Regular Research Article
A Randomized Cross-over Controlled Study on Cognitive Rehabilitation of Instrumental Activities of Daily Living in Alzheimer Disease

https://doi.org/10.1016/j.jagp.2013.03.008Get rights and content

Objective

The goal of the study was to investigate the effectiveness of a memory rehabilitation program to re-learn instrumental activities of daily living (IADLs) in patients with Alzheimer disease (AD).

Design

This was a 6-month block-randomized cross-over controlled study.

Setting

All evaluation and training sessions were performed at each patient's home.

Participants

Twenty participants with mild to moderate AD.

Intervention

The trained IADL was chosen by the patient and his/her caregiver in order to target the patient's needs and interests. Participants were trained twice a week for 4 weeks with the errorless learning (ELL) and spaced retrieval (SR) cognitive techniques. After training, there were several follow-ups over a period of at least 3 months.

Measurements

Performance on the trained IADL was assessed by a Direct Measure of Training (DMT), an observational instrument adapted from a well-validated scale. General cognitive function, everyday memory functioning, quality of life, neuropsychiatric symptoms and ADL/IADL of patients, as well as the caregiver's burden were assessed as secondary outcomes.

Results

A statistical significant difference was found between the trained and untrained groups on the DMT immediately following the intervention. Improvements were maintained for a 3-month period. The training did not have effects on any other measures.

Conclusions

The present study showed that it is possible for AD patients to relearn significant IADLs with the ELL and SR techniques and to maintain these gains during at least 3 months. The findings of this study emphasize the importance to design robust but individualized intervention tailored on patients' particular needs.

Section snippets

Participants

Twenty patients were recruited from May 2008 to March 2011 at the Alzheimer Society (Quebec City Division) (N = 6), at homes for the elderly (N = 5), using public advertisement and local papers (N = 5), at Memory Disorders Clinic (N = 3), and through an ongoing research project (N = 1). The participants had to meet the following inclusion criteria: 1) diagnosis of AD,10 confirmed by medical records, history, and results of the neuropsychological evaluation performed at screening; 2) be in mild

Participant's Characteristics

Ten patients per group participated in the trial. One participant (Group 1) abandoned the trial during the intervention phase because of his high level of anxiety, and two participants in Group 2 withdrew after baseline evaluation because of 1) the caregiver's high level of burden (first patient) and 2) dissatisfaction of the participant regarding the randomization process (second patient). Because insufficient data was available for these participants, they were excluded from the analyses.

Discussion

This trial demonstrated the effectiveness of cognitive rehabilitation to re-learn IADLs in patients with mild to moderate AD—all patients significantly improved their performances following training compared to baseline. Moreover, a significant difference between Group 1 (trained) and Group 2 (untrained) was found at post-treatment 1, which underlines the positive effect of the cognitive intervention. The improvements of both groups were maintained, to some extent, 2 to 3 months after the end

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