Comparing two programs of cognitive training in Alzheimer's disease: a pilot study

Benefits of an educational intervention on functional capacity in community-dwelling older adults with frailty phenotype: A randomized controlled trial

BACKGROUND

There is an urgent demand for nurses to expand their knowledge and skills in managing frailty in primary care. Frailty is a multifaceted condition that is prevalent among older adults and often leads to reduced functional capacity. Currently, there is a limited understanding of the effectiveness of educational interventions aimed at improving functional capacity among community-dwelling frail older adults in a primary care setting.

OBJECTIVE

This study aimed to evaluate the impact of an educational program on functional capacity among pre-frail and frail older adults living in the community.

DESIGN

A 12-month, multicenter, randomized controlled trial.

SETTINGS

The FRAGSALUD study was conducted across 14 healthcare centers situated within the regions of Cadiz and Malaga, Spain.

PARTICIPANTS

A total of 199 frail/pre-frail community-dwelling older adults (74.2 ± 6.4 years).

METHODS

Participants who met at least one Fried's criteria were assigned to either the control group (n = 90), which received usual healthcare assistance, or the intervention group (n = 109). The 6-month intervention comprised four group sessions and six telephone calls conducted by professional nurses, sport scientists, and nutritionists. This educational program focused on guidelines for physical activity, nutritional habits, cognition, and psychosocial well-being. Functional capacity was assessed using questionnaires for basic (Barthel Index) and instrumental (Lawton and Brody Scale) activities of daily living. All outcome measures were evaluated at baseline, immediately after the intervention (6-month), and six months after the intervention as a follow-up (12-month). Differences in functional capacity (Barthel Index and Lawton and Brody Scale scores) across the three time points were analyzed using Friedman's ANOVA, with Wilcoxon signed-rank test for pairwise comparisons.

RESULTS

At both 6-month and 12-month assessments, the control group showed a statistically significant decline in basic and instrumental activities of daily living compared to the intervention group, which maintained similar levels, preventing this age-related decline.

CONCLUSIONS

The educational intervention, designed for easy implementation within healthcare systems, especially for nurses, successfully maintained levels of functional capacity in basic and instrumental activities of daily living, while the control group experienced a decline in functional capacity during the 12-month follow-up. Thus, educational interventions are encouraged for preserving the functional independence of frail/pre-frail older adults living in the community.

REGISTRATION

This trial was registered at ClinicalTrials.gov (Identifier: NCT05610605) and the first participant was registered in March 2022.

TWEETABLE ABSTRACT

The FRAGSALUD educational intervention prevents the age-related decline in functional independence over 12 months in frail older adults.

Placebo controlled phase II clinical trial: Safety and efficacy of combining intranasal insulin & acute exercise

A growing number of investigations are exploring the utility of intranasal insulin as a means of mitigating cognitive decline. However, as a basic tenant of dementia prevention programs is increasing physical activity, it is essential to obtain a preliminary assessment of the safety profile of combining intranasal insulin with physical activity; to ensure that undue risks are not incurred. Utilizing a randomized double-blind placebo-controlled design, a sample of 116 non-diabetic, fasted college-aged adults were randomly assigned to receive a dose of 0-to-120 IU of NovoLog (Insulin Aspart) before being randomized to 20 min of exercise or sitting control condition. The safety of intranasal insulin was assessed by examining the incidence of potential symptoms of hypoglycemia and changes in peripheral blood glucose. The efficacy of a combination therapeutic approach was assessed using behavioral measures of inhibition and sustained attention alongside neuroelectric indices of attentional engagement. The frequency of symptoms reported following administration of intranasal insulin were not observed to interact with exercise so as to make their occurrence any more or less prominent, nor was the frequency observed to relate to the dose of intranasal insulin. However, doses of intranasal insulin of 100 IU or more were observed to result in a 7-fold increase in the likelihood of a level 1 hypoglycemic event for those individuals in the exercise condition. This study provides preliminary evidence to suggest that exercise is not associated with an increase in risk when combined with lower doses of intranasal insulin.Clinical trial registration The trial is registered at ClinicalTrials.gov, number NCT04292535.

The Effect of Cognitive Intervention on Cognitive Function in Older Adults With Alzheimer's Disease: A Systematic Review and Meta-Analysis

Cognitive intervention includes cognitive stimulation, cognitive training, and cognitive rehabilitation. This systematic review was performed to re-assess the efficacy of cognitive intervention for the patients with Alzheimer's disease (AD). Twenty studies (2012 participants) were eventually included. For global cognitive function, the combined mean difference (MD) in eight studies was 1.67 (95% Confidence Interval: 0.45, 2.89, p = 0.007; Q = 33.28, df = 8, p < 0.0001, τ² = 2.17, I² = 76%) for the short term. The pooled standardized mean difference (SMD) of six RCTs was 1.61 (95% Confidence Interval: 0.65, 2.56, p = 0.0009; Q = 127.66, df = 6, p < 0.00001, τ² = 1.56, I² = 95%) for the medium term. The pooled SMD of seven studies was 0.79 (95% Confidence Interval: 0.33, 1.25, p = 0.0008; Q = 35.10, df = 7, p < 0.0001, τ² = 0.33, I² = 80%) for the long term. For depression, the pooled SMD of two trials was -0.48 (95% Confidence Interval: -0.71, -0.24; p < 0.0001, I² = 4%) for the short term. Cognitive training may show obvious improvements in global cognitive function whether after short, medium, or long-term interventions and in depression after short term intervention. However, the positive effect of the intervention on general cognitive function or depression did not seem to persist after intervention ended. There is still a lack of reliable and consistent conclusions relevant to the effect of cognitive stimulation and cognitive rehabilitation on observed outcomes, cognitive training for memory or other non-cognitive outcomes. PROSPERO registration number: CRD42019121768.

Preventing dementia? Interventional approaches in mild cognitive impairment

Mild cognitive impairment (MCI) is defined as an intermediate state between normal cognitive aging and dementia. It describes a status of the subjective impression of cognitive decline and objectively detectible memory impairment beyond normal age-related changes. Activities of daily living are not affected. As the population ages, there is a growing need for early, proactive programs that can delay the consequences of dementia and improve the well-being of people with MCI and their caregivers. Various forms and approaches of intervention for older people with MCI have been suggested to delay cognitive decline. Pharmacological as well as non-pharmacological approaches (cognitive, physiological, nutritional supplementation, electric stimulation, psychosocial therapeutic) and multicomponent interventions have been proposed. Interventional approaches in MCI from 2009 to April 2019 concerning the cognitive performance are presented in this review.

A randomised feasibility study of computerised cognitive training as a therapeutic intervention for people with Huntington's disease (CogTrainHD)

BACKGROUND

Huntington's disease (HD) is associated with a range of cognitive deficits including problems with executive function. In the absence of a disease modifying treatment, cognitive training has been proposed as a means of slowing cognitive decline; however, the impact of cognitive training in HD patient populations remains unclear. The CogTrainHD study assessed the feasibility and acceptability of home-based computerised executive function training, for people impacted by HD.

