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Abstract

Non-pharmacological treatment in Alzheimer's Disease has gained great attention in recent years. The limited efficacy of drug therapy and the plasticity of human central nervous system are the two main reasons that explain this growing interest in rehabilitation. Different approaches have been developed. Here we discuss the efficacy of non-pharmacological therapy in the frame of two main approaches: Multistrategy Approaches (Reality Orientation, Reminiscence Therapy and Validation Therapy) and Cognitive Methods.
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... • Estimulació cognitiva: es basa en el reconeixement de la neuroplasticitat cerebral com a mecanisme fisiològic reparador de les lesions del sistema nerviós central i el concepte de reserva funcional com a capacitat de substituir funcions perdudes amb recursos adquirits. Amb la finalitat de millorar o mantenir tant com sigui possible la capacitat funcional del pacient i de reduir la càrrega del cuidador, cada vegada hi ha major evidència de la utilitat d'aquesta teràpia (Cotelli, Calabria, i Zanetti, 2006;Yu et al., 2009). Per entendre el concepte d'EC, és útil comparar el cervell amb un múscul: si tenim una malaltia que destrueix un múscul de forma progressiva, sens dubte la millor opció serà exercitar tot el possible aquest múscul per hipertrofiar-lo i compensar l'atrofia produïda per la malaltia. ...
... Recent studies have shown that deterioration in performing instrumental activities of daily living (IADLs) may be an early predictor for cognitive deterioration, and possibly even for conversion from mild cognitive impairment (MCI) to AD [7]. These particular findings are similar to previous results showing that the deterioration of the IADLs is affected by cognitive function, and relatively early in the dementia spectrum [8]. In particular, in the MCI [9,10], the executive functioning as part of specific IADL tasks requires frontal cortex activation [11]. ...
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Background: At present, the assessment of autonomy in daily living activities, one of the key symptoms in Alzheimer's disease (AD), involves clinical rating scales. Methods: In total, 109 participants were included. In particular, 11 participants during a pre-test in Nice, France, and 98 participants (27 AD, 38 mild cognitive impairment-MCI-and 33 healthy controls-HC) in Thessaloniki, Greece, carried out a standardized scenario consisting of several instrumental activities of daily living (IADLs), such as making a phone call or preparing a pillbox while being recorded. Data were processed by a platform of video signal analysis in order to extract kinematic parameters, detecting activities undertaken by the participant. Results: The video analysis data can be used to assess IADL task quality and provide clinicians with objective measurements of the patients' performance. Furthermore, it reveals that the HC statistically significantly outperformed the MCI, which had better performance compared to the AD participants. Conclusions: Accurate activity recognition data for the analyses of the performance on IADL activities were obtained.
... 8 Reminiscence group therapy aims to share positive experiences in group environment and thus to make elderly individuals to feel themselves stronger, valuable, and self-confident. 9 Tadaka and Kanagawa studied the effects of reminiscence group therapy on adapting to daily life and concluded that reminiscence therapy had a positive influence on Alzheimer's patients. 10 Various studies reveal that reminiscence therapy has positive outcomes for elderly in terms of variables such as mood and some cognitive abilities, quality of life, well-being, communication, egointegrity, and depression. ...
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Background Alzheimer is a disease leading to various neuropsychiatric behavioral disorders, and the most common symptom observed during the prognosis of Alzheimer's disease is dysmnesia. The aim of the present study is to investigate the effect of reminiscence therapy on cognitive functions, depression, and quality of life in Alzheimer's patients. Methods The present study was a randomized controlled single blind study with two groups, which was designed in the experimental pretest‐posttest pattern in the city of Konya, Turkey. It was decided to include a total of 60 elderly individuals. Information form that evaluated socio‐demographic characteristics and disease history of individuals in intervention and control groups and was developed by the researcher. Standardized Mini‐Mental State Examination (SMMSE), Cornell Scale for Depression in Dementia, and the Quality of Life in Alzheimer's Disease (QOL‐AD) Scale were used to collect the data. Reminiscence therapy was applied once a week and lasted for 8 weeks. Every session took 60 minutes. Groups consisted of six people. Results Mini‐Mental Test, depression, and quality of life mean scores of the elderly in intervention group before reminiscence therapy program increased after the administration, and the difference was statistically significant (P < 0.05). In the intergroup comparison, a significant difference was found between elderly individuals' posttest Mini‐Mental Test, depression, and quality of life mean scores (P < 0.05). Conclusions Our results suggest that regular reminiscence therapy should be considered for inclusion as routine care for the improvement of cognitive functions, depressive symptoms, and quality of life in elderly people with Alzheimer.
... Depending on the stage of the disease, the deficits differ. In comparison to those with mild cognitive impairment (MCI), individuals with earlystage dementia appear to perform more poorly in more than one cognitive domain, leading to a more substantial interference in daily activities and independent function [5], which may negatively affect the quality of life of patients and their caregivers [6][7][8]. Unfortunately, current pharmacological therapies have limited efficacy in reversing or even halting AD progression [9,10]. ...
