It Takes a Team: Who Supports a Person Living with Dementia?

A dementia diagnosis can feel overwhelming — not only for the person receiving the diagnosis, but also for their family and caregivers. The good news is that you are not alone. Caring for someone with dementia involves a team of healthcare professionals who each play an important role in supporting independence, safety, and quality of life.

Let’s take a closer look at how each team member helps.

🧠 Neurologist

A Neurology specialist, the neurologist focuses on the brain and nervous system.

They:

• Diagnose different types of dementia (such as Alzheimer’s disease or vascular dementia)
• Order brain imaging (MRI, CT scans)
• Prescribe and monitor medications for memory and behavior changes
• Track disease progression over time

The neurologist helps guide the medical treatment plan and answers questions about what is happening in the brain.

🧠 Neurophysiologist

A neurophysiologist studies how the nervous system functions.

They may:

• Perform specialized tests to measure brain activity
• Evaluate nerve function
• Help differentiate dementia from other neurological conditions

While not every person with dementia will see a neurophysiologist, they can be helpful in complex cases.

🩺 Primary Care Provider (PCP)

Your Primary Care Provider is often the “home base” of your healthcare team.

They:

• Monitor overall health (blood pressure, diabetes, heart health)
• Identify reversible causes of confusion (infection, vitamin deficiency)
• Coordinate care between specialists
• Provide routine preventive care

Since other medical conditions can worsen memory symptoms, your PCP plays a critical role in maintaining overall wellness.

🛠 Occupational Therapist (OT)

Occupational therapists focus on helping people stay independent and engaged in meaningful daily activities — even as cognitive changes occur.

OTs help with:

• Dressing, bathing, cooking, and medication management
• Home safety modifications to reduce fall risk and confusion
• Establishing structured daily routines
• Energy conservation and fall prevention
• Caregiver education and training

In addition, OTs provide cognitive therapy and memory training, which may include:

• Teaching memory strategies (written reminders, calendars, visual cues)
• Practicing problem-solving and attention tasks
• Breaking complex activities into manageable steps
• Training in the use of memory aids and technology
• Supporting executive functioning skills such as planning and sequencing

Rather than simply focusing on memory loss, OT addresses how cognitive changes impact real-life function. Therapy is personalized to help individuals maintain independence, confidence, and participation in the activities that matter most to them.

 

🚶 Physical Therapist (PT)

Physical therapists focus on mobility and strength.

They help:

• Improve balance and reduce fall risk
• Strengthen muscles
• Maintain walking ability
• Address changes in posture or coordination

As dementia progresses, mobility can decline. PT helps people stay active and safe.

🗣 Speech-Language Pathologist (ST)

Speech therapists support communication and swallowing.

They help with:

• Word-finding difficulties
• Memory strategies
• Understanding and expressing language
• Swallowing safety if eating becomes difficult

Communication changes are common in dementia, and speech therapy can preserve connection and safety.

💬 Mental Health Therapist

Living with dementia can bring anxiety, depression, grief, and frustration.

A therapist can:

• Provide coping strategies
• Support emotional adjustment
• Help caregivers manage stress
• Address behavioral changes

Mental health care is just as important as physical health.

🤝 Social Worker

Social workers help families navigate the practical side of care.

They assist with:

• Community resources
• Support groups
• Long-term care planning
• Financial and insurance guidance
• Advance care planning

They are often the bridge between medical care and real-life needs.

📋 Case Manager

Case managers coordinate services across the healthcare system.

They:

• Ensure appointments are scheduled
• Help communicate between providers
• Advocate for needed services
• Assist with discharge planning after hospital stays

They help keep everything organized and reduce caregiver burden.

Why a Team Approach Matters

Dementia affects thinking, movement, emotions, communication, and daily function. No single provider can address all of these areas alone. A collaborative team ensures that care is:

• Holistic
• Coordinated
• Personalized
• Focused on quality of life

You Are Not Alone

If you or a loved one has been diagnosed with dementia, remember: support is available. Early intervention and a strong care team can help maintain independence, dignity, and meaningful engagement in life.

