Research has shown that interventions designed to provide a wide variety of stimuli can have a significant and positive impact on individuals with Alzheimer’s disease and other cognitive impairments. Additional research also supports multimodal approaches as being the most beneficial in both cognitive and social enhancement.
One multimodal intervention, known as Therapeutic Thematic Arts Programming for Older Adults Method (TTAP Method), is an art/recreation group therapy process that engages creative recreation activity within a nine-step structure. The TTAP Method has been shown, in some cases, to inhibit and slow the progression of mild cognitive impairment and Alzheimer’s disease. It has also been shown to slow the deterioration process of those already diagnosed with Alzheimer’s disease.
The TTAP Method has been researched in more than 11 studies in the United States, while further research out of Finland also supports it.

Meeting Social Needs

The use of thematic approaches maximizes interaction among participants of all cultures, stimulates all aspects of brain functioning, addresses social and emotional needs, and integrates opportunities for life review.
The TTAP Method provides the early intervention needed to assist older adults in retaining cognitive and psychosocial abilities, as well as a proven approach to enhancing engagement in community centers, assisted living communities, and long term care centers.
In 2010, a pilot study of 18 patients on a geropsychiatric/dementia unit showed that when all staff were trained to use a thematic approach to conversation activities and activities of daily living, the unit saved $160,000 in nursing supervisory costs.

How A Thematic Approach Is Used

Research into the brain is unlocking the understanding of how important the use of positive, rich language through recall and reminiscence really is to overall brain wellness. It is also known that long-term memory stays with people much longer than short-term memory, whether someone suffers from cognitive decline or not.
The TTAP Method’s nine-step intervention directs the focus of therapy on helping cognition and the reinforcement and utilization of remaining strengths, such as accessing long-term memory or controlling motor coordination.
The innovative approach of the TTAP Method instructs caregivers, health care professionals, and family members how to tap into this memory using themes of people’s lives, such as holidays, family traditions, vacations, and the seasons, to guide conversations and activities that are both positive and meaningful.
The difference with this innovative approach is that all of the individuals surrounding the person diagnosed with Alzheimer’s may interact in concert, thus supporting and reinforcing conversations, memories, and activities during the sessions.
TTAP methodThe TTAP Method utilizes all the creative arts in its nine steps, and sessions are structured in sequential order: group discussion, music/guided imagery, drawing/painting, sculpture, movement, poetry, food, photography, and a themed event (see Table 1, left). By utilizing the nine steps, the caregiver or therapist is facilitated in developing personalized programming.

The second step is the most significant in assisting participants to identify their own personal needs. Step two brings music, body relaxation, and meditation into the session, allowing for a moment of introspection.
Meditation has been linked to an increased likelihood of a later experience of “flow” in that it allows increased levels of concentration in the experience and a loss in awareness of the external environment.

Brain Function Stimulated

Previous research on brain plasticity, neural regeneration, and the phenomena of cognitive reserve demonstrates that positive changes in neural activity can be activated by visual, auditory, and sensory stimulation. During the TTAP Method program, participants are provided with these types of stimulation, as well as stimulation to three distinct brain systems: the affective system, the strategic system, and the recognition system.
Brain research now indicates that the brain can change in mass and density through increased stimulation in these three areas.
The use of multiple forms of interaction is essential to the TTAP Method. Blooms’ Taxonomy of Learning is incorporated into the approach, and each of the nine steps is designed to stimulate the visual, musical, linguistic, interpersonal, intrapersonal, kinesthetic, and spatial learner responses in participants.
Enhancing social interaction by stimulating all types of learners ensures a higher likelihood of full participation from each participant within the group experience and has a protective effect on the hippocampus, decreasing the likelihood that individuals with Alzheimer’s disease will show signs of further decline in language abilities and short-term memory.
The integration of various artistic activities elicits an integration of higher cortical thinking, such as planning, attentiveness, problem solving, and emotional investment, in both the topic of discussion and in goal accomplishment. It thereby promotes faster cognitive and emotional processing and facilitates learning and memory.
Guided imagery synchronized with music is one of the most unique and significant steps in the methodology, in that it allows the individual to access positive long-term memory.   

Maximizing Interaction

Communication, in all forms, is a crucial aspect of social support, as it serves in “maintaining or retaining feelings of connectedness to one’s self and to the larger community of peers, friends, and family,” according to Linda Levine Madori, PhD, in her new book, “Transcending Dementia Through the TTAP Method: A New Psychology of Art, Brain, and Cognition.”
The TTAP Method employs dynamic interaction by incorporating avenues for both nonverbal and verbal communication in a group context, which has been shown to regulate functions within the cerebral cortex, promoting brain wellness and skill retention among older adults.
As a result of the nine-step structure, the TTAP Method naturally increases the total time a participant spends in programming by exposing the participant to longer levels of increased stimulation.

Addressing Emotional Needs

Recent research suggests that when social and emotional needs are addressed, feelings of self-worth, self-esteem, mood, and overall quality of life are enhanced. The TTAP Method, in its thematic orientation, structures sessions in order to meet the specific needs of persons with Alzheimer’s, which includes the exploration of feelings of hope, love, grief, and sorrow, as well as fortitude.
Cognitive difficulties, specifically short-term memory loss, are a defining feature of Alzheimer’s and are one of the central problems experienced on a daily basis. For an individual with early-stage Alzheimer’s, memory loss can have a major impact on daily living skills, which impedes self-confidence and can lead to anxiety, depression, and withdrawal from activities and other social involvements.
Social withdrawal can result in a general increase in symptoms, including enhanced memory loss.
This increase in symptoms beyond those attributable to the disease process is an example of what has been termed “excess disability.” TTAP, through its person-centered approach, naturally enhances feelings of self-worth, which has a direct correlation to motivation levels directed at creating enhanced social support systems, thus decreasing the likelihood of withdrawal among participants.
Depression, coupled with feelings of hopelessness, can have a detrimental impact on cognitive functioning. Emotions directly affect cognition and, therefore, subsequent motor coordination, memory, self-esteem, and the perception of one’s own health. Cognitive evaluation tests show that cognitive performance is significantly impaired during depressive states, and 15 to 30 percent of individuals with Alzheimer’s disease have clinically significant levels of depression symptoms.
Successful depression treatment, through the use of multimodal interventions such as the TTAP Method, has been correlated with significant alleviation of cognitive impairments and, therefore, an overall improvement in independent functioning.

Linda Levine MadoriLinda Levine Madori, PhD, author of “Transcending Dementia Through TTAP: A New Psychology of Art, Brain, and Cognition (The TTAP Method),” is credentialed in both Therapeutic Recreation and New York state licensing in Creative Arts Therapy. Levine Madori has worked for the past 15 years at St. Thomas Aquinas College. Her dissertation research in Alzheimer’s disease, cognitive functioning, and psychosocial well-being is the basis for “Therapeutic Thematic Arts Programming for the Older Population (TTAP Method).” For more information, go to