Abstract
Dementia or cognitive impairment has been considered as an obstacle of performing rehabilitation for such patients and considered as non-indication. However, recent increase of the number of patients forced us to decide the indication based on the evidences. For patients with Alzheimer's disease, the use of choline-esterase inhibitors as anti-dementia drugs is necessary and background of rehabilitation. Relatively high grade evidence was reported by reality orientation with reminiscence approach ; this also indicated the maximum effect of the drugs, not simply attributed to the three-point increase by the Mini-Mental State Examination scores. Regarding patients with vascular dementia, the management of vascular risk factors and the use of drugs for secondary prevention of stroke are essential and background. I herein present a case with learning disability as gait training, a case with severe aphasia but responded to music therapy, together with the research data with improved activities of daily livings by comprehensive approach through motor and psychosocial interventions, and the Alzheimer vs vascular dementia difference by the sequential use of tool use task. A further investigation on the indication of rehabilitation would be hopefully stimulated. Through this rehabilitation approach for a patient, I hope we as medical practitioners can together produce evidence of rehabilitation for dementia, not falling into therapeutic nihilism, but by unifying already established evidence and findings for individual patients, by a bio-psycho-socio-spiritual approach.
