Dementia and Occupational Therapy Guide

This article will introduce you to the many ways occupational therapy can help people living with dementia. 

No matter what stage of dementia you—or your family member—are in, there are things you can do to improve your quality of life. And, occupational therapy professionals are trained to come alongside you and help you make a plan that is right for you and your family.

What is dementia?

Dementia is the progressive loss of cognitive functions such as memory, safety awareness, reasoning, and judgment.

Dementia can be caused by many different conditions or diseases. Some of the most common types of dementia are Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. Some people may have more than one type of dementia, a condition known as mixed dementia. We’ll discuss considerations for OT and different types of dementia below.

Identifying early cognitive decline

Dementia does not appear overnight. Changes in thinking usually show up in everyday activities years before anyone receives a diagnosis, and occupational therapy practitioners are often the first professionals in a position to notice them. We cover identifying early cognitive decline and OT's role in addressing risk factors in depth in our episode, Risk Factors for Cognitive Decline with Ganesh Babulal. The next two sections the main takeaways:

Normal aging vs. something more

Some slowing is a normal part of aging. We may take longer to respond, forget a name at a party, or misplace our keys. The key difference is that with normal aging, new learning still happens without trouble. When new learning becomes disrupted and daily tasks start to break down, it’s time to look closer.

The stages of cognitive decline

On our podcast, Ganesh Babulal, an OT and professor of neurology at the Mayo Clinic, described the stages of Alzheimer’s disease, the most common cause of dementia, this way:

• Preclinical. The person is cognitively normal, but proteins (beta amyloid and tau) have begun to build up in the brain. Everyday activities may become slightly less efficient. This stage can last 15 to 20 years, so someone diagnosed at 65 may have had changes starting in their late 40s or early 50s.

• Mild cognitive impairment (MCI). Changes are now measurable. Basic self-care (ADLs) is usually intact, but instrumental activities like managing finances, medications, and driving start to take a hit. Family members often notice before the person does. MCI does not always progress to dementia.

• Mild dementia. Roughly two years. The person needs moderate to significant help with IADLs and can still do most ADLs.

• Moderate dementia. Roughly two to four years. ADLs are significantly affected and become the focus of care.

• Severe dementia. Roughly one to two years. Maximum assistance is needed for both ADLs and IADLs.

Function changes first

Cognitive screens like the SLUMS, MoCA, and MMSE are useful, but they are snapshots. They tell you how someone is doing on paper, at that moment, in one cognitive domain. They don’t show what the person was like a year ago or how they are managing real tasks at home.

IADLs are the canary in the coal mine. These are highly over-learned but complex activities, so small disruptions in the brain show up there first. Watch for changes in:

• Driving: no longer driving at night, avoiding the highway, driving only outside rush hour, or taking a different route than usual

• Medication management

• Meal preparation and cooking

• Managing finances

Because we observe people doing real activities, OT practitioners often catch these changes before colleagues who are only having short conversations with the patient. Watching someone sequence through a task, crack an egg, or choose clothing for the weather gives you data a paper-and-pencil test can’t.

A word about acute care

In the hospital, cognition often takes a dip. The person is out of their natural environment, may be ill, and may not want to be there. Take a baseline, then reassess over time to see whether they return to their pre-hospitalization level. One low score in acute care is not a diagnosis.

Rule out what’s treatable

Several conditions can mimic or worsen cognitive decline in the early statges, and many of them are treatable:

• Depression. Depression can look like cognitive impairment, and it is also a risk factor for dementia. A quick, free screen like the PHQ-2 or PHQ-9 fits easily into a session.

• Sleep. During sleep, the brain clears the toxic proteins that build up during the day. Sleep apnea, insomnia, and other sleep disorders disrupt this process and can impair daily function even in people with no dementia.

• Medications. Opioids and drug-drug interactions from polypharmacy can impair thinking. A medication review is worth requesting.

• Other neurological conditions, such as traumatic brain injury and seizures.