If you have questions about how occupational therapy or other services can help, talk with your healthcare provider about building your care team today.

Common Manifestations Seen in Occupational Therapy

Visual-Spatial Problems

• Misjudging distances
• Difficulty arranging objects
• Trouble assembling puzzles
• Getting lost in familiar spaces

Visual-Motor Dysfunction

• Poor handwriting
• Struggles with utensil use
• Inconsistent cutting skills

Visual Closure Issues

• Difficulty identifying partially hidden objects
• Trouble recognizing words when letters are missing
• Slower object recognition

The Role of Occupational Therapy

Occupational therapy focuses on improving functional participation—not just visual skills in isolation.

Intervention may include:

Functional Skill Training

Practicing real-world tasks such as dressing, cooking, or workplace organization with graded supports.

Environmental Modifications

• Reducing visual clutter
• Increasing contrast
• Improving lighting
• Using color-coded systems
• Labeling drawers and containers

Compensatory Strategies

• Teaching systematic visual scanning
• Breaking tasks into step-by-step sequences
• Using tactile or auditory cues to supplement visual input

Visual-Motor Integration Activities

• Structured drawing and copying tasks
• Targeted hand-eye coordination activities
• Obstacle courses for spatial awareness

Collaboration with Other Specialists

Occupational therapists may collaborate with optometrists, vision therapists, and neurologists to ensure comprehensive care.

Supporting Functional Independence

With appropriate intervention, individuals with visual perception deficits can build compensatory strategies, improve functional performance, and regain confidence in daily life.

Early identification and intervention are key—but progress is possible at any age.

By addressing both the physical and emotional components of visual perception challenges, occupational therapy empowers individuals to engage more fully in the activities that matter most to them.

Occupational Therapy Strategies for Freezing of Gait in Parkinson’s Disease

Freezing of gait (FOG) is a common and frustrating symptom experienced by individuals living with Parkinson’s disease. During a freezing episode, a person may feel as if their feet are “glued to the floor,” making it difficult to initiate or continue walking. These episodes can increase the risk of falls and may limit independence in everyday activities.

Occupational therapy focuses on helping individuals maintain independence and safely participate in daily life. Through movement retraining, cognitive strategies, and environmental modifications, occupational therapists teach practical tools to help people overcome freezing episodes and move more confidently.

Understanding Why Freezing Happens

Walking is normally an automatic movement controlled by areas of the brain that allow us to move without thinking about every step. In Parkinson’s disease, these automatic pathways become disrupted.

Occupational therapy helps by teaching the brain to use conscious attention and external cues to bypass these disrupted pathways.

Instead of relying on automatic movement, individuals learn strategies that intentionally guide movement.

External Cueing Techniques

External cues give the brain something to focus on outside the body, helping to restart movement.

Visual Cues

Visual cues help guide stepping patterns and improve stride length.

Examples include:

• Placing bright colored tape on the floor
• Using lines or markers to step over
• Using laser cue devices on canes or walkers

These cues provide a clear visual target that encourages the brain to initiate movement.

Auditory Cues

Rhythmic sounds can help regulate walking cadence.

Common examples include:

• A metronome
• Walking to the beat of music
• Counting steps out loud

The rhythm helps coordinate movement and maintain a steady walking pattern.

Tactile Cues

Physical cues can help initiate movement.

Examples include:

• Light rhythmic tapping on the leg
• Tapping a walking aid before stepping

Cognitive Strategies for Freezing Episodes

Because freezing often occurs when the brain becomes overloaded, cognitive strategies help simplify the movement process.

The “Stop, Sigh, Shift, Step” Method

A commonly used technique includes four steps:

1. Stop – Pause when freezing occurs
2. Sigh – Take a slow breath to reset the body
3. Shift – Shift weight from side to side
4. Step – Take a large intentional step forward

This structured approach helps reset movement.