METHODS

Thirty HD gene carriers were recruited and randomised to either executive function training or non-intervention control groups. Participants allocated to the intervention group were asked to complete executive function training three times a week for 30 min for 12 weeks in their own homes. Semi-structured interviews were conducted with participants and friends, family or carers, to determine their views on the study.

RESULTS

26 out of 30 participants completed the baseline assessments and were subsequently randomised: 13 to the control group and 13 to the intervention group. 23 of the 30 participants were retained until study completion: 10/13 in the intervention group and 13/13 in the control group. 4/10 participants fully adhered to the executive function training. All participants in the control group 13/13 completed the study as intended. Interview data suggested several key facilitators including participant determination, motivation, incorporation of the intervention into routine and support from friends and family members. Practical limitations, including lack of time, difficulty and frustration in completing the intervention, were identified as barriers to study completion.

CONCLUSIONS

The CogTrainHD feasibility study provides important evidence regarding the feasibility and acceptability of a home-based cognitive training intervention for people with HD. Variable adherence to the cognitive training implies that the intervention is not feasible to all participants in its current form. The study has highlighted important aspects in relation to both the study and intervention design that require consideration, and these include the design of games in the executive function training software, logistical considerations such as lack of time, the limited time participants had to complete the intervention and the number of study visits required. Further studies are necessary before computerised executive function training can be recommended routinely for people with HD.

TRIAL REGISTRATION

ClinicalTrials.gov, Registry number NCT02990676.

A Systematic Review of Multimodal Non-Pharmacological Interventions for Cognitive Function in Older People with Dementia in Nursing Homes

INTRODUCTION

Multimodal non-pharmacological interventions (MNPIs) have been reported to be effective in improving the cognitive function. Therefore, it is necessary to study these interventions in older people with dementia (PWD) in nursing homes (NHs).

AIMS

This study aimed to investigate the effects, contents, frequency, duration, length, and form of MNPIs on the global and specific cognitive functions of PWD in NHs through a systematic review, and to consider what kind of intervention design is most effective.

METHODS

A systematic search of peer-reviewed literature published between January 2008 and October 2018 was performed on the PubMed, Cochrane Library, Web of Science and CINAHL databases.

RESULTS

Six randomized controlled trials (RCTs) and one non-RCTs were extracted from electronic databases, and a review was carried out.

CONCLUSION

Our review suggests that MNPIs may improve the global, executive function and memory of PWD in NHs. The combination of exercise, cognitive training and activities of daily living, and intervention at least 3 times a week over at least 8 weeks with, at least 30 min per session using the integrated form is recommended for improving the global and specific cognitive functions of PWD in NHs.

Cognitive training for people with mild to moderate dementia

BACKGROUND

Cognitive impairment, a defining feature of dementia, plays an important role in the compromised functional independence that characterises the condition. Cognitive training (CT) is an approach that uses guided practice on structured tasks with the direct aim of improving or maintaining cognitive abilities.

OBJECTIVES

• To assess effects of CT on cognitive and non-cognitive outcomes for people with mild to moderate dementia and their caregivers.• To compare effects of CT with those of other non-pharmacological interventions, including cognitive stimulation or rehabilitation, for people with mild to moderate dementia and their caregivers.• To identify and explore factors related to intervention and trial design that may be associated with the efficacy of CT for people with mild to moderate dementia and their caregivers.

SEARCH METHODS

We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialised Register, on 5 July 2018. ALOIS contains records of clinical trials identified through monthly searches of several major healthcare databases and numerous trial registries and grey literature sources. In addition to this, we searched MEDLINE, Embase, PsycINFO, CINAHL, LILACS, Web of Science Core Collection, ClinicalTrials.gov, and the World Health Organization's trials portal, ICTRP, to ensure that searches were comprehensive and up-to-date.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that described interventions for people with mild to moderate dementia and compared CT versus a control or alternative intervention.

DATA COLLECTION AND ANALYSIS

We extracted relevant data from published manuscripts and through contact with trial authors if required. We assessed risk of bias using the Cochrane 'Risk of bias' tool. We divided comparison conditions into active or passive control conditions and alternative treatments. We used a large number of measures and data to evaluate 19 outcomes at end of treatment, as well as 16 outcomes at follow-up in the medium term; we pooled this information in meta-analyses. We calculated pooled estimates of treatment effect using a random-effects model, and we estimated statistical heterogeneity using a standard Chi² statistic. We graded the evidence using GradePro.

MAIN RESULTS

The 33 included trials were published between 1988 and 2018 and were conducted in 12 countries; most were unregistered, parallel-group, single-site RCTs, with samples ranging from 12 to 653 participants. Interventions were between two and 104 weeks long. We classified most experimental interventions as 'straight CT', but we classified some as 'augmented CT', and about two-thirds as multi-domain interventions. Researchers investigated 18 passive and 13 active control conditions, along with 15 alternative treatment conditions, including occupational therapy, mindfulness, reminiscence therapy, and others.The methodological quality of studies varied, but we rated nearly all studies as having high or unclear risk of selection bias due to lack of allocation concealment, and high or unclear risk of performance bias due to lack of blinding of participants and personnel.We used data from 32 studies in the meta-analysis of at least one outcome. Relative to a control condition, we found moderate-quality evidence showing a small to moderate effect of CT on our first primary outcome, composite measure of global cognition at end of treatment (standardised mean difference (SMD) 0.42, 95% confidence interval (CI) 0.23 to 0.62), and high-quality evidence showing a moderate effect on the secondary outcome of verbal semantic fluency (SMD 0.52, 95% CI 0.23 to 0.81) at end of treatment, with these gains retained in the medium term (3 to 12 months post treatment). In relation to many other outcomes, including our second primary outcome of clinical disease severity in the medium term, the quality of evidence was very low, so we were unable to determine whether CT was associated with any meaningful gains.When compared with an alternative treatment, we found that CT may have little to no effect on our first primary outcome of global cognition at end of treatment (SMD 0.21, 95% CI -0.23 to 0.64), but the quality of evidence was low. No evidence was available to assess our second primary outcome of clinical disease severity in the medium term. We found moderate-quality evidence showing that CT was associated with improved mood of the caregiver at end of treatment, but this was based on a single trial. The quality of evidence in relation to many other outcomes at end of treatment and in the medium term was too low for us to determine whether CT was associated with any gains, but we are moderately confident that CT did not lead to any gains in mood, behavioural and psychological symptoms, or capacity to perform activities of daily living.

AUTHORS' CONCLUSIONS

Relative to a control intervention, but not to a variety of alternative treatments, CT is probably associated with small to moderate positive effects on global cognition and verbal semantic fluency at end of treatment, and these benefits appear to be maintained in the medium term. Our certainty in relation to many of these findings is low or very low. Future studies should take stronger measures to mitigate well-established risks of bias, and should provide long-term follow-up to improve our understanding of the extent to which observed gains are retained. Future trials should also focus on direct comparison of CT versus alternative treatments rather than passive or active control conditions.

