Efficacy of Cognitive Rehabilitation in Alzheimer Disease: A 1-Year Follow-Up Study

Abstract

Introduction: The benefit of cognitive rehabilitation (CR) for patients with early-stage Alzheimer disease (AD) remains difficult to assess. Method: An observational, prospective study was conducted in a sample of 52 patients with AD included in a clinical, individualized CR program. Cognitive rehabilitation consisted of 1 weekly session during 3 months at home, followed by 1 monthly contact for 9 months. Rehabilitation techniques were used by experienced therapists to adapt activities important for the patient. Evaluation of patient's dependence in activities and objective and subjective caregiver's burden was performed with a research quantitative scale immediately after the intervention and at 6-month and 1-year follow-up. Results: Analyses with repeated measure analysis of variance showed decreased patient's dependence for adapted activities at 3 months, 6 months, and 1 year. Objective and subjective percentage of caregiver's burden was also decreased at all evaluations with our research functional scale, while there was no change on Zarit's burden scale. Global cognition slightly decreased over 1 year. Conclusions: This observational study in a clinical setting is in line with the benefit of CR for patients with mild AD reported in recent randomized controlled trials. The benefit obtained for adapted activities remained after 1 year, even if global cognition declined. Moreover caregiver's burden related to all individually relevant daily activities (from a list of 98) evaluated within the CR program was decreased after 1 year. Those preliminary results emphasize the importance of choice for the measurement instrument to report CR efficacy and claim for further validation of such tools.

Efficacy of Cognitive Rehabilitation Versus Usual Treatment at Home in Patients With Early Stages of Alzheimer Disease

“…Measuring the benefit of CR for caregivers remains quite difficult. 8 As in our previous study, 21 and contrary to a recent RCT, 7 we could not demonstrate any benefit on caregiver's burden with the classical Zarit burden interview. 16 However, the score on this scale did not increase in the CR group despite an increase in global cognitive impairment.…”

“…The procedure is illustrated elsewhere. 21 Briefly, the caregiver had to identify and estimate the difficulties in 98 daily life activities. The total score corresponded to the severity of reported difficulties, with 0 point if no difficulties, 1 point for lack of activity initiation, omission of one or several steps, or wrong execution of one or several steps (maximum 3 points), 4 points corresponding to perseveration errors, and 5 points if the activity could not be carried out; points were summed over all the assessed activities and expressed in percentage of the maximal dependency score.…”

The Impact of a Twelve-Month Comprehensive Program of Cognitive Training for Alzheimer Patients: A Pilot Study

“…This decline was lower compared to the average annual rate of change with no treatment reported by other studies: 3.6 points [42], 2.3 points [37], and 2.2 points [13]. Germain et al [43] observed a two-point decrease in the MMSE from baseline to twelve months in AD patients subjected to cognitive rehabilitation.…”

Cognitive-Based Therapies in Alzheimer Disease

“…Ayrıca bu hastaların bakım verenlerinin duygusal tükenmişliğinde kontrollere göre artma olmadığı ve hatta 1 yıl sonraki günlük aktivitelerle ilişkili bakım veren tükenmişliğinde azalma olduğu gösterilmiştir. 25 BR, aynı zamanda yaşam kalitesini iyileştiren ve sağlık kurumuna yatışı geciktiren uygulanabilir bir yaklaşımdır. 26,27 AH sürecinin önemli bir parçası hastaların %90-98'inde görülen, davranışsal ve psikiyatrik belirtilerdir.…”