Evaluation of the efficacy of a cognitive rehabilitation treatment on a group of Alzheimer's patients with moderate cognitive impairment: a pilot study

[PReCAMDi Cognitive Rehabilitation Program for Older Adults with Type 2 Diabetes: quasi-experimental study protocol]

INTRODUCTION

During the aging process, different changes in the body structures appear, increasing the susceptibility to develop type 2 diabetes (T2DM) and mild cognitive impairment (MCI). The association between T2DM and MCI has been described in different studies. Despite the scientific evidence that shows that cognitive rehabilitation improves the cognitive performance of older adults with MCI, currently, there are few studies evaluating the effectiveness of cognitive rehabilitation in older adults with T2DM and MCI.

PARTICIPANTS AND METHODS

Pretest and posttest quasi-experimental design. Participants will be randomly assigned (1:1) to the intervention and control groups. The intervention group will undergo a 12-week cognitive rehabilitation program with a restorative approach. The control group will not receive any intervention. All participants will be followed up three months after randomization.

EXPECTED RESULTS

To develop a cognitive rehabilitation program that improves memory, processing speed and executive functions, as well as the level of glycemic control of the participants assigned to the intervention group. These results will allow us to acquire the necessary data to carry out a pilot test.

CONCLUSIONS

This is the first quasi-experimental study in Mexico in which a cognitive rehabilitation program with a restorative approach is developed for older adults with T2DM and MCI. By carrying out this program, older adults will have an alternative treatment that improves their autonomy, specifically in the control of T2DM. In addition, this study makes important methodological contributions in the lines of research of T2DM and MCI.

A scoping review on the psychosocial interventions used in day care service for people living with dementia

BACKGROUND

Adult Day care centres provide an important aspect of care provision through all phases of the dementia illness from diagnosis to the end of life (Dabelko HI 2008) supporting the well-being of both older people living with dementia and their care partners. Services within adult day care settings are designed to provide biopsychosocial health benefits to participants as well as care partner respite.

OBJECTIVE

To examine research studies, literature reviews and grey literature and identify and map the literature on psychosocial interventions used in day care services for older people living with dementia and chart their use, evaluation and outcomes. The research review question is "what are the psychosocial interventions used in day care service for older people living with dementia?" Psychosocial interventions are important non-pharmacological interventions which support people's wellbeing.

METHODS

Inclusion/Exclusion criteria were identified and guided the search strategy. Participants were people aged 60 years and over living with dementia attending day care services. The use of psychosocial interventions for this cohort was the focus of the review. Databases were searched (Cochrane Reviews, CINAHL, Embase, Medline EBSCO, Medline Ovid, Medline PubMed, PsycINFO, Scopus, Open Grey, Lenus and WHO Global Index Medicus databases) using keywords/terms with Boolean operators from 2011 to 2023. Rayyan was used to extract and manage the data.

RESULTS

The findings present a narrative and charting of the data from the 45 papers that met the review criteria, and this data is mapped onto the five objectives. Within this review, interventions were grouped into five broad types: nature (n = 6 papers), memory/cognitive (n = 11 papers), social (n = 17 papers), animal (n = 4 papers), or physical/sensory (n = 7 papers) based interventions.

CONCLUSIONS

This review has illustrated the wide variety in the types, range and facilitation of psychosocial interventions within adult day care services. This review highlights the potential benefits of these interventions. However, findings must be considered in the context that many were provided as brief intervention studies with little evidence of continuation after the study and further research is required given the complex and diverse range of interventions. Results will be of interest to practitioners planning to implement or evaluate psychosocial interventions used in day care services for older people living with dementia.

Exploring outcome measures with cognitive stimulation therapies and how these relate to the experiences of people with dementia: A narrative literature review

A narrative literature review was undertaken to consider the outcome measures used in research on cognitive stimulation therapy (CST), cognitive training (CT) and cognitive stimulation (CS) interventions. This review extends findings from previous reviews by including a broad range of study methodologies, both qualitative and quantitative, and explored whether participant experiences of taking part in the research are discussed. A database search identified 1261 articles matching the search criteria, with 29 included in this review. Studies tended to use the manualised CST model, with 11 other models identified. Randomised control trials were chosen as the most used method to explore impact. Across the studies, 65 different outcome measures were used with people with dementia, and only four studies used a qualitative approach. Little information is provided on the assessment process in terms of time taken, assessor, or of the experience of the person with dementia. There is heterogeneity of measures used, within and across domains, and number, and agreement or consistency of measures would provide greater comparability across CS studies. Gaps in reporting were noted on the detail of the assessment process and the experience of people with dementia taking part in this research.