Comparison of Cognitive Intervention Strategies for Older Adults With Mild to Moderate Alzheimer's Disease: A Bayesian Meta-analytic Review

OBJECTIVES

We aimed to identify the best form of cognitive therapy among 3 main cognitive interventions of Alzheimer's disease (AD) including cognitive training (CT), cognitive stimulation (CS), and cognitive rehabilitation (CR).

DESIGN

Systematic review and Bayesian network meta-analysis.

SETTING AND PARTICIPANTS

An exhaustive literature search was conducted based on PubMed, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, the China National Knowledge Infrastructure database, the Chinese Biomedical Literature database, the Wan Fang database, and Web of Science and other database and randomized controlled trials were identified from their inception to May 1, 2018. Older adult participants diagnosed with AD were recruited.

MEASURES

We conducted a Bayesian network meta-analysis (NMA) to rank the included treatments. Cognitive functions were measured based on the Mini-Mental State Examination (MMSE). A series of analyses and assessments, such as the Pairwise meta-analysis and the risk of bias, were performed concurrently.

RESULTS

Only 22 studies were included in our analysis based on a series of rigorous screenings, which comprised 1368 participants. No obvious heterogeneities were found in NMA (I² = 32.7%, P = .07) after the data were pooled. The mean difference (MD) of CT [MD = 2.1, confidence interval [CI]: 1.0, 3.2), CS (MD = 0.92, CI: -0.20, 2.0), and CR (MD = 2.0, CI: 0.73, 3.4) showed that CT and CR could significantly improve cognitive function as measured by MMSE in the treatment group whereas the CS was less effective. CT had the highest probability among the 3 cognitive interventions [the surface under the cumulative ranking curve (SUCRA) = 84.7%], followed by CR (SUCRA = 50.0%) and CS (SUCRA = 47.4%).

CONCLUSIONS/RELEVANCE

Our study indicated that the CT might be the best method for improving the cognitive function of AD patients. The findings from our study may be useful for policy makers and service commissioners when they make choices among different alternatives.

Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial

BACKGROUND/AIMS

There is no consensus regarding the optimal nonpharmacological intervention to slow down dementia-related decline. We examined whether physical stimulation interventions were effective in reducing cognitive, physical, mood, and behavioral decline in nursing home residents with dementia.

METHODS

Eighty-seven nursing home residents with dementia were randomly assigned to 3 physical activity interventions: activities of daily living (ADL) training, multicomponent exercise training, or combined multicomponent exercise and ADL training. Outcomes were measured at baseline, and after 3 and 6 months.

RESULTS

A 6-month ADL training benefitted executive functions, physical endurance, and depression among men. Exercise training benefitted only grip strength of participants with mild-to-moderate cognitive impairment. A combined training benefitted functional mobility compared to ADL training, depressive symptoms and agitation compared to exercise training, and physical endurance compared to no physical stimulation.

CONCLUSIONS

ADL training appears to be effective for nursing home residents with moderately severe dementia. It remains unclear whether exercise training is an effective type of stimulation.

Cognitive training for people with mild to moderate dementia

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To evaluate the effects of cognitive training on cognitive and non‐cognitive outcomes for people with mild to moderate dementia and their caregivers. To compare the effects of cognitive training with those of other non‐pharmacological interventions, including cognitive stimulation or rehabilitation. To identify and explore factors related to intervention and trial design that may be associated with the efficacy of cognitive training.

Exploring computerised cognitive training as a therapeutic intervention for people with Huntington's disease (CogTrainHD): protocol for a randomised feasibility study

BACKGROUND

Cognitive impairments, especially deficits of executive function, have been well documented as a core and early feature in Huntington's disease (HD). Cognitive impairments represent considerable burden and can be devastating for people and families affected by HD. Computerised cognitive training interventions that focus on improving executive function present a possible non-pharmacological treatment option. We propose to determine the feasibility, acceptability, and appropriate outcome measures for use in a randomised controlled feasibility study.

METHODS/DESIGN

Participants will be randomised into either a computerised cognitive training group or a control group. Those randomised to the training group will be asked to complete a cognitive training intervention based on the HappyNeuron Pro software tasks of executive function, for a minimum of 30 min, three times a week for the 12-week study duration. Participants in the control group will not receive computerised cognitive training but will receive a similar degree of social interaction via equivalent study and home visits. We will explore quantitative outcome measures, including measures of cognitive performance, motor function, questionnaires and semi-structured interviews, as well as magnetic resonance imaging (MRI) measures in a subset of participants. Feasibility will be determined through assessment of recruitment, retention, adherence and acceptability of the intervention.

DISCUSSION

The results of this study will provide crucial guidance and information regarding the feasibility of conducting a randomised controlled study into computerised cognitive training in HD. This study is crucial for the development of larger definitive randomised controlled trials which are powered to determine efficacy and for the development of future cognitive training programmes for people affected by HD.

TRIAL REGISTRATION

The study is registered on clinicaltrials.gov and has the unique identifier NCT02990676.

Effectiveness of cognition-focused interventions in activities of daily living performance in people with dementia: A systematic review

Introduction

Dementia affects cognitive functions and has a direct impact on the ability to perform activities of daily living. Studies have focused on the impact of cognition-focused interventions on cognitive functions, but less on the daily functionality of people with dementia. The aim of this study was to review systematically evidence of the effectiveness of cognition-focused interventions on the ability of people with dementia to perform activities of daily living.

Method

A search of randomised controlled trials was performed in 10 databases to find all available evidence on the subject. Two reviewers independently selected articles based on predetermined inclusion criteria. The articles had to describe randomised controlled trials involving cognition-focused interventions in people with some form of dementia, aged 65 years or over, and specify their score on the Mini-Mental State Examination or the Clinical Dementia Rating. Eleven articles met the inclusion criteria for the review.

Results

Cognitive rehabilitation through functional tasks led to maintenance or improvement in everyday tasks in some cases. In cognitive stimulation studies the subjects maintained their performance in activities of daily living with respect to the control condition, but this was not the case in reminiscence stimulation groups. Subjects who underwent cognitive training of cognitive functions did not show significant improvements in activities of daily living.

Conclusion

The evidence on the effectiveness of cognition-focused interventions suggests that multi-component programmes that include cognitive rehabilitation or cognitive stimulation could maintain or improve functionality in people with dementia.

