The aging of society inevitably leads to an increase in the numbers of elderly with dementia who reside in nursing homes, and delaying disease progression of residents with dementia has become a big concern. Rehabilitation that focuses directly on training cognitive function (e.g. memory training) reveals what patients are unable to do. Realization of their cognitive deficits can devastate their self-confidence and lead to anxiety, depression and the lowering of self-esteem (Small et al., 1997). We propose rehabilitation that encourages patients' motivation for self-improvement through social interaction based on five principles as follows: (1) the activities should be enjoyable and comfortable for patients, (2) therapists should praise the patients naturally to motivate them, (3) the activities should be associated with empathetic two-way communication to make patients feel valued and safe, (4) therapists should encourage the patients to play “social roles” to restore self-worth, and (5) error-less learning based on brain-activating rehabilitation (BAR; Yamaguchi et al., in press) should be adopted wherever possible. It is suggested that the positive feelings activate those areas of the brain related to reward, which plays a critical role in motivation (Berridge et al., 2003), and it is a typical social reward to be praised and appreciated in public.

The authors wish to add the following Acknowledgment:

This work was supported by an award from the U.K. NIHR Biomedical Research Centre for Ageing and Age-related Disease to the Newcastle upon Tyne Hospitals NHS Foundation Trust.