OT’s role in addressing risk factors and building protective factors

A cognitive change, or even a diagnosis of MCI or Alzheimer’s disease, is not a sentence. The 2024 Lancet Commission on dementia prevention, intervention, and care estimates that about 45% of dementia cases could be prevented or delayed by addressing 14 modifiable risk factors across the lifespan. Many of those factors sit squarely within an OT’s scope.

The 14 modifiable risk factors

• Early life: less education

• Midlife: hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use

• Later life: social isolation, air pollution, vision loss

Source: Livingston G, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 2024. Commission page · Risk factor infographic

Risk factors are protective factors, too

Think of each factor as a spectrum. Depending on where a person sits, the same factor is either adding risk or adding protection. Ganesh suggested treating this like a report card: show the client where they are on each one, and let them choose where to start.

In practice, that conversation might sound like: “Here are the 14 factors. Is there one that stands out to you that we could work on? Let’s talk about your hearing. Is there anything getting in the way of a hearing test that I can help with?”

Starting with one factor the client cares about keeps the plan realistic and keeps the client in the driver’s seat.

Personal-level factors OTs can address

• Hearing and vision. We are not audiologists, but we can screen, start the conversation, and refer. Men are especially slow to adopt hearing aids, so this conversation often needs to happen more than once.

• Sleep. Ask about sleep quality, snoring, and daytime fatigue. Refer for evaluation of sleep apnea or insomnia, and address the bedroom environment (see below).

• Physical activity. Build movement into the daily routine in a way that fits the person’s environment and abilities.

• Depression. Screen, treat what is within scope, and refer.

• Medications. Request a medication review when polypharmacy or sedating medications are in play.

• Diet, smoking, alcohol, and chronic conditions like diabetes and hypertension. Support habits and routines, and coordinate with the medical team.

Environmental factors: the exposome

The exposome is the total of everything a person has been exposed to over their lifetime: the air they breathe, the noise and light around them, the green space and walkability of their neighborhood, and their social environment, including poverty, isolation, and discrimination. This will sound familiar to OTs. It is the environment piece of the PEOP, KAWA, and other models we already use.

Research on the exposome and brain health is growing quickly. A few findings Ganesh shared, including from his lab’s 2025 study in Alzheimer’s & Dementia (Li K, et al.; open access via PubMed Central):

• Fine particulate air pollution (PM2.5) and nitrogen oxides can cross the blood-brain barrier and are linked to inflammation and higher dementia risk.

• In his lab’s study of older adults with and without preclinical Alzheimer’s disease, living in more walkable areas and areas with more green space was associated with better cognitive function, while greater light pollution was associated with poorer cognitive function.

• Noise and light pollution disrupt sleep, which in turn affects daily function.

• Chronic stress and conflict are linked to neuroinflammation and higher dementia risk.

These studies show associations, not causation, so apply them with that in mind. But they point to practical, low-threat places to start, and talking about the environment often feels less like personal blame than talking about weight or diet.

What OTs can do about the environment

• Expand the home evaluation to the neighborhood. Beyond throw rugs and trip hazards, ask: How often do you go for walks? Do you feel safe in your neighborhood? How close is the nearest park or green space? Do you have transportation to get there?

• Measure what you can. Most smartphones and smartwatches can measure ambient noise in decibels. Use them to check the bedroom and other living spaces.

• Modify the bedroom for sleep. Blackout curtains, reduced noise, and a consistent routine are inexpensive changes that support restorative sleep.

• Build social support. Social connection buffers the effects of a less-than-ideal environment. Help the client strengthen their network and find community participation that is meaningful to them.

• Use available data. Tools like the Area Deprivation Index let you look up the level of disadvantage in a client’s neighborhood by address. Public data on air quality, light pollution, and noise is increasingly available, too.

So far we’ve focused on spotting early changes and lowering risk. Now let’s turn to occupational therapy for people who are living with dementia. And as soon as we do, we need to start talking about care partners.

Who are care partners?

