**4. Reminiscence therapy**

Initially, reminiscence was developed for elderly people with normal aging to offer them a chance to remember and organize the most significant events in their lives [66]. However, the idea of using reminiscence therapy in people with dementia was introduced in 1979 [67].

Reminiscence, defined by Webster [68] as "the present recall and interpretation of life events experienced at some time in the past, generally in the distant past", is a way of maintaining the personal past and perpetuating the person's identity. It is a very complete technique because it uses stimulation, communication, socialization, and entertainment [69]. In addition, reminiscence involves the systematic recall of old memories: recalling personal events in all their depth, noises, smells, images, emotions, as a way of activating the personal past [70]. Thus, reminiscence can be described as the organized and systematic use of memories and recollections to awaken or strengthen identity and self-esteem.

Some definitions of reminiscence refer to recalling personally important memories from the past, a selective process in which the memories are events in the life of a person or group of people [71]. It is an organized, complex mental activity with an important purpose: to reawa‐ ken or strengthen identity and self-esteem, recoding them in scenarios and scenes, people, events, traumas, and topics based on autobiographical memory [72].

The definition of reminiscence in the field of dementias frequently appears in the literature and offers a more detailed description of the processes that intervene in it [73]. Reminiscence therapy includes the discussion of past activities, experiences, and events with another person or group of people, generally with the help of eliciting stimuli or indications [73].

Reminiscence has been shown to be a useful intervention in interdisciplinary work between the neuropsychologist and gerontologist, due to its low cost and because it allows the psy‐ chostimulation mainly of the language and memory functions. It establishes connections between the past, present, and future person, promoting sociability and openness to interper‐ sonal relationships, confirming a sense of identity, and reinforcing feelings of self-esteem, personal worth, coherence, and continuity [74]. This intervention has commonly been used in people with cognitive impairment [75]. In fact, some authors [74, 76] show that people with dementia can benefit from this intervention to foment and/or strengthen their current rela‐ tionships and maintain them over time, and protect themselves from isolation and withdrawal. In addition, others indicate an improvement in cognition, mood, and behavior in general, and a reduction in caregiver stress [73].

Before explaining the process of holding a reminiscence session for people with dementia and the benefits of doing so, it should be mentioned that Wong and Watt described six types of reminiscence [77], and in 2007 Cappeliez et al. [78] added two others, finally yielding eight types of reminiscence, defined in **Table 1**.


**Table 1.** Types of reminiscence.

the past, imagining the personal future, and maintaining one's self-identity [65]. In fact, the semantic AM supports the knowledge about personal traits, roles, thoughts, and beliefs, aspects related to self-referential thinking, which is highly conceptual and independent from the medial temporal lobe [65]. Therefore, semantic AM, which is relatively preserved in the initial and moderate stages of AD, can be used as an aid to improve self-identity and self-

The objective of the clinical rehabilitation of the AM in AD is to recover, as much as possible, the inaccessible memories, or at least maintain the "pool" of autobiographical memories that are still available. There are different therapeutic strategies, one of which is reminiscence

This therapy focuses on the conscious recall of personal memories from one's life in order to report, think about, tell, or show something about our experiences from the past. Reminiscence was originally proposed by Butler [66], who has promoted it as a tool to improve well-being and reduce depressive symptoms in older adults. Since then, reminiscence has been widely

Initially, reminiscence was developed for elderly people with normal aging to offer them a chance to remember and organize the most significant events in their lives [66]. However, the idea of using reminiscence therapy in people with dementia was introduced in 1979 [67].

Reminiscence, defined by Webster [68] as "the present recall and interpretation of life events experienced at some time in the past, generally in the distant past", is a way of maintaining the personal past and perpetuating the person's identity. It is a very complete technique because it uses stimulation, communication, socialization, and entertainment [69]. In addition, reminiscence involves the systematic recall of old memories: recalling personal events in all their depth, noises, smells, images, emotions, as a way of activating the personal past [70]. Thus, reminiscence can be described as the organized and systematic use of memories and

Some definitions of reminiscence refer to recalling personally important memories from the past, a selective process in which the memories are events in the life of a person or group of people [71]. It is an organized, complex mental activity with an important purpose: to reawa‐ ken or strengthen identity and self-esteem, recoding them in scenarios and scenes, people,

The definition of reminiscence in the field of dementias frequently appears in the literature and offers a more detailed description of the processes that intervene in it [73]. Reminiscence therapy includes the discussion of past activities, experiences, and events with another person

or group of people, generally with the help of eliciting stimuli or indications [73].

applied in cognitive rehabilitation in aging, including in pathologies like AD.

recollections to awaken or strengthen identity and self-esteem.

events, traumas, and topics based on autobiographical memory [72].

continuity, and to develop the self-referential cognition strategy.

therapy.

456 Update on Dementia

**4. Reminiscence therapy**

**3.6. Clinical rehabilitation of the autobiographical memory in AD**

These eight types of reminiscence have been grouped in an integrated model through a triadic system [79] (see **Figure 2**). Therefore, the eight types of reminiscence are divided into three specific functions: the *self*, reminiscences of an interpersonal nature that seek coherence and meaning; *orientation*, in terms of recalling and sharing personal knowledge and experiences; and *social connectedness*, providing the basic elements for maintaining relationships, with an interpersonal and continuity nature, and proposing emotion management as a basic charac‐ teristic. Although the first two functions mainly refer to coping and the orientation, other authors point out that both involve the reactivation and strengthening of a feeling of personal competence or self-efficacy [79]. Therefore, there is a degree of overlapping between the function of guide and the *self*, especially in integrative reminiscence.