ApoE and SNAP-25 Polymorphisms Predict the Outcome of Multidimensional Stimulation Therapy Rehabilitation in Alzheimer’s Disease

Background. Alzheimer’s disease (AD) is a highly prevalent neurodegenerative disorder. Rate of decline and functional restoration in AD greatly depend on the capacity for neural plasticity within residual neural tissues; this is at least partially influenced by polymorphisms in genes that determine neural plasticity, including Apolipoprotein E4 ( ApoE4) and synaptosomal-associated protein of 25 kDa ( SNAP-25). Objective. We investigated whether correlations could be detected between polymorphisms of ApoE4 and SNAP-25 and the outcome of a multidimensional rehabilitative approach, based on cognitive stimulation, behavioral, and functional therapy (multidimensional stimulation therapy [MST]). Methods. Fifty-eight individuals with mild-to-moderate AD underwent MST for 10 weeks. Neuro-psychological functional and behavioral evaluations were performed blindly by a neuropsychologist at baseline and after 10 weeks of therapy using Mini-Mental State Examination (MMSE), Functional Living Skill Assessment (FLSA), and Neuropsychiatric Inventory (NPI) scales. Molecular genotyping of ApoE4 and SNAP-25 rs363050, rs363039, rs363043 was performed. Results were correlated with ΔMMSE, ΔNPI and ΔFLSA scores by multinomial logistic regression analysis. Results. Polymorphisms in both genes correlated with the outcome of MST for MMSE and NPI scores. Thus, higher overall MMSE scores after rehabilitation were detected in ApoE4 negative compared to ApoE4 positive patients, whereas the SNAP-25 rs363050(G) and rs363039(A) alleles correlated with significant improvements in behavioural parameters. Conclusions. Polymorphisms in genes known to modulate neural plasticity might predict the outcome of a multistructured rehabilitation protocol in patients with AD. These data, although needing confirmation on larger case studies, could help optimizing the clinical management of individuals with AD, for example defining a more intensive treatment in those subjects with a lower likelihood of success.

Cognitive training modifies disease symptoms in a mouse model of Huntington's disease

Huntington's disease (HD) is an incurable neurodegenerative disorder which causes a triad of motor, cognitive and psychiatric disturbances. Cognitive disruptions are a core feature of the disease, which significantly affect daily activities and quality of life, therefore cognitive training interventions present an exciting therapeutic intervention possibility for HD. We aimed to determine if specific cognitive training, in an operant task of attention, modifies the subsequent behavioural and neuropathological phenotype of the Hdh(Q111) mouse model of HD. Three testing groups comprising both Hdh(Q111) mice and wildtype controls were used. The first group received cognitive training in an operant task of attention at 4months of age. The second group received cognitive training in a comparable non-attentional operant task at 4months of age, and the third group were control animals that did not receive cognitive training. All groups were then tested in an operant task of attention at 12months of age. Relative to naïve untrained mice, both wildtype and Hdh(Q111) mice that received cognitive training in the operant task of attention demonstrated an increased number of trials initiated, greater accuracy, and fewer 'time out' errors. A specific improvement in response time performance was observed in Hdh(Q111) mice, relative to naïve untrained Hdh(Q111) mice. Relative to the group that received comparable training in a non-attentional task, both wildtype and Hdh(Q111) mice that received attentional training demonstrated superior accuracy in the task and made fewer 'time out' errors. Despite significant behavioural change, in both wildtype and Hdh(Q111) mice that had received cognitive training, no significant changes in neuropathology were observed between any of the testing groups. These results demonstrate that attentional cognitive training implemented at a young age significantly improves attentional performance, at an older age, in both wildtype and Hdh(Q111) mice. Attentional cognitive training also improved motor performance in Hdh(Q111) mice, thus leading to the conclusion that cognitive training can improve disease symptoms in a mouse model of HD.

Cognitive Training in a Large Group of Patients Affected by Early-Stage Alzheimer's Disease can have Long-Lasting Effects: A Case-Control Study

Introduction: Cognitive training in Alzheimer's disease (AD) has recently started to demonstrate its efficacy. We used our ‘puzzle-like’ task (GEO) as training for a large group of early-stage AD patients, to detect its effects over time.

Method: AD patients (N = 40) and healthy controls (N = 40) were involved. Participants were administered the Geographical Exercises for cognitive Optimization (GEO) task. Participants underwent individual sessions with GEO three times a week for 2 months, and then their performance was recorded again. Lastly, at the 12-month follow-up the GEO task was administered for the last time.

Results: Patients’ scores were significantly worse than controls’ scores only on a few neuropsychological tests. We ran a repeated measures GLM by considering groups’ performance on the GEO task at the assessment points. Results showed a significant main effect of group, and a significant effect of the interaction between group and time: patients’ performances both at the end of the training and at the follow-up were virtually identical to controls’ performances.

Conclusions: Patients effectively acquired new procedural abilities, and their achievements were stable at follow-up. This study suggests the GEO is a useful strategy for cognitive training in AD, and should prompt further investigations about the degree of generalisability of patients’ acquired skills.

Study of Spirituality in Elderly With Subjective Memory Complaints

Subjective memory complaints are very common among elderly. They can be due to depression, cognitive decline, or be a part of normal aging process. Spirituality is another important dimension in elderly, and it is believed to help them cope with various adversities. This study was done to find out whether any relation exists between these 2 variables in elderly. A total of 120 elderly individuals, presenting with subjective memory complaints, were divided into 3 groups - controls, elderly with depression, and elderly with mild cognitive impairment (MCI). Spirituality in them was studied by dividing it into the subdomains of self-transcendence, presence of meaning in life, search for meaning in life, and locus of control. Spirituality was the highest in controls, followed by MCI group, and then depression group. Spirituality had a direct negative relationship with severity of depression, while relationship of spirituality with severity of cognitive decline was more complex. Relationship of spirituality with mental health status in elderly patients seemed bidirectional, that is, cause as well as effect relationship.

Cognitive rehabilitation for elderly people with early-stage Alzheimer's disease

[Purpose] The purpose of this study was to investigate the effect of cognitive rehabilitation including tasks of cognitive training on performance of everyday activities in elderly people with early-stage Alzheimer’s disease. [Subjects and Methods] Forty-three elderly people (15 men, 28 women) with a diagnosis of Alzheimer’s disease who had a Mini-Mental State Examination (MMSE) score of 18 or above were randomly assigned to two groups: the cognitive rehabilitation group (experimental) and control group. This study used a randomized controlled trial design. Cognitive rehabilitation is consisted of 8 sessions, each lasting 60 minutes (individual 30 min, group 30 min). The eight weekly individual sessions of cognitive rehabilitation were performed consisting of an individualized intervention focusing on a personally meaningful goal. The eight weekly group sessions involved practicing time-and-place orientation, matching faces and names, and learning memory and sustaining attention. [Results] Significant improvements were observed in rating of occupation performance and satisfaction, Quality of Life in Alzheimer’s Disease (QOL-AD), and the orientation subscale of the MMSE in the experimental group, whereas participants in the control group did not show any significant difference in any tests between before and after the intervention. [Conclusion] Cognitive rehabilitation including tasks of cognitive training is an effective intervention for improving performance and satisfaction with respect to activities of daily living and specific cognitive functions.

