evaluation of futute intetgenerational proman and Wald (1992-1993)found that older adults with
charactedsticsof dementia in a day cate service increased gtams. Fot example, the results from Camp and colleagues
(1997) could be due to the implementation of Montessori
their positive behaviots while childten were present in an
intergenetational music program. Mote recent studies have techniques (as found in ptevious studies). Reseatchers must
begun to use assessmenttools to classi$rparticipants,espe- determine the unique impact of a preschooler mentoring
cially older adults with AD, based on theit cognitive and ptogram on the behavior and cogrrition of older adults with
Alzheimet s disease, especially in the long temr. Secondatily,
anales de paicologia,2006,
vol. 22, n" 2 (diciembre)
l?etrogenesistheory in Alzheimer'sdisease:Evidenceand clinicql int)lications
the consequeflcesfor the preschoolersshould also be measured. Accordiog to their scores on the FAST, youth rilith
developmental ages ranging from age one to six should be
paked with older adults of higher developmental ages.Activitres should be developmentally appropriate and incorporate movement, music, crafts, and games.Fot example,for a
DA of one to two, the pair ot group could play kick ball ot
balloon volleyball and engagein activities that tap into all of
the senses.At DA two to four, the pair could engagein sorting tasks, simple courrting activities, and sing songswith accofnpanFng motions. At older DAs, the pairs can complete
crafts togetherand read books to eachother. Besideschanging the method of evaluating functional and cognitive capacify, additional outcomes should be measuted in both the
older adults and the preschool children. Self-report and
*ritd-party evaluation of behaviot and cognition change (ot
maintenance) both during and outside of the IGP must be
'fhe
recotded.
young children and older adults should be
famitar with the activities before any intergenerational contact and the same g{oups should meet frequently (i.e., at
least two times a week) in ordet to foster the development
of closepersonalrelationships.
These recommendationsare based on the evidencefot
the rettogenesisphenomenon supported in this paper and
can only be effective if the participants are appropriately
paired based on their developmental age.Wirh careful planning and implernentation of evidence-basedtreatment practices such as this one, positive consequencescan be expected for behavior and cogrrition, including a reduction in
the speed of decline. Knowledge of such outcomes would
add to the presentliterature on the effects of IGPs and em-
265
phasize the clinical importance of teftogenesis and determining cotrespondingdevelopmentalages.
The ,{.medcan Health Care Association teports that
67%-77% of the 1.5 million Amedcans residing in nutsing
homes in the United States ate suffeting ftom dementia
(Jfarchol, 2004).As peoplelive longer and the proportion of
older people contfuiues to grow, only an effective pharmacological teatmest will stop the diseaseprocess.However,
until a cure is found, it must be remembered that individuals
with Alzheimefs diseaseare people too, even in the severe
stages of the disease. Ihere are many things that suffers
ft'om AD are still able to do, and the implementation of
programs based on cuffent (esearchcarr serve to temind
them and their caregivers of that regardlessof the stage of
the disease,suffers retain their own personhood.Evidencebasedrehabilitation activities such as those descdbedin this
paper are expected to enhance the quality of life of these individuals with dementi^ and h^ve a beneficial impact on
ftrnctioning. Although the retorgenesis theory may not be
stricfly true in all cases,it is a framework that may be helpful
to developmentalpsychologists,neuropsychologists,occupational therapists,physical thetapists, speech therapists and
social workets and othet rehabilitation orofessionals to examine the qualitative nature of the changes taking place in
patient$ with AD. As an intetdisciplinary team, these professionals are the ones who will be asked to design meaningfi.rl
activities that are structured to accomrnodate the cognitive
deficits seen irr those udth dementia while taking advantage
of the abilities that remain pteserved in order to foster a
senseof pride and personalwell-being,and possiblyprevent
fulther cognitive and fi.rnctional decline (Arango, Femandez
& Ardila, 2003).
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