Mental Imagery

Visualization can help guide movement.

Examples include imagining:

• Stepping over a line
• Marching like a soldier
• Taking large exaggerated steps

Large-Movement Focus

Thinking about bigger movements helps counteract the small, shuffling steps common in Parkinson’s.

Patients may practice:

• High marching steps
• “Big step” walking
• Exaggerated arm swing

Cognitive Remediation Therapy

Occupational therapy may also include cognitive remediation therapy, which focuses on strengthening thinking skills that influence movement.

These skills include:

• Attention
• Processing speed
• Working memory
• Executive function

When cognition becomes overloaded—such as walking while talking, turning, or navigating crowded environments—freezing episodes are more likely.

Cognitive remediation exercises may include:

• Sequencing activities
• Dual-task training (gradually adding tasks)
• Problem-solving activities
• Reaction time tasks

Improving these cognitive skills helps individuals better manage complex environments and reduce freezing triggers.

Visual Perception Training

Visual perception plays a major role in navigation and movement. Many individuals with Parkinson’s experience difficulty with:

• Depth perception
• Spatial awareness
• Visual scanning
• Judging distances

Occupational therapists may incorporate visual perception training to improve how the brain interprets visual information.

Exercises may include:

• Tracking objects across space
• Scanning for targets in different areas of the visual field
• Practicing stepping over obstacles
• Depth perception activities
• Navigation tasks in structured environments

Improving visual processing can help the brain better guide safe and efficient movement.

Movement Retraining Strategies

Occupational therapists also focus on specific movement patterns that reduce freezing.

Weight Shifting

Freezing often occurs when weight is evenly distributed on both feet.

Practicing side-to-side rocking helps initiate stepping.

Examples include:

• Rocking side to side before stepping
• Lifting one foot slightly before walking

Turning Strategies

Turning is one of the most common triggers for freezing.

Instead of pivoting in place, therapists encourage:

• Wide “U-shaped” turns
• Taking several small steps instead of twisting

This approach keeps movement flowing and reduces the likelihood of freezing.

Environmental Modifications at Home

The home environment can either trigger or prevent freezing episodes.

Occupational therapists assess the home and recommend modifications such as:

• Removing loose rugs
• Reducing clutter in walking paths
• Improving lighting
• Adding visual stepping cues in difficult areas
• Organizing frequently used items within reach

Creating a clear and predictable environment improves both safety and confidence.

Reducing Dual Tasking

Doing multiple things at once—such as walking while talking or carrying objects—can increase freezing episodes.

Occupational therapists often encourage:

• Focusing on one task at a time
• Pausing before initiating movement
• Breaking complex activities into smaller steps

This reduces cognitive overload and allows movement to occur more smoothly.

Supporting Independence Through Occupational Therapy

The goal of occupational therapy is not just to improve walking—it is to help individuals continue participating in meaningful daily activities.

Through cueing strategies, cognitive training, movement retraining, and environmental adaptations, occupational therapists help people living with Parkinson’s regain confidence in their mobility.

With the right strategies and practice, many individuals can learn to recognize triggers for freezing and apply techniques that help them move forward safely and independently.

What to Expect During a Cognitive-Focused Occupational Therapy Evaluation

When memory, attention, organization, or problem-solving begin to feel more difficult, an occupational therapy (OT) evaluation can help identify what’s happening and how to support improvement.

A cognitive-centered OT evaluation focuses on how thinking skills affect daily life — not just test scores, but real-world function.

Below is a patient-friendly guide to what you can expect.

1. Occupational Profile: Understanding Your Daily Life

Your therapist will begin by learning about you.

You may be asked:

• What cognitive changes have you noticed?
• When did they begin?
• What daily tasks feel harder?
• Are you forgetting appointments, misplacing items, or feeling overwhelmed?
• What are your goals?

Cognition affects everything from managing medications to participating in conversations. Understanding your daily routines helps guide meaningful treatment.