**Figure 2.** Triadic reminiscence system.

Using reminiscence with people with dementia is not the same as using this type of interven‐ tion with people who have no cognitive pathologies. It is necessary to make a series of changes or modifications [80]. The objectives of the sessions have to be flexible enough to adapt them to the participants and their cognitive ability. The materials used should be as close as possible to the participants to facilitate the evocation of the memory. The groups must be small, and the cognitive performance of the participants should be taken into account. It is important to obtain the participation of family members in preparing the sessions, or they can even participate in them. In this way, there is better knowledge about the participants' personal information, and they can refer to their own biography during the sessions and provide support when necessary. It is advisable and important to refrain from correcting memories that diverge from reality, as the main objective of the activity must be the emotional validation of the orientation, and not of the memory itself.

The intervention must be directed by a psychologist or professional trained in carrying out these types of programs. Normally, it will consist of 10 or 15 sessions lasting 60 min each, with one session per week. In each session, all the life stages will be worked on (childhood, youth, adulthood, and old age) through a specific topic. All the sessions must follow the same structure: at the beginning, the members of the group are welcomed and told what topic will be addressed. After that, two activities are performed using specific stimuli (music, images, objects, etc.) to evoke their memories and sayings and quotations related to the topic of the session. In both cases, participants perform a free-association exercise that consists of saying or writing the first word or expression the stimulus brings to mind; then open questions are formulated to facilitate the emergence of positive personal memories; finally, participants try to connect these memories with the present [81].

competence or self-efficacy [79]. Therefore, there is a degree of overlapping between the

Using reminiscence with people with dementia is not the same as using this type of interven‐ tion with people who have no cognitive pathologies. It is necessary to make a series of changes or modifications [80]. The objectives of the sessions have to be flexible enough to adapt them to the participants and their cognitive ability. The materials used should be as close as possible to the participants to facilitate the evocation of the memory. The groups must be small, and the cognitive performance of the participants should be taken into account. It is important to obtain the participation of family members in preparing the sessions, or they can even participate in them. In this way, there is better knowledge about the participants' personal information, and they can refer to their own biography during the sessions and provide support when necessary. It is advisable and important to refrain from correcting memories that diverge from reality, as the main objective of the activity must be the emotional validation

The intervention must be directed by a psychologist or professional trained in carrying out these types of programs. Normally, it will consist of 10 or 15 sessions lasting 60 min each, with one session per week. In each session, all the life stages will be worked on (childhood, youth, adulthood, and old age) through a specific topic. All the sessions must follow the same structure: at the beginning, the members of the group are welcomed and told what topic will be addressed. After that, two activities are performed using specific stimuli (music, images,

function of guide and the *self*, especially in integrative reminiscence.

**Figure 2.** Triadic reminiscence system.

458 Update on Dementia

of the orientation, and not of the memory itself.

With regard to the results obtained from reminiscence therapy in people with dementia, various studies have shown their efficacy and effectiveness, especially in improving mood and reducing depressive symptoms, increasing life satisfaction, and reducing agitation behaviors [75, 82–85].

In the case of depressive symptomatology and self-esteem, some studies reveal the effective‐ ness of this type of therapy [86–91]. This therapy has been shown to have the main consequence of reducing depressive symptomatology, reducing feelings of desperation and loneliness, and increasing positive mood state. Moreover, if we take into account the relationship between this type of therapy and positive psychology, some authors [92] indicate that one of the most characteristic facets of reminiscence is its capacity to transform negative events into good results, as the intervention fosters the positive reevaluation of less favorable situations for the participants. Thus, the use of this type of intervention leads to positive results in improving the life satisfaction of people who participate in reminiscence sessions [83, 93, 94].

In addition to the improvement in mood, an increase has also been found in some of the dimensions of psychological well-being, self-acceptance, positive relations with others, autonomy, and control over the environment [71, 81, 87, 95, 96].

As described above, Alzheimer-type dementia is produced as a characteristic of the loss of consciousness of the self. Therefore, the increase in or maintenance of the self-acceptance dimension, as shown in the studies highlighted, could slow down the appearance of depend‐ ence in the person with this pathology and play a large role in the reconstruction of the self, approaching the idea of integrity developed by Erikson [97]. Regarding the dimension of positive relationships with others, authors highlight that there is an active interaction among the members of the group, making this therapy a stimulating, happy and integrating activity and establishing a connection among the participants that creates positive relationships [98]. This quality is achieved through the narrative contributions made by the group members throughout the sessions, as they help people with greater cognitive impairment and difficulty in evoking their memories to be able, for a few moments, to glimpse in their memory some hint of their past or a similar situation experienced and share it with the other members of the group. Finally, the application of this type of therapy has increased their independent thinking, the feeling of control and competence in managing the environment they deal with in daily life, and their ability to choose and create contexts adapted to their own needs.

With regard to the results obtained on autobiographical memory after reminiscence interven‐ tion and life review procedure, results suggest that people with dementia who attend remi‐ niscence sessions improve their autobiographical memory [85, 99, 100], being observed improvements in recalling both facts and events, that is, in semantic memory and episodic memory.

Numerous studies [85, 101–103] have shown the benefits of this therapy, observing that elderly people with AD who had participated in a reminiscence program, compared to a control group that did not participate, showed an improvement in the amount of autobiographical memory, specifically semantic AM.

Therefore, reminiscence therapy is a useful intervention that has many benefits for both the healthy population and people with cognitive impairment. Specifically in the AD population, positive effects have been observed at the emotional, cognitive, and psychosocial levels.

However, and on the emotional plane, in addition to the changes mentioned, there is a broad range of emotional or psychological and behavioral impairment in AD that has to be treated in order to improve the quality of life of the patient and his/her family context.