Rehabilitation for People Living with Dementia: A Scoping Review of Processes and Outcomes

Objectives

The aim of this scoping review was to map intervention studies of rehabilitation for people living with dementia regarding processes and outcomes, with a particular focus on whether the intervention is person-centred, home-based, or organised adopting a multidisciplinary approach and measures outcomes relating to everyday functioning and well-being.

Methods

A systematic search of electronic databases was conducted in PubMed, CINAHL, PsycINFO, Embase, and Cochrane. Studies from 2005 to November 2018 were collected and screened for relevance and quality. Randomised control trials and prospective cohort trials reporting a statistically significant effect on one or more outcome measures were included. Included studies were mapped according to selected processes and outcome measures.

Results

Twenty-six intervention studies were included and mapped. Nineteen of the interventions were person-centred, nine were home-based, and 14 reported a multidisciplinary approach. Twelve of the interventions had activities of daily living as an outcome measure, and 14 had quality of life as an outcome measure.

Conclusion

Person-centredness appears in most rehabilitation interventions for people living with dementia. Other processes and outcomes are heterogeneously described in the research literature. Rehabilitation programmes can be home-based or take place at a centre. Although not exclusive, the organisation of rehabilitation can be multidisciplinary. Fewer than half of the intervention studies measure the impact on activities of daily living and quality of life. Future guidelines must take into account the weak evidence regarding these aspects.

The effects of cognitive training on gait speed and stride variability in old adults: findings from a pilot study

BACKGROUND

The interrelationship between gait performance and higher-order cognitive functions has been established through a number of different investigations. In turn, enabling gait by improving cognition is a new and emerging field of research.

AIMS

Investigating if and to what extent a structured cognitive training program influences gait-related parameters in a sample of old and frail nursing home residents.

METHODS

Twenty-one nursing home residents were quasi-randomized to an intervention group following a 6-week structured cognitive training program or a control group. Gait was investigated during normal pace and under two dual-task conditions (simple and complex dual-task walking conditions), using the GAITRite(®) system at three predefined time points (pre-intervention, post-intervention, 3-month follow-up). Outcome measures were gait speed and stride variabilities.

RESULTS

Confirmation of the interrelationship between gait and cognition evidenced by decreased gait parameters during complex dual-task walking. Observation of clinical meaningful improvements in gait stability and gait speed after the training program under the complex dual-task situations, with only speed remaining stable over a period of 3 months.

DISCUSSION

This study on the effects of cognitive training on gait is promising, with several results going in the expected direction. Our data corroborate previous findings and extend them to the group of frail old nursing home residents.

CONCLUSIONS

The present pilot study's approach of improving gait under challenging walking situations by interventions designed to improve cognitions adds encouraging results to this emerging field of research, although restrictions in sample size and in the control group prevent us from drawing firm conclusions.

Beneficial effects of multisensory and cognitive stimulation on age-related cognitive decline in long-term-care institutions

The aim of the present report was to evaluate the effectiveness and impact of multisensory and cognitive stimulation on improving cognition in elderly persons living in long-term-care institutions (institutionalized [I]) or in communities with their families (noninstitutionalized [NI]). We compared neuropsychological performance using language and Mini-Mental State Examination (MMSE) test scores before and after 24 and 48 stimulation sessions. The two groups were matched by age and years of schooling. Small groups of ten or fewer volunteers underwent the stimulation program, twice a week, over 6 months (48 sessions in total). Sessions were based on language and memory exercises, as well as visual, olfactory, auditory, and ludic stimulation, including music, singing, and dance. Both groups were assessed at the beginning (before stimulation), in the middle (after 24 sessions), and at the end (after 48 sessions) of the stimulation program. Although the NI group showed higher performance in all tasks in all time windows compared with I subjects, both groups improved their performance after stimulation. In addition, the improvement was significantly higher in the I group than the NI group. Language tests seem to be more efficient than the MMSE to detect early changes in cognitive status. The results suggest the impoverished environment of long-term-care institutions may contribute to lower cognitive scores before stimulation and the higher improvement rate of this group after stimulation. In conclusion, language tests should be routinely adopted in the neuropsychological assessment of elderly subjects, and long-term-care institutions need to include regular sensorimotor, social, and cognitive stimulation as a public health policy for elderly persons.