Procedural memory stimulation in Alzheimer's disease: impact of a training programme

Abstract

The study evaluates the efficacy of a procedural memory stimulation programme in mild and mild-moderate Alzheimer's disease (AD). Twenty basic and instrumental activities of daily living have been selected, and divided into two groups, comparable for difficulty. Ten normal elderly subjects (age 68.0 +/- 4.8 years; MMSE score: 28.7 +/- 0.9; education: 7.6 +/- 3.5 years) were asked to perform the two groups of daily activities and the time required to perform the tasks of each group was recorded and used as a reference. Ten mild and mild-moderate AD patients (age 77.2 +/- 5.3 years; MMSE score: 19.8 +/- 3.5; education: 7.3 +/- 4.7 years) without major behavioural disturbances constituted the experimental group. Patients were evaluated in all 20 daily activities and the time employed was recorded at baseline and after a 3-week training (1 h/d, 5 d/week) period. Five patients were trained during the 3 weeks on half of the 20 daily activities and the other five patients were trained on the remainder. This procedure was adopted in order to detect separately the improvement in "trained" and "not trained" activities, allowing to control better the effects of the intervention. The assessment of the functional impact of the training was directly measured, through the variation of time employed to perform tasks before and after training. After 3 weeks of training a significant improvement was observed for the trained activities, from 3.6 to 1.9 standard deviations below the performance of the normal elderly controls (P < 0.05). AD patients improved also in not-trained activities from 3.5 to 2.7 standard deviations below the controls' performance (P < 0.05). The rehabilitation of activities of daily living through developing procedural memory strategies may be effective in mild and mild-moderate AD patients.

Nonpharmacological Treatment of Alzheimer Disease

“…Additional research into implicit learning techniques included a small RCT with 20 people with mild-to-moderate AD randomized to an active treatment group receiving an intervention that targeted 20 key activities designed to improve motor skills, or to a control group. 25 During 3 weeks, the active treatment group learned these activities more successfully than the control group.…”

Implementación de un programa de estimulación cognitiva en personas con demencia tipo Alzheimer: un estudio piloto en chilenos de la tercera edad

“…Tales hallazgos resultan coincidentes con lo que la literatura ha señalado, ya que resulta poco probable que las modificaciones en áreas cognitivas, fundamentalmente, puedan tener impactos significativos en las áreas de funcionamiento e independencia Zanetti et al, 1997;Zanetti et al, 2001).…”

Tratamento da doença de Alzheimer: recomendações e sugestões do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Aprendizado com a utilização da memória implí -c i t a p re s e rvada parece ser útil em pacientes com quadros leves a moderados, por meio de técnicas de p r é -a t i v a ç ã o ('priming') e de memória de pro c ed i m e n t o. Podem ser realizados por meio da técnica de ensaio pro g re s s i v o ('expanding rehearsal technique') com resultados positivos, porém sem generalização; método das pistas evanescentes ( ' m e t h o d of vanishing cues') 8 8 , 8 9 ; a p rendizado sem erro ( ' e rrorless learning') em que casos isolados ou em nú-m e ro reduzido são relatados na DA 9 0 . Estudo randomizado comparando dois programas de tre i n amento com memória de procedimento e tre i n amento de funções cognitivas pre s e rvadas mostro u melhora nas atividades de vida diária no gru p o com treinamento das atividades diárias [91][92][93] . Os auxílios mnemônicos externos ( c a l e n d á r i o s , diários, cadernos de memória) são estratégias da reabilitação que necessitam de estudos bem cont rolados em DA, havendo evidências que pare c e m apontar na melhora do funcionamento dos pacientes 90,94 .…”