RELATING MOTOR AND COGNITIVE INTERVENTIONS IN ANIMALS AND HUMANS

Cognition and motor performance are essential components of human functioning. Recent research has provided evidence that these two domains are more interrelated than previously thought. This is a potentially important area of research with many questions that warrant further exploration and have practical implications to the field of neurological rehabilitation. In this review of literature we included animals and humans in healthy conditions as well as pathological conditions affecting the central nervous system. Our primary goal was to comprehensively review the relevant basic science and clinical literature on the effects of motor interventions on cognitive function and vice versa. We found more evidence supporting positive effects of exercise on cognition than effects of cognitive training on motor function. In addition, we examined the extent to which findings from animal literature have been or can be translated to humans. We found that, with the exception of one study in monkeys, most animal studies which investigate rodents are somewhat challenging to translate to human studies, independent of the intervention employed. It is difficult to find a human parallel to exercise in rodents, because both the voluntary and forced exercise paradigms used in rodents happen in a different context than humans. In addition it is difficult to find an animal parallel to cognitive training in humans, because the environmental enrichment intervention cannot be considered "purely" cognitive stimulation as it also involves sensory, motor and social components. We conclude the review by suggesting avenues for future research and intervention strategies.

A combination of physical activity and computerized brain training improves verbal memory and increases cerebral glucose metabolism in the elderly

Physical exercise interventions and cognitive training programs have individually been reported to improve cognition in the healthy elderly population; however, the clinical significance of using a combined approach is currently lacking. This study evaluated whether physical activity (PA), computerized cognitive training and/or a combination of both could improve cognition. In this nonrandomized study, 224 healthy community-dwelling older adults (60-85 years) were assigned to 16 weeks home-based PA (n=64), computerized cognitive stimulation (n=62), a combination of both (combined, n=51) or a control group (n=47). Cognition was assessed using the Rey Auditory Verbal Learning Test, Controlled Oral Word Association Test and the CogState computerized battery at baseline, 8 and 16 weeks post intervention. Physical fitness assessments were performed at all time points. A subset (total n=45) of participants underwent [(18)F] fluorodeoxyglucose positron emission tomography scans at 16 weeks (post-intervention). One hundred and ninety-one participants completed the study and the data of 172 participants were included in the final analysis. Compared with the control group, the combined group showed improved verbal episodic memory and significantly higher brain glucose metabolism in the left sensorimotor cortex after controlling for age, sex, premorbid IQ, apolipoprotein E (APOE) status and history of head injury. The higher cerebral glucose metabolism in this brain region was positively associated with improved verbal memory seen in the combined group only. Our study provides evidence that a specific combination of physical and mental exercises for 16 weeks can improve cognition and increase cerebral glucose metabolism in cognitively intact healthy older adults.

Effect of unawareness on rehabilitation outcome in a randomised controlled trial of multicomponent intervention for patients with mild Alzheimer's disease

Unawareness of deficit has been shown to affect the outcome of targeted cognitive intervention programmes applied to patients with Alzheimer' disease (AD), but the effects on multimodal therapeutic approaches have not yet been explored. This research investigated the efficacy of the Multi-Intervention Programme (MIP) approach on improving cognitive, functional, affective, and behavioural symptoms in people with mild AD. In addition, we examined whether the presence of unawareness influences the MIP outcomes. Sixty-one mild stage AD patients were randomly assigned to either an experimental group which carried out an MIP individually (48 sessions, 16 weeks duration), combining diverse cognitive tasks, training in daily life and recreational activities, or a waiting list group which did not receive any treatment for the same time period. The efficacy of MIP (vs. waiting list) was tested using various standardised neuropsychological, functional, and behavioural outcome measures. Planned analyses were carried out to determine the effect of unawareness versus awareness on such outcomes. The results showed that patients overall benefited from the MIP in terms of both cognitive and non-cognitive symptoms. AD patients with awareness of deficits showed positive effects on all outcome measures in comparison with the waiting list group, while AD patients with unawareness showed improvements in non-cognitive symptoms only. In conclusion, the presence of unawareness reduces the cognitive and functional effects of MIP in patients with mild AD.

Multistimulation Group Therapy in Alzheimer’s Disease Promotes Changes in Brain Functioning

Background. The growing social emergency represented by Alzheimer’s disease (AD) and the lack of medical treatments able to modify the disease course have kindled the interest in nonpharmacological therapies. Objective. We introduced a novel nonpharmacological approach for people with AD (PWA) named Multidimensional Stimulation group Therapy (MST) to improve PWA condition in different disease domains: cognition, behavior, and motor functioning. Methods. Enrolling 60 PWA in a mild to moderate stage of the disease, we evaluated the efficacy of MST with a randomized-controlled study. Neuropsychological and neurobehavioral measures and functional magnetic resonance imaging (fMRI) data were considered as outcome measures. Results. The following significant intervention-related changes were observed: reduction in Neuropsychiatric Inventory scale score, improvement in language and memory subscales of Alzheimer’s Disease Assessment Scale–Cognitive subscale, and increased fMRI activations in temporal brain areas, right insular cortex, and thalamus. Conclusions. Cognitive-behavioral and fMRI results support the notion that MST has significant effects in improving PWA cognitive-behavioral status by restoring neural functioning.

Implications of a longitudinal cognitive intervention program in mild Alzheimer's disease

The implications of a longitudinal (5 years) intervention program in a mild Alzheimer's disease (mAD) patient targeting mainly the language deficits were investigated. The program had 2 parts: the intensive one included training strategies and tasks that enhanced his impairments (memory, naming, comprehension), and the second one (the next 4 years), without guidelines or teaching. The first follow up (11 months later) showed significant improvements to memory, categorical verbal fluency, comprehension and written narrative ability even to untrained functions (behavior and functional ability). The second follow up (5 years later) showed retained improvement to delayed memory tasks, language and general cognitive state. Long life cognitive programs retrograde the mAD and seem to maintain the independence of the patient and make remote the possibility of the institutionalization.

Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia

BACKGROUND

Cognitive impairments, particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific interventional approaches designed to address difficulties with memory and other aspects of cognitive functioning. The present review is an update of previous versions of this review.

OBJECTIVES

The main aim of the current review was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation for people with mild Alzheimer's disease or vascular dementia in relation to important cognitive and non-cognitive outcomes for the person with dementia and the primary caregiver in the short, medium and long term.

SEARCH METHODS

The CDCIG Specialized Register, ALOIS, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS and many other clinical trial databases and grey literature sources, was most recently searched on 2 November 2012.

SELECTION CRITERIA

Randomised controlled trials (RCTs), published in English, comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting relevant outcomes for the person with dementia and/or the family caregiver, were considered for inclusion.

DATA COLLECTION AND ANALYSIS

Eleven RCTs reporting cognitive training interventions were included in the review. A large number of measures were used in the different studies, and meta-analysis could be conducted for 11 of the primary and secondary outcomes of interest. Several outcomes were not measured in any of the studies. The unit of analysis in the meta-analysis was the change from baseline score. Overall estimates of treatment effect were calculated using a fixed-effect model, and statistical heterogeneity was measured using a standard Chi(2) statistic. One RCT of cognitive rehabilitation was identified, allowing examination of effect sizes, but no meta-analysis could be conducted.

MAIN RESULTS

Cognitive training was not associated with positive or negative effects in relation to any reported outcomes. The overall quality of the trials was low to moderate. The single RCT of cognitive rehabilitation found promising results in relation to a number of participant and caregiver outcomes, and was generally of high quality.

