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Errorless practice as a possible adjuvant to donepezil in Alzheimer’s disease

Published online by Cambridge University Press:  01 March 2009

LESLIE J. GONZALEZ ROTHI ,
RENEE FULLER ,
SUSAN A. LEON ,
DIANE KENDALL ,
ANNA MOORE ,
SAMUEL S. WU ,
BRUCE CROSSON ,
KENNETH M. HEILMAN  and
STEPHEN E. NADEAU
LESLIE J. GONZALEZ ROTHI*
Affiliation:
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida Geriatric Research, Education and Clinical Center, Malcom Randall VA Medical Center, Gainesville, Florida Department of Neurology, University of Florida, Gainesville, Florida
RENEE FULLER
Affiliation:
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida Cardinal Hill Rehabilitation Hospital, Lexington, Kentucky
SUSAN A. LEON
Affiliation:
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida Department of Communication Sciences and Disorders, University of Florida, Gainesville, Florida Neurology Service, Malcom Randall VA Medical Center, Gainesville, Florida
DIANE KENDALL
Affiliation:
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington
ANNA MOORE
Affiliation:
Rehabilitation Research Center of Excellence, VA Medical Center, Atlanta, Georgia Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia
SAMUEL S. WU
Affiliation:
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida Department of Epidemiology and Health Policy Research, University of Florida, Gainesville, Florida Rehabilitation Outcomes Research Center, Malcom Randall VA Medical Center, Gainesville, Florida
BRUCE CROSSON
Affiliation:
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
KENNETH M. HEILMAN
Affiliation:
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida Geriatric Research, Education and Clinical Center, Malcom Randall VA Medical Center, Gainesville, Florida Department of Neurology, University of Florida, Gainesville, Florida Neurology Service, Malcom Randall VA Medical Center, Gainesville, Florida
STEPHEN E. NADEAU
Affiliation:
Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida Geriatric Research, Education and Clinical Center, Malcom Randall VA Medical Center, Gainesville, Florida Department of Neurology, University of Florida, Gainesville, Florida
*
*Correspondence and reprint requests to: Leslie J. Gonzalez Rothi, Ph.D., Brain Rehabilitation Research Center, Room 151a, Malcom Randall VA Medical Center, 1601 SW Archer Road, Gainesville, Florida 32608-1197. E-mail: gonzalj@neurology.ufl.edu
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Abstract

Six individuals with probable Alzheimer’s disease (AD) participated in a phase 1 study employing a repeated measures, parallel baseline design testing the hypothesis that error-free experience during word production practice combined with an acetyl cholinesterase inhibitor would improve confrontation naming ability. While acetyl cholinesterase inhibitors are safe and delay cognition decline associated with AD, improvement over baseline cognition is less evident; clinically significant cognitive deficits persist and progress. Both animal and clinical research strongly implicate acetylcholine in learning, a form of neuroplasticity. In clinical practice, however, people with AD are given cholinergic medications without concomitant systematic/targeted retraining. In this study six participants with probable AD and taking donepezil participated in targeted word production practice using an errorless learning strategy. Results showed that combining behavioral enrichment training and an acetyl cholinesterase inhibitor resulted in significant improvements in verbal confrontation naming of trained items for three of six participants. Differences in baseline dementia severity, living conditions, and medications may have influenced the training response. Detection of substantial treatment effects in 50% of subjects suggests further language treatment studies in AD in combination with an acetyl cholinesterase inhibitor are warranted and provide useful information on inclusion/exclusion criteria for use in subsequent studies. (JINS, 2009, 15, 311–322.)

Keywords

DementiaRehabilitationAnomiaCholinesterase inhibitorsLanguage therapyVerbal learning
Type
Neurobehavioral Grand Rounds
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 2 , March 2009 , pp. 311 - 322
Copyright
Copyright © INS 2009

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