When we discuss OT and dementia, we have to emphasize something important:

1. OT professionals work with people living with dementia AND their care partners.

2. “Care partners” is a newer term for “caregivers.” We typically refer to care partners as being either “informal” or “formal.”

Examples of Informal Care Partners:

• Family members (e.g., spouses, partners, children, or siblings)

• Friends

• Neighbors

Examples of Formal Care Partners:

• Non-medical home care

• Staff in skilled nursing facilities, assisted living facilities, or memory care communities

• Adult day program staff

• Home healthcare professionals

One encouraging development: with the caregiver training CPT codes introduced in 2024, OT practitioners can now bill for training care partners directly, even when the person living with dementia is not present. We cover these codes in depth in our course Caregiver Training Codes.

How can OT help someone living with dementia?

Occupational therapy (OT) plays a crucial role in helping people living with dementia (PLWD) to maintain or enhance their:

• participation in daily activities,

• safety, and

• quality of life.

Occupational therapy practitioners also play an important role in supporting care partners of PLWD.

We collaborate with care partners of PLWD by: 

• providing education and training to adapt tasks,

• adjusting care partner communication,

• modifying environments, and

• maximizing meaningful activity participation.

Part of our goal in these collaborations is to reduce dementia-related behaviors, decrease care partner burden, and improve safety and quality of life for people living with dementia.

When we work with PLWD, we use a habilitative approach.

Habilitation focuses on promoting a client’s current participation, function, and/or performance. This is achieved by enhancing an individual’s preserved capabilities. OTs who take a habilitative approach focus on the dyad, or team, which includes both the PLWD and their care partners.

By contrast, a rehabilitative approach focuses on restoring lost function and typically only addresses the “patient,” which often is not appropriate for dementia care.

How to find an OT who works with dementia

When searching for an OT professional who has experience working with PLWD, it’s important to verify the following prior to starting care. You can usually find this information on a company’s website, but if not, you can call the company to ask.

Questions to ask when seeking an OT professional can include: 

1. Do they have experience working with PLWD?

2. Do they focus on the care partner as well as the patient?

3. Has the professional taken additional courses or certifications specific to dementia?

Here are some websites that may help you in your search: 

• Dementia Society of America’s provider database

• Skills2Care Certified OT professional search

You can also search within the OT Directory to find OT professionals who have tagged dementia care as a focus area. 

Common OT screens and assessments for people living with dementia

The occupational therapist will conduct an initial evaluation to assess the individual’s strengths and limitations in daily tasks, which helps identify areas requiring assistance or support.

Through the use of standardized assessments and clinical observations, the OT will gain insight into the individual’s level of cognition, physical abilities, and environmental factors that may contribute to their functional impairments. They will also ask the care partner questions to identify their priorities and concerns.

This information will guide the development of an individualized plan of care. Here are some examples of the screens or assessments that occupational therapists may administer during their sessions.

You can find links to all of our assessments on our OT Assessment Search. 

Cognitive Screens/Assessments:

• Allen Cognitive Level Screen

• Saint Louis University Mental Status Examination (SLUMS)

• Mini Mental State Examination (MMSE)

• Montreal Cognitive Assessment (MoCA)

Depression Screens:

• Patient Health Questionnaire - 2 (PHQ2)

• Patient Health Questionnaire (PHQ-9)

• Geriatric Depression Scale (GDS)

Pain:

• Pain Assessment in Advanced Dementia Scale (PAINAD)

Quality of Life:

• Quality of Life in Alzheimer's Disease (QoL-AD)

Behavior:

• Skills2Care® Caregiver Assessment of Management Problems (CAMP)

• Neuropsychiatric Inventory Questionnaire (NPI-Q)

Social Behavior/Comportment:

• Comportment Scale

Care Partner:

• AD8 Dementia Screening Interview

• Perceived Change Index (PCI)

• Modified Caregiver Strain Index (MCSI)

• Zarit Burden Interview

• Functional Capacity Card Sort (FCCS)

Home Safety:

• Home Environmental Assessment Protocol (HEAP)

OT treatments for someone living with dementia

Below are common OT treatments for people living with dementia. I’ll give examples of each intervention.