AUTHORS' CONCLUSIONS

Available evidence regarding cognitive training remains limited, and the quality of the evidence needs to improve. However, there is still no indication of any significant benefit derived from cognitive training. Trial reports indicate that some gains resulting from intervention may not be captured adequately by available standardised outcome measures. The results of the single RCT of cognitive rehabilitation show promise but are preliminary in nature. Further, well-designed studies of cognitive training and cognitive rehabilitation are required to obtain more definitive evidence. Researchers should describe and classify their interventions appropriately using available terminology.

Cognitive rehabilitation therapies for Alzheimer's disease: a review of methods to improve treatment engagement and self-efficacy

Cognitive rehabilitation therapies for Alzheimer's disease (AD) are becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. However, people with AD may have difficulty adhering to these cognitive treatments due to denial of memory deficits, compromised brain systems, cognitive incapacity for self-awareness, general difficulty following through on daily tasks, lack of motivation, hopelessness, and apathy, all of which may be either due to the illness or be secondary to depression. Cognitive rehabilitation training exercises are also labor intensive and, unfortunately, serve as a repeated reminder about the memory impairments and attendant functional consequences. In order for cognitive rehabilitation methods to be effective, patients must be adequately engaged and motivated to not only begin a rehabilitation program but also to remain involved in the intervention until a therapeutic dosage can be attained. We review approaches to cognitive rehabilitation in AD, neuropsychological as well as psychological obstacles to effective treatment in this population, and methods that target adherence to treatment and may therefore be applicable to cognitive rehabilitation therapies for AD. The goal is to stimulate discussion among researchers and clinicians alike on how treatment effects may be mediated by engagement in treatment, and what can be done to enhance patient adherence for cognitive rehabilitation therapies in order to obtain greater cognitive and functional benefits from the treatment itself.

"Keep up the good work"! A case study of the effects of a specific cognitive training in Alzheimer's disease

Alzheimer's disease (AD) is a neurodegenerative condition characterized by significant impairment in multiple cognitive domains. In recent years, the development of cognitive trainings in AD has received significant attention. In the present case study we designed a cognitive training program (GEO, Geographical Exercises for cognitive Optimization) based on an errorless paradigm and tailored to the patient's cultural interests. The aim of this training was to investigate the potential for acquiring and possibly retaining both procedural and verbal knowledge in early-stage AD. This study involved an 80-year-old female patient diagnosed with early-stage AD, and 10 matched healthy subjects. Participants were asked to perform the two GEO training tasks: a "puzzle-like" task for procedural memory, and an "association" task for verbal memory. Both the patient and the healthy controls were subsequently trained with GEO using the same two tasks for 2 months. Although the patient's performance before training in both tasks was poor compared to healthy controls, after the training these differences disappeared. Our results showed that the patient was able to acquire new procedural abilities and verbal knowledge, and that her achievements were stable at the follow-up testing scheduled 3 months after the end of the intervention. This case study suggests a potentially useful strategy for cognitive training in AD.

Non-pharmacological intervention for memory decline

Non-pharmacological intervention of memory difficulties in healthy older adults, as well as those with brain damage and neurodegenerative disorders, has gained much attention in recent years. The two main reasons that explain this growing interest in memory rehabilitation are the limited efficacy of current drug therapies and the plasticity of the human central nervous and the discovery that during aging, the connections in the brain are not fixed but retain the capacity to change with learning. Moreover, several studies have reported enhanced cognitive performance in patients with neurological disease, following non-invasive brain stimulation [i.e., repetitive transcranial magnetic stimulation and transcranial direct current stimulation to specific cortical areas]. The present review provides an overview of memory rehabilitation in individuals with mild cognitive impairment and in patients with Alzheimer’s disease with particular regard to cognitive rehabilitation interventions focused on memory and non-invasive brain stimulation. Reviewed data suggest that in patients with memory deficits, memory intervention therapy could lead to performance improvements in memory, nevertheless further studies need to be conducted in order to establish the real value of this approach.

Physical fidelity versus cognitive fidelity training in procedural skills acquisition

OBJECTIVE

The current study examined whether training simulators for the acquisition of procedural skills should emphasize physical fidelity or cognitive fidelity of the task.

BACKGROUND

Simulation-based training for acquiring and practicing procedural skills is becoming widely established. Generally speaking, these simulators offer technological sophistication but disregard theory-based design, leaving unanswered the question of what task features should be represented in the simulators.The authors compared real-world training and two alternative virtual trainers, one emphasizing physical fidelity and the other cognitive fidelity of the task.

METHOD

Participants were randomly assigned to one of four training groups in a LEGO assembly task: virtual-physical fidelity, cognitive fidelity, real world, and control. A posttraining test to assess the development of procedural skills was conducted.

RESULTS

Both the virtual-physical fidelity and cognitive fidelity training methods produced better performance time than no training at all, as did the real-world training. The cognitive fidelity training was inferior in terms of test time compared to the real-world training, whereas the virtual-physical fidelity training was not. In contrast, only the real-world and the cognitive fidelity groups, and not the virtual-physical fidelity group, required significantly less time than the control group for error correction.

CONCLUSION

The two training methods have complementary advantages.

APPLICATION

Combining physical fidelity and cognitive training methods can enhance procedural skills acquisition when real-world training is not practicable.

A review of the effectiveness of memory interventions in mild cognitive impairment (MCI)

BACKGROUND

Mild cognitive impairment (MCI) is commonly associated with memory impairment. There have been a number of studies attempting to ameliorate this through memory interventions including memory rehabilitation and training. The current paper reviews the evidence for the effectiveness of such interventions in enhancing learning of specific information, their impact on untrained material, compensation for memory impairment and improving everyday functioning.

METHODS

The literature was systematically searched for studies focusing on interventions targeting memory impairment in MCI using relevant search terms. Studies were screened for inclusion or exclusion using a priori criteria and, once identified, studies were examined for quality using pre-specified criteria.

RESULTS

A total of 226 studies were identified in the search, ten of which were included in the final review. Only one study was an RCT of "adequate" methodology. It was tentatively suggested that people with MCI can learn specific information, although there was little evidence to suggest that memory training can generalize. There was some limited evidence of ability to learn to compensate for memory difficulties and contradictory findings regarding improvement in everyday life.

CONCLUSIONS

The poor methodological quality of the included studies implies that the ability to draw conclusions is limited. MCI is a controversial concept and there is a need for good quality trials examining the efficacy of memory interventions. There are some indications that memory impairment in MCI might best be targeted by interventions developing compensatory strategies and targeting the learning of specific information relevant to the individual.

How should we teach everyday skills in dementia? A controlled study comparing implicit and explicit training methods

OBJECTIVE

To compare the immediate and delayed effects of implicit and explicit training methods for everyday skills in patients with dementia.

DESIGN

Counterbalanced self-controlled cases series.

SUBJECTS

Convenience sample of 10 patients with dementia (Mini-Mental State Examination score between 15 and 26) and 16 age- and education-matched controls.