2. Medical and Health History Review

Your therapist will review factors that may impact cognition, such as:

• Neurological conditions (stroke, concussion, mild cognitive impairment)
• Mental health history (anxiety, depression)
• Sleep patterns
• Medications
• Imaging or specialist reports

Cognition is influenced by physical health, emotional health, and environmental stressors, so this full picture is important.

3. Cognitive Assessment

This portion evaluates different areas of thinking skills. These may include:

Attention

• Sustained attention (staying focused)
• Selective attention (ignoring distractions)
• Alternating attention (shifting between tasks)
• Divided attention (dual-tasking)

Memory

• Short-term memory
• Working memory
• Delayed recall
• Prospective memory (remembering to do something later)

Executive Function

• Planning
• Organization
• Problem-solving
• Task initiation
• Cognitive flexibility

Processing Speed

• How quickly you can take in and respond to information

 

Dual Tasking

Performing two tasks at the same time or combining a cognitive and physical task. Dual tasking is essential for safe and efficient participation in daily life activities (e.g., walking while talking, cooking while monitoring time).

Types of Dual Tasking

Motor–Motor Dual Tasking
Performing two physical tasks simultaneously
Example: Carrying groceries while walking

Cognitive–Motor Dual Tasking
Performing a cognitive task while completing a physical task
Example: Walking while counting backward

Cognitive–Cognitive Dual Tasking
Managing two thinking-based tasks at once
Example: Listening to instructions while organizing materials

Functional Dual Tasking
Combining tasks within real-life activities
Example: Cooking while having a conversation

 

Common standardized tools may include but not limited to:

• Montreal Cognitive Assessment
• Trail Making Test
• Saint Louis University Mental Status Examination
• Hopkins Verbal Learning
• TUG
• BERG Balance test 

These assessments help identify patterns of strengths and challenges.

4. Functional Cognitive Assessment

In occupational therapy, we don’t just assess cognition at a desk — we assess it in action.

You may be asked to complete tasks such as:

• Following multi-step directions
• Organizing a mock pill box
• Interpreting a bill or calendar
• Sequencing a cooking task
• Completing a divided attention activity
• Ability to dual task

This shows how cognitive skills translate into real-life performance.

5. Visual-Perceptual and Visual-Motor Screening

Cognition and vision work closely together. Your therapist may assess:

• Visual scanning
• Spatial awareness
• Pattern recognition
• Visual memory

These skills are essential for reading, driving, managing finances, and navigating environments safely.

6. Emotional and Behavioral Considerations

Cognitive changes can also affect:

• Frustration tolerance
• Anxiety levels
• Task avoidance
• Fatigue

Your therapist may explore how stress or mood impacts your thinking and daily functioning.

7. Collaborative Goal Setting

Together, you and your therapist will develop functional, meaningful goals.

Examples:

• Improve divided attention to safely cook while conversing.
• Increase short-term memory to independently manage appointments.
• Enhance executive functioning to return to work tasks.
• Improve task sequencing to complete morning routines independently.

Goals focus on participation and independence, not just cognitive scores.

8. Plan of Care

At the end of the evaluation, your therapist will outline:

• Recommended frequency of therapy based on insurance 
• Cognitive rehabilitation strategies
• Home program activities
• Compensatory techniques (planners, reminders, environmental modifications)

Treatment may include restorative cognitive exercises, strategy training, environmental supports, and real-life simulations.

Why a Cognitive OT Evaluation Matters

Cognition affects independence, safety, and confidence.

A cognitive-centered occupational therapy evaluation helps identify:

• What skills are intact
• Where breakdowns occur
• How to improve function
• How to compensate when needed

The goal is not perfection — it is meaningful participation in the activities that matter most to you.

Preparing for Your Appointment

• Bring glasses or hearing aids if needed
• Bring your ID and insurance cards
• Bring a medication list and list of providers
• Be prepared to discuss daily challenges
• Bring a family member if additional insight would be helpful