Care partner education and training

Care partner involvement is a critical element of occupational therapy intervention for those living with dementia. Individuals living with dementia likely will be unable to independently initiate or use strategies that are recommended to them during sessions; therefore, it’s important that the care partner is an active participant in the sessions and that they are able and willing to implement the recommended strategies.

Example:

A woman living with dementia becomes agitated when her husband tries to help her dress in the morning, stating, “I know how to get dressed!” She is often found wearing multiple layers of clothing.

Environmental Modification

Environmental modifications can reduce dementia-related behaviors, increase participation in an occupation, and improve client safety. These changes can be small and inexpensive, although some modifications may be more substantial.

Example: 

We may place curtains over sections of the individual’s closet to prevent her from engaging with multiple outfits.

Task Adaptation

This involves making changes to the way tasks or activities are set up—or to the items used during a task.

Example:

If the client typically dresses in the bathroom, ask her husband to place an outfit in the bathroom the night before.

Adjusting Communication

This includes modifying the words that care partners say to the PLWD, while also considering tone of voice and body language.

Example: 

Encourage the husband to avoid saying, “You need to get dressed.” This might be triggering the client’s agitation, and the phrasing might be too abstract. Instead, ask the husband to hand the client one item of clothing at a time or to try using simpler, clearer instructions such as, “Put the sock on your foot.”

Promoting Activity Participation

There is a wealth of research that shows the benefits of improving activity participation for PLWD. Engaging in meaningful activities can reduce dementia-related behaviors and improve quality of life for both the PLWD and their care partner. These activities may include sensory stimulation, physical activity, cognitively stimulating activities, leisure activities, or social engagement.

Example:

Consider asking the husband to play calming or relaxing music before, during, or after the dressing task to reduce agitation.

Evidence-based intervention programs:

As occupational therapists, we always strive to follow the best available evidence. This can mean using individual interventions that have a strong research base behind them. But, there are also entire programs that have been well researched. These include:

• Skills₂Care^® 

  • Skills₂Care^® is an evidence-based intervention that has been developed in collaboration with people living with dementia, their families, and OT professionals. Skills₂Care^® aims to improve the communication, interaction, and engagement of people living with dementia through care partner involvement. The program includes the development of personalized action plans, education for care partners, and the implementation of a “taking care of self” protocol for care partners. Studies have shown that Skills₂Care^® can reduce dementia-related behavior, enhance participation, and reduce care partner burden.

• Care of Older Persons in the Environment (COPE)

  • People living with dementia often have difficulty performing daily activities such as bathing, dressing, and meal preparation. COPE is a program that focuses on the modification of the environment to improve the performance of daily activities. COPE incorporates home visits by OT professionals, identification of environmental barriers, development of a personalized plan, and installation of adaptive equipment. Studies have shown that COPE improves the performance of daily activities and reduces caregiver burden.

• Tailored Activity Program (TAP)

  • The tailored activity program (TAP) is an individualized approach to promoting engagement in meaningful activities for people with dementia. TAP involves the identification of a person’s interests, abilities, and preferences, and the development of a personalized activity plan. This program includes both cognitive and physical activities and can be done in groups or individually. Research has shown that TAP improves quality of life and reduces behavioral symptoms in people with dementia.

Other dementia care programs can be found here.

Considerations for OT and different types of Dementia

While dementia manifests differently in each client, there are some defining characteristics for various types of dementia that require special consideration. Of course, occupational therapy practitioners will maintain a client-centered approach regardless of diagnosis.

• Alzheimer’s disease (AD)

  • Typically progresses as slow gradual decline.

  • Most educational resources available to the public are geared toward AD.

    • Early onset AD:

      • Alzheimer’s disease onset before age 65; clients are typically in their 40s and 50s.

      • Most clients do not have physical impairment.

      • Younger clients may still be working, raising children, etc.

      • Care partners may be especially overwhelmed financially and emotionally.

