Cognitive Rehabilitation Therapies for Alzheimer’s Disease: A Review of Methods to Improve Treatment Engagement and Self-Efficacy

Abstract

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.

The Cognitive Effects of Wearable Cameras in Mild Alzheimer Disease – An Experimental Study

“…These similar effects between SenseCam and Memo+ might indicate that the SenseCam, which was our "test" intervention in this study, is not necessarily a better alternative to a traditional and intensive memory training programmes, because its effects in cognitive performance of AD patients are equivalent. However, the passive nature of SenseCam intervention, the pleasantness of using the device and the social nature of reviewing its images (for example: "I really like to see what I was doing these days with my daughter"), coupled with the low burden for caregivers compared to other external memory aids (e.g., a written diary) makes it a practical solution when there are few human resources to provide active cognitive interventions like Memo+ and also an alternative resource for patients who tend to deny their difficulties (in the mild stages, this is common, [32]). Therefore, it is our opinion that the best way to provided more confidence in this device as an efficient alternative to traditional memory training interventions would be usability testing to examine how enjoyable are each tool is to use (such as is done, for example, with online cognitive training platforms, [53]).…”

“…In short, we included training and practice in the following domains: exercises to improve motivation [32], attention [33], working memory [34], autobiographical and episodic memory [35,36,37,38] semantic memory [39] and implicit memory [40]. An adapted motivational interview was constructed for the start of the sessions [32] (that included a set of open questions regarding the actual interest of the participants in taking part in the study, expectations about possible gains to be obtained in the study, and also questions regarding the prior existence of self-initiated activities to stimulate the brain -such as crosswords, Sudoku, reading, etc.) and some psychoeducation was given at the first session about neurodegenerative diseases and the content of the cognitive training sessions.…”

Effect of Cognitive Rehabilitation on Set-Shifting Attention of Adult with Mild Cognitive Impairment

“…According to Olsen (2004), it seems that training can increase the plasticity of the brain as a result of cognitive stimulation and sensory and psychic activities (Choi & Twamley, 2013). Also, the attempt to return the missing cognitive capacities through exercises and target-based stimulants (training) led to recovery on the part of MCI individuals in the experimental group.…”

“…The study by Small et al (2006), implementing a 14-day brain stimulant combination program, verbal memory training, physical exercise, stress reduction , and a healthy food diet revealed better verbal fluency and the reduction of the left dorsolateral prefrontal cortex on the part of the participants. The reduction of the related cortex activity represents the cognitive skills of a brain region that is involved in working memory (Choi & Twamley, 2013). In summary, there are two main approaches regarding cognitive rehabilitation; the first one is the compensation or recovery process, while the second is cognitive therapy.…”

Metabolomics in the Study of Alzheimer's Disease

“…The search for therapeutic treatments at all phases of cognitive decline is imperative since up to date, no drug can reverse pathological process of this chronic disease. On the other hand, there are evidences suggesting that concurrent pharmacologic and behavioral methods may exploit functional benefits for patients suffering from dementia [41,42]. Although no specific disease-modifying treatment has yet been shown to be effective for dementias, it is particularly important to develop effective, targeted treatments to halt or delay the onset of cognitive decline from preclinical and MCI states to AD related dementia.…”