Goal-Oriented Cognitive Rehabilitation for People With Early-Stage Alzheimer Disease: A Single-Blind Randomized Controlled Trial of Clinical Efficacy

被引:213
作者
Clare, Linda [1 ]
Linden, David E. J. [1 ]
Woods, Robert T. [1 ]
Whitaker, Rhiannon [2 ]
Evans, Suzannah J. [1 ]
Parkinson, Caroline H. [1 ]
van Paasschen, Jorien [1 ]
Nelis, Sharon M. [1 ]
Hoare, Zoe [2 ]
Yuen, Kenneth S. L. [1 ]
Rugg, Michael D. [3 ]
机构
[1] Bangor Univ, Sch Psychol, Bangor LL57 2AS, Gwynedd, Wales
[2] Bangor Univ, N Wales Org Randomised Trials Hlth NWORTH, Bangor LL57 2AS, Gwynedd, Wales
[3] Univ Calif Irvine, Ctr Neurobiol Learning & Memory, Irvine, CA 92717 USA
关键词
Goal attainment; clinometric measure; memory; carer; fMRI; DEMENTIA; PLASTICITY; NETWORK; RECALL;
D O I
10.1097/JGP.0b013e3181d5792a
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objectives: To provide evidence regarding the clinical efficacy of cognitive rehabilitation (CR) in early-stage Alzheimer disease (AD). Design: Single-blind randomized controlled trial comparing CR with relaxation therapy and no treatment. Setting: Outpatient, community-based setting. Participants: Sixty-nine individuals (41 women, 28 men; mean age 77.78 years, standard deviation 6.32, range = 56-89) with a diagnosis of AD or mixed AD and vascular dementia and a Mini-Mental State Examination score of 18 or above, and receiving a stable dose of acetylcholinesterase-inhibiting medication. Forty-four family carers also contributed. Intervention: Eight weekly individual sessions of CR consisting of personalized interventions to address individually relevant goals supported by components addressing practical aids and strategies, techniques for learning new information, practice in maintaining attention and concentration, and techniques for stress management. Measurements: The primary outcomes were goal performance and satisfaction, assessed using the Canadian Occupational Performance Measure. Questionnaires assessing mood, quality of life and carer strain, and a brief neuropsychological test battery were also administered. A subset of participants underwent functional magnetic resonance imaging (fMRI). Results: CR produced significant improvement in ratings of goal performance and satisfaction, whereas scores in the other two groups did not change. Behavioral changes in the CR group were supported by fMRI data for a subset of participants. Conclusions: The findings support the clinical efficacy of CR in early-stage AD. CR offers a means of assisting people with early-stage AD and their families in managing the effects of the condition. (Am J Geriatr Psychiatry 2010; 18:928-939)
引用
收藏
页码:928 / 939
页数:12
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