        • We often hear things like “we had plans for our retirement that will never happen,” which illustrates the many aspects of grief that care partners are experiencing.

      • These clients may not feel as though they “fit in” at local adult day programs, memory care communities, etc. This requires a creative approach to support care partners with respite while maintaining client dignity.

• Vascular dementia

  • Onset may be gradual or may appear as a sharp decline in cognition and functioning following a stroke, though not all cases of vascular dementia are caused by strokes.

• Dementia with Lewy bodies (DLB)

  • Typically presents as cognitive symptoms first with increased motor symptoms as the disease progresses. These motor symptoms will present similar to Parkinson’s disease (e.g., shuffling gait or decreased amplitude of movement).

  • These clients commonly present with fluctuating functional cognition. This can be particularly challenging for care partners, because a strategy that is effective for them one day (or one hour) may not be as effective the next day or even later the same day.

• Frontotemporal dementia (FTD)

  • Often involves an earlier onset, with more than half of those with FTD displaying symptoms prior to age 65.

  • Many of the considerations for FTD are similar to those for early onset AD.

  • Impulsivity is often a big concern. This may include gambling, shopping, being scammed via phone and email, leaving the home unexpectedly, etc.

• Parkinson’s disease (PD) dementia

  • Typically presents as motor symptoms first with cognitive symptoms appearing later in the disease progression.

  • Similar to DLB, fluctuating functional cognition can be challenging for care partners to manage.

• Posterior cortical atrophy (PCA)

  • Sometimes classified as a subtype of Alzheimer’s disease, this condition manifests first as visual impairment. Occupational therapy practitioners may approach these clients similar to how they approach clients with low vision; however, it’s also important to consider that depending on their level of cognitive function, the PLWD may not be able to learn new information.

  • It’s crucial to involve the care partner and educate them on how they can support the PLWD.

• Primary progressive aphasia (PPA)

  • Typically presents as expressive aphasia first and impacts other cognitive functions as disease progresses.

  • Sometimes classified as a type of AD.

• Creuzfeldt-Jakob disease

  • Typically comes with an early onset and progresses very rapidly.

  • It’s important to prepare the family for making changes quickly throughout disease progression.

While it may be helpful to know the diagnosis or cause of dementia and to consider the information above, many times PLWD do not get a formal diagnosis. There are benefits and downsides to a formal diagnosis (e.g., not putting the PLWD through hours of potentially stressful testing).

Regardless of the diagnosis, it’s important for the occupational therapy practitioner to collaborate with the care partners and healthcare team to find the root causes or triggers of any challenges identified by the care partner and the patient. 

Resources related to OT and dementia

There are many national organizations that have resources for families and healthcare professionals working with someone living with dementia:

• Dementia Society of America

• Alzheimer’s Association

• The Association for Frontotemporal Degeneration

• Lewy Body Dementia Association

For occupational therapists looking for more support in dementia care, check out the following resources:

• The Dementia Collaborative

  • Skills2Care® training/certification

  • Dementia Squad: OT professionals who meet bi-monthly to host guest speakers, discuss common challenges in dementia care, and offer support

• The Crisis Prevention Institute 

Conclusion

Caring for someone living with dementia can be difficult and overwhelming at times, and occupational therapy practitioners can help reduce some of this burden for care partners. Occupational therapy practitioners play an essential role in the care of PLWD by providing client and family-centered interventions that enhance participation, safety, and quality of life for both the PLWD and their care partner.

We’ll close with a quote from one of Rachel’s clients, which she shared because it captures what this work can mean for a family:

“My dad...lived with dementia for nearly ten years before passing away in November. He lived well—with dignity and humor—directly due to the [occupational therapy] services my family received...The burden on our family, specifically on my mom, was lifted considerably once we started working with [our occupational therapist]...High quality of life with dementia is achievable, both for the diagnosed and for their caregivers, with expert-level support...Their interventions are game-changers and have the potential to turn dementia from a death sentence into a manageable chronic disease.”