INTERVENTION

Two everyday tasks (using a microwave oven and a coffee machine) that were novel to all participants were trained in five 15-minute sessions. Each participant learned both tasks, one using an implicit learning method (modelling) and the other using an explicit learning method (providing verbal cues). Tasks and conditions were counterbalanced.

MEASURES

The participants' performance was videotaped to assess how well the tasks were performed before training, after each training session, and 7-10 days after the final training session. A rater, who was blind to the training method used, scored the number of correctly executed steps by viewing the videotapes.

RESULTS

The two training methods were effective in both the patient and healthy control groups, with there being a significant baseline-to-follow-up increase in the number of correctly completed steps (P < 0.001). There were no differences between the training methods (P = 0.16) and no significant interaction between training method and group (P = 0.31).

CONCLUSIONS

Older patients with mild dementia are able to acquire new skills that are relevant for daily life, showing a similar rate of learning regardless of whether implicit or explicit learning techniques are used.

Effectiveness of nonpharmacological approaches in patients with mild cognitive impairment

BACKGROUND

Mild cognitive impairment (MCI) patients are at increased risk of developing dementia. There is a conflict if cognitive interventions can improve cognitive and functional performances in order to delay the development of dementia.

OBJECTIVES

This study aimed to examine the effectiveness of a holistic cognitive rehabilitation program on patients with MCI.

METHODS

The participants, 176 MCI patients with Mini-Mental State Examination = 27.89 (1.73), were classified into 2 groups matched for age, gender, education and cognitive abilities: (1) patients (104) on nonpharmacological therapy and (2) patients (72) on no therapy at all. The effectiveness of the interventions was assessed by neuropsychological evaluation performed at baseline and at the end of the interventions.

RESULTS

Between-group difference in benefit of the experimental group was demonstrated in abilities of executive function (p = 0.004), verbal memory (p = 0.003), praxis (p ≤ 0.012), daily function (p = 0.001) and general cognitive ability (p ≤ 0.005). The experimental patients improved cognitive and functional performances, while the control patients demonstrated deterioration in daily function (p = 0.004).

CONCLUSIONS

Our findings indicate that nonpharmacological therapy of the holistic approach can improve MCI patients' cognitive and functional performances.

Cognitive intervention in Alzheimer disease

Alzheimer disease (AD) is one of the most prevalent chronic medical conditions affecting the elderly population. The effectiveness of approved antidementia drugs, however, is limited-licensed AD medications provide only moderate relief of clinical symptoms. Cognitive intervention is a noninvasive therapy that could aid prevention and treatment of AD. Data suggest that specifically designed cognitive interventions could impart therapeutic benefits to patients with AD that are associated with substantial biological changes within the brain. Moreover, evidence indicates that a combination of pharmacological and non-pharmacological interventions could provide greater relief of clinical symptoms than either intervention given alone. Functional and structural MRI studies have increased our understanding of the underlying neurobiological mechanisms of aging and neurodegeneration, but the use of neuroimaging to investigate the effect of cognitive intervention on the brain remains largely unexplored. This Review provides an overview of the use of cognitive intervention in the healthy elderly population and patients with AD, and summarizes emerging findings that provide evidence for the effectiveness of this approach. Finally, we present recommendations for future research on the use of cognitive interventions in AD and discuss potential effects of this therapy on disease modification.

Persons with Alzheimer's disease perform daily activities using verbal-instruction technology: a maintenance assessment

OBJECTIVE

To assess whether verbal-instruction technology could help persons with mild and moderate Alzheimer's disease maintain their recaptured performance of daily activities.

METHODS

This study followed nine patients who had participated in previous studies aimed at helping them recapture one or more functional daily activities (i.e. table setting, coffee, tea or snack preparation, use of make-up and shaving). The plan was to follow each patient for at least 6 months after the intervention, unless his/her condition called for an earlier end of the study.

RESULTS

The study was interrupted after 5 months for two patients who developed serious behavioural problems and continued for 6-14 months for the other seven patients who had largely accurate performance with some adaptations of instructions/steps. Most patients also showed mood improvement during activity.

CONCLUSION

Verbal-instruction technology might be considered a critical tool to help persons with Alzheimer's disease enhance their activity and mood.

Cognitive exercise and its role in cognitive function in older adults

Converging lines of research indicate that complex mental activity is associated with reduced dementia risk. Thus, intense interest exists in whether different forms of cognitive exercise can help protect against cognitive decline and dementia. However, there is considerable confusion in terminology that is hindering progress in the field. We therefore introduce a concrete definition of cognitive training (CT) and make this the focus of our article. Clinical research that has evaluated CT in normal aging, mild cognitive impairment, and dementia is then critically reviewed. Despite many methodological shortcomings, the overall findings indicate that multidomain CT has the potential to improve cognitive function in healthy older adults and slow decline in affected individuals. Finally, practical issues, including the strengths and weaknesses of commercial products, are explored, and recommendations for further research and clinical implementation are made.

Persons with mild and moderate Alzheimer's disease use verbal-instruction technology to manage daily activities: effects on performance and mood

OBJECTIVE

To extend the evaluation of verbal-instruction technology for helping persons with mild and moderate Alzheimer's disease recapture daily activities and improve their mood.

METHODS

Two studies targeted two activities (i.e. snack preparation/sharing and shaving) with six and three new participants, respectively. Intervention effects on activity performance were assessed through non-concurrent multiple baseline designs across participants. The impact of intervention (activity) on mood was assessed by recording indices of happiness or indices of unhappiness during activity and non-activity trials.

RESULTS

The use of a technology providing verbal instructions helped all participants perform the target activities. Performance was largely accurate with seven of the participants. Eight of the participants also showed mood improvement (i.e. increases in indices of happiness or decreases in indices of happiness) during activity.

CONCLUSION

These results suggest that the approach reported may be a useful strategy for helping persons with Alzheimer's disease enhance their activity and mood.

Cognitive rehabilitation: Literature review based on levels of evidence

The aim of this study was to review the scientific publications on cognitive rehabilitation in Alzheimer's disease by year published and methodology employed. The principles of systematic review by the Brazilian Cochrane Center were used. Reviews conducted by this Center were identified together with those held on the LILACS and Medline scientific databases. Nine levels of evidence were considered for analysis and a total of 37 articles were found. The results showed a growing number of publications from 2001 onwards, with majority being published early this decade. Few studies have been published on cognitive rehabilitation, with an average of three articles published per year during the study period (1985-2008). The highest levels of evidence were observed in the more recently published studies. Cognitive rehabilitation can yield greater benefits in rehabilitating patients when associated with other forms of intervention. The latest studies demonstrating greater scientific evidence concluded that results remain limited and that further studies on the topic are needed.

Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial

We performed a pilot randomized, controlled trial of intensive, computer-based cognitive training in 47 subjects with mild cognitive impairment. The intervention group performed exercises specifically designed to improve auditory processing speed and accuracy for 100 min/d, 5 d/wk for 6 weeks; the control group performed more passive computer activities (reading, listening, visuospatial game) for similar amounts of time. Subjects had a mean age of 74 years and 60% were men; 77% successfully completed training. On our primary outcome, Repeatable Battery for Assessment of Neuropsychological Status total scores improved 0.36 standard deviations (SD) in the intervention group (P=0.097) compared with 0.03 SD in the control group (P=0.88) for a nonsignificant difference between the groups of 0.33 SD (P=0.26). On 12 secondary outcome measures, most differences between the groups were not statistically significant. However, we observed a pattern in which effect sizes for verbal learning and memory measures tended to favor the intervention group whereas effect sizes for language and visuospatial function measures tended to favor the control group, which raises the possibility that these training programs may have domain-specific effects. We conclude that intensive, computer-based mental activity is feasible in subjects with mild cognitive impairment and that larger trials are warranted.

Persons with moderate Alzheimer's disease improve activities and mood via instruction technology

BACKGROUND

Three studies assessed the (a) effectiveness of verbal instructions presented via technology in helping persons with moderate Alzheimer's disease perform daily activities and (b) impact of activity engagement on mood.

METHODS

The 3 studies targeted coffee preparation with 2 women, use of make-up with 2 women, and use of make-up and tea preparation with 3 women. Intervention effects on activity performance were assessed through nonconcurrent multiple baseline designs across participants or multiple baseline designs across activities. The impact of activity on mood was assessed by recording indices of happiness during activity trials and parallel nonactivity periods.

RESULTS

Verbal instructions presented via technology were effective in helping all participants perform the target activities. The participants also showed mood improvement (ie, increases in indices of happiness) during the activity.

CONCLUSION

These results suggest that the approach reported may be a useful strategy for helping persons with Alzheimer's disease.

Helping persons with mild or moderate Alzheimer's disease recapture basic daily activities through the use of an instruction strategy

PURPOSE

The present three pilot studies assessed the effectiveness of verbal instructions, presented automatically through simple technology, in helping persons with mild-to-moderate Alzheimer's disease recapture basic daily activities. The activities were morning bathroom routine, dressing, and table-setting.

METHOD

The studies that focused on morning bathroom routine and on table-setting included three participants each, while the study that focused on dressing involved four participants. A non-concurrent multiple baseline design across participants was used for each study. The instructions and technology were available only during the intervention phases.

RESULTS

Data showed that the intervention strategy involving verbal instructions for the single activity steps presented automatically through technology was effective in helping all participants on each of the activities. The participants' mean percentages of correct steps across activities raised from 13 - 54 during the baseline periods to above 80 or 90 during the intervention periods.

CONCLUSIONS

The results suggest that the intervention strategy reported may represent a suitable approach for helping persons with mild or moderate Alzheimer's disease to recapture basic daily activities. New research should target other activities and check maintenance and generalization issues.

Persons with mild or moderate Alzheimer's disease managing daily activities via verbal instruction technology

Four studies assessed the effectiveness of verbal instructions presented via technology in helping persons with mild or moderate Alzheimer's disease perform daily activities. The first 2 studies were replication efforts concerning morning bathroom routine and table setting and included 4 and 2 participants, respectively. The third study targeted coffee preparation with 3 participants. The fourth study assessed maintenance and generalization of morning bathroom routine and dressing with 1 participant. Nonconcurrent multiple baseline designs served for the first 3 studies and a 5-month postintervention data collection for the fourth study. Verbal instructions for the activity steps presented via technology were effective in helping the participants of the first 3 studies reacquire basic daily activities and the participant of the fourth study retain the reacquired activities across time and settings. These results suggest that the approach reported may be a useful strategy for helping persons with Alzheimer's disease.

Multidyad memory notebook intervention for very mild dementia: a pilot study

This pilot study examines the efficacy of a group memory notebook intervention. Five individuals with very mild dementia and 4 spouses who served as coaches attended 14 group treatment sessions. Therapists use educational strategies and learning activities packets to teach memory notebook use. At posttreatment, coaches report fewer symptoms of depression, and participants with very mild dementia report greater confidence in ability to obtain support. Modified laboratory memory testing reveals that participants with dementia demonstrate improved posttreatment memory scores because of increased note-taking behavior and more frequent referencing of notes. Although more frequent everyday memory strategies use is reported at posttreatment, this does not translate into reports of fewer everyday memory failures or greater everyday independence for the participants with dementia. This study demonstrates that a multidyad group intervention can successfully be used to teach patients with very mild dementia to use a memory notebook, with beneficial effects for both members of the care dyad.

Nonpharmacological cognitive interventions in aging and dementia

There have been increasing efforts to develop cognitive interventions to ameliorate cognitive problems experienced by older adults. In healthy elderly populations, cognitive training has centered on the enhancement of memory and speed of processing, with the goal of maximizing current function and reducing the risk of cognitive decline. Among elderly persons with nonprogressive neurological conditions such as traumatic brain injury (TBI) and stroke, there has been an emphasis on rehabilitation to help restore function. Most recently, there has been increased attention on the development of new cognitive techniques to treat persons with progressive neurodegenerative conditions such as Alzheimer disease. The literature is reviewed on current approaches to cognitive interventions in elderly healthy populations, and a particular emphasis is placed on the most recent strides in progressive neurocognitive conditions, particularly Alzheimer disease. Important issues such as study design, the use of ecologically and functionally valid outcome measures, the need to examine heterogeneous populations and cross-cultural variables, and the incorporation of technologically based systems are examined. It is concluded that cognitive interventions in the elderly show considerable promise and deserve further study.

Enhanced cognitive activity--over and above social or physical activity--is required to protect Alzheimer's mice against cognitive impairment, reduce Abeta deposition, and increase synaptic immunoreactivity

Although social, physical, and cognitive activities have each been suggested to reduce the risk of Alzheimer's disease (AD), epidemiologic studies cannot determine which activity or combination of activities is most important. To address this question, mutant APP transgenic AD mice were reared long-term in one of four housing conditions (impoverished, social, social+physical, or complete enrichment) from 1(1/2) through 9 months of age. Thus, a stepwise layering of social, physical, and enhanced cognitive activity was created. Behavioral evaluation in a full battery of sensorimotor, anxiety, and cognitive tasks was carried out during the final 5 weeks of housing. Only AD mice raised in complete enrichment (i.e., enhanced cognitive activity) showed: (1) protection against cognitive impairment, (2) decreased brain beta-amyloid deposition, and (3) increased hippocampal synaptic immunoreactivity. The protection provided by enhanced cognitive activity spanned multiple cognitive domains (working memory, reference learning, and recognition/identification). Cognitive and neurohistologic benefits of complete enrichment occurred without any changes in blood cytokine or corticosterone levels, suggesting that enrichment-dependent mechanisms do not involve changes in the inflammatory response or stress levels, respectively. These results indicate that the enhanced cognitive activity of complete enrichment is required for cognitive and neurologic benefit to AD mice-physical and/or social activity are insufficient. Thus, our data suggest that humans who emphasize a high lifelong level of cognitive activity (over and above social and physical activities) will attain the maximal environmental protection against AD.