Title: Applying GentleCare to older adults with dementia (Reply)
Abstract: CorrespondenCeApplying GentleCare to older adults with dementia (Reply) In the previous issue, Mauro Colombo 1 extended the concepts of Luria and Fozard 2 to the daily practice of older adults with dementia in the GentleCare concept of Moyra Jones 3 .Colombo mentioned the three basic elements that make up a pleasant environment: (i) the individual with whom the person with dementia interacts, (ii) the physical space in which the person lives, and (iii) the activities in which the person engages.We also work with these basic three elements, and call it the Brain-Environment-Methodology (BEM, in Dutch: BOM).BEM is based on neuroscientific results stating that in the damaged brain, programming of behaviour is determined by the environment.By knowing how the damaged brain is processing incentives, we can understand what kind of environment we have to design.As to the three environmental aspects mentioned above, we start with items (i) and (ii) when organizing the environment for persons with dementia.The physical environment is prioritized.If wrong incentives are present in its design, gentle interaction by carers has no lasting effect.The physical environment encompasses chairs, kitchens, colours, tablecloths, apparatus, technology, programs on flat screen, etc. Hierarchical brain organisationOur brain can be thought of as having four functioning levels with a hierarchy of increasing complexity.At increased levels, there is also an increased competence in understanding complex situations (input) and in reacting with adjusted or sophisticated behaviour (output).The two lower levels of brain functionality are completed at the age of 3.Here the incoming incentives are sorted out and ordened, an image of the situation emerges and the lower part of the limbic system screens the image for (i) nice/nasty, (ii) pleasant/unpleasant, and (iii) safe/hostile.Initial uncontrolled emotions start here.The two higher levels (3 and 4) are ready at around our 25 th year of life.They contain the higher brain functions like self-knowledge, control of emotional impulses, forming an overview of the situation, abstract thinking, recognising cues, imagining virtual plans, and choose one of them to execute 4 .Levels 3 and 4 are vulnerable since they use an intensive network of connections with all corners of the brain involved.Many brain diseases have their focal point at the higher levels.An anatomically small injury can cause an enormous dysfunction in thinking and behaving.Demen-