Long-Term Observation of a Multicomponent Cognitive Intervention in Mild Cognitive Impairment
Kbo-Inn-Salzach Klinikum, Psychiatric Hospital, Gabersee Haus 13, D-83512 Wasserburg/Inn, Germany . The Journal of Clinical Psychiatry
(Impact Factor: 5.5).
12/2012; 73(12):e1492-8. DOI: 10.4088/JCP.11m07270
Recent studies demonstrated benefits of cognitive intervention in mild cognitive impairment (MCI), but few studies have determined long-term effects on cognition, conversion rate to Alzheimer's disease, and the role of early intervention.
A 6-month multicomponent cognitive group intervention was applied in participants with single- or multiple-domain amnestic MCI (defined according to Petersen's criteria). One group (n = 12) received the intervention at the beginning of the study period and was compared with an active control group (n = 12) who received it after an 8-month time lag. Follow-up assessments were conducted at 15 and 28 months (study period was August 2007-December 2009). The primary outcome was change in cognitive function as determined by changes in scores on the Mini-Mental State Examination and the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), and the secondary outcomes were change in specific cognitive and noncognitive functions and conversion to Alzheimer's disease (according to DSM-IV/NINCDS-ADRDA criteria and NAI-AA criteria for probable Alzheimer's dementia with increased level of certainty).
Eighteen participants completed the study after 28 months. Long-term data revealed a stable intervention effect on the primary outcome ADAS-cog in the early-intervention group (P = .024). The participants in the later-intervention (control) group appeared to benefit to a lesser extent from the cognitive intervention compared to those who received it earlier. Only participants in the later-intervention group (6 of 12) converted to Alzheimer's disease during the 28-month study period.
Benefits of our 6-month cognitive intervention on global cognitive status appear to be preserved over extended follow-up periods. Early cognitive intervention may delay conversion to Alzheimer's disease. Findings in a small sample encourage the use of the intervention in larger-scale studies.
ClinicalTrials.gov identifier: NCT00544856.
Available from: Stefan Teipel
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ABSTRACT: Demographic and epidemiological studies predict an increasing number of people with Alzheimer's disease and dementia worldwide. Early diagnosis and intervention will help to attenuate the course of disease and lower its burden on patients, care-givers and the health care systems. Going even beyond early clinical diagnosis, new diagnostic research criteria define preclinical and predementia stages of Alzheimer's disease based on imaging and neurochemical biomarkers. Studying Alzheimer's disease in its preclinical stages gives researchers the chance to explore how brain function and structure mediates the effect of amyloid and other molecular lesions on cognitive performance and how this interaction is modulated by genetic and environmental risk and protective factors. This will have three major implications: (i) to design novel intervention studies that aim to strengthen protective factors and cognitive reserve, (ii) to provide an in vivo test system for the mode of action of potentially protective interventions, and (iii) to serve as a secondary endpoint for the effectiveness of interventions. This review summarizes key findings of the best established imaging markers of Alzheimer's disease, including markers of amyloid, metabolic and synaptic function, structural connectivity and brain atrophy. It outlines the present and future role of multimodal imaging in defining a preclinical stage of Alzheimer's disease and in the identification and evaluation of factors of risk and resilience of Alzheimer's disease.
Geriatric Mental Health Care 09/2013; 1(3):47–55. DOI:10.1016/j.gmhc.2013.04.003
Available from: Jens Kurth
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ABSTRACT: The increasing age of the population due to improvements in health care in the past century contributes to an increase in the number of people with dementia. However, with an appropriate support and symptomatic treatment, many patients can continue to have an active life and a good quality of life. Treatment and support work best if they are applied at an early stage and also new disease modifying treatments need to focus on predementia and presymptomatic stages of disease.This article focuses on the role of molecular neuroimaging biomarkers in the reliable clinical diagnosis of dementia at the earliest possible stage of different forms of dementia like Alzheimer's disease, Dementia with Lewy Bodies and frontotemporal lobar degeneration. These different types of dementia are associated with characteristic patterns of hypometabolism in F-18-FDG PET. These reductions occur already years before the onset of symptoms and are strongly correlated with clinical severity.Recently developed Amyloid-PET-tracers hold promises to be efficient tools in the near future to depict the earliest stages of AD. They may also serve to directly monitor changes of amyloid load due to new treatment approaches.
Geriatric Mental Health Care 09/2013; 1(3):56–62. DOI:10.1016/j.gmhc.2013.04.006
Available from: Rosana Magalhães
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ABSTRACT: In recent years, cognitive difficulties associated with normal aging and dementia have been receiving increased attention from both public and scientific communities. With an increase in overall lifespan, promoting healthy cognition has become a priority and a necessity for minimizing and preventing individual and societal burdens associated with cognitive dysfunctions in the elderly. The general awareness concerning the efficacy of preventive (e.g., lifestyles) and palliative treatment strategies of cognitive impairments, related to either healthy or unhealthy trajectories in cognitive aging, is continuously rising. There are several therapeutic strategies which can be broadly classified as either pharmacological or non-pharmacological/psychosocial. In face of the modest evidence for success of pharmacological treatments, especially for dementia related impairments, psychosocial interventions are progressively considered as a complementary treatment. Despite the relative spread of psychosocial interventions in clinical settings, research in this area is rather scarce with evidence for success of these therapies remaining controversial. In this work we provide an evidence based perspective on cognitive intervention(s) for healthy aging, pre-dementia (mild cognitive impairment), and dementia populations. Current evidence and future directions for improving cognitive functions in the elderly are discussed as well.
11/2013; 1(8):233-241. DOI:10.12998/wjcc.v1.i8.233
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