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Background and Purpose There is an increasing interest in the effect of nonpharmacological interventions on the course of patients with Alzheimer's disease (AD). The objective of the present study is to determine the benefits of a structured, multidomain, mostly computer-based, cognitive training (MCT) οn the cognitive performance of patients with early-stage AD. Method Fifty patients with early-stage AD participated in the study. Patients were randomly allocated either to the training program group (n = 25) or to a wait list control group (n = 25). The training program group received computer-assisted MCT and linguistic exercises utilizing pen and paper supplemented by cognitive-linguistic exercises for homework. The duration of the MCT intervention program was 15 weeks, and it was administered twice a week. Each session lasted for approximately one hour. Objective measures of episodic memory, delayed memory, word recognition, attention, executive function, processing speed, semantic fluency, and naming were assessed at baseline and after the completion of the program in both groups. Results Analysis showed that in controls, delayed memory and executive function had deteriorated over the observation period of 15 weeks, while the training group improved their performance in word recognition, Boston Naming Test (BNT), semantic fluency (SF), clock-drawing test (CDT), digit span forward (DSF), digit span backward (DSB), trail-making test A (TMT A), and trail-making test B (TMT B). Comparison between the training group and the controls showed that MCT had a significant beneficial effect in delayed memory, naming, semantic fluency, visuospatial ability, executive functions, attention, and processing speed. Conclusions The study provides evidence of a beneficial effect of MCT with an emphasis on cognitive-language performance of patients with early-stage AD. Considering the limited efficacy of current pharmacological therapies in AD, concurrent computer-based MCT may represent an additional enhancing treatment option in early-stage AD patients.
... [10][11][12][13] Given the limited effectiveness of pharmacological treatments, non-pharmacological interventions to prevent and treat cognitive deficits and the associated difficulties with activities of daily living, neurodegenerative disease patients have gained attention in recent years, and among these cognitive training offers a potential approach for dementia prevention and the improvement of cognitive function. [14][15][16][17][18][19][20][21][22][23] A critical aspect of cognitive training programmes is that the most promising interventions have involved intensive in-person sessions that are unlikely to be cost-effective or feasible for large-scale implementation. 24 An increasing need for alternative kinds of dementia service delivery is necessary because of the growing demand and cost of healthcare and is made possible by the rapid developments of technology. ...
Article
Introduction: Given the limited effectiveness of pharmacological treatments, non-pharmacological interventions in neurodegenerative diseases have gained increasing attention in recent years and telerehabilitation has been proposed as a cognitive rehabilitation strategy. The purpose of this systematic review is to examine the evidence for the efficacy of cognitive telerehabilitation interventions compared with face-to-face rehabilitation in patients with mild cognitive impairment, Alzheimer's disease and frontotemporal dementia. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of the Medline database was conducted. Out of 14 articles assessed for eligibility, five studies were identified, three in participants with mild cognitive impairment or Alzheimer's disease, two in patients with primary progressive aphasia. Results: The Physiotherapy Evidence Database scale was used to assess the methodological quality of four out of five studies included in this systematic review, with only one report receiving a high-quality rating. Effect-size analysis evidenced positive effects of telerehabilitation interventions, comparable with those reported for face-to-face rehabilitation. Discussion: The available evidence for the effectiveness of cognitive telerehabilitation is limited, and the quality of the evidence needs to be improved. The systematic review provides preliminary evidence suggesting that cognitive telerehabilitation for neurodegenerative disease may have comparable effects as conventional in-person cognitive rehabilitation.
... Neuropsychiatric symptomatology, including mood disturbances should always be an outcome of rehabilitation [37]. The limited efficacy of drug therapy and the plasticity of human central nervous system are the main reasons that explain the growing interest in rehabilitation [51]. This type of treatment is cost-effective and can be easily implemented in both hospital and community settings [35,36]. ...
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Background: Given the complexity of Alzheimer's disease (AD), it is a key object to explore broad outcomes, such as patient health-related quality of life (HRQoL) in relation to other variables including the feeling of burden experienced by caregivers. Methods: Validated tests and questionnaires were used in this survey for the assessment of clinical variables of patients, the severity of the caregiver burden, and the measurement of the HRQoL of mild-to-moderate AD patients. This study was carried on also in order to evaluate the appropriateness of the questionnaires (DEMQOL and DEMQOL-Proxy) utilized in measuring HRQoL in AD and of their capability to identify whether there is agreement between ratings obtained by patients and caregivers. Results: The amount of burden for caregivers was found to be positively correlated with several measures of cognitive, psychological, behavioral, and motor impairment of the patients. Carers evaluated HRQoL worse than AD sufferers. A significant correlation was demonstrated between the caregiver stress and severity of depressive symptoms in the patients. The DEMQOL-PROXY was found to be significantly correlated with the patient level of depressive symptoms. Conclusions: Depressive symptoms mostly worsen the caregiver tolerability of the patient mental impoverishment. It is of great importance to assess patients with mild-to-moderate AD carefully in terms of depressive symptoms because they may have a great clinical implication. There was relatively low agreement between ratings concerning HRQoL obtained by patients and caregivers despite the capacity of the questionnaire to yield many clinical shades concerning the patient HRQoL. © 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society.
Chapter
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder with multiple pathophysiological mechanisms affecting every organ and system in the body. Cerebral hypoperfusion, hypoxia, mitochondrial failure, abnormal protein deposition, multiple neurotransmitters and synaptic failures, white matter lesions, and inflammation, along with sensory-motor system dysfunctions, hypodynamia, sarcopenia, muscle spasticity, muscle hypoxia, digestive problems, weight loss, and immune system alterations. Rehabilitation of AD patients is an emerging concept aimed at achieving optimum levels of physical and psychological functioning in the presence of aging, neurodegenerative processes, and progression of chronic medical illnesses. We hypothesize that the simultaneous implementation of multiple rehabilitation modalities can delay the progression of mild into moderate dementia. This chapter highlights recent research related to a novel treatment model aimed at modifying the natural course of AD and delaying cognitive decline for medically ill community-dwelling patients with dementia. For practical implementation of rehabilitation in AD, the standardized treatment protocols are warranted.
Conference Paper
Cognitive Stimulation aims to improve cognitive skills and quality of life for people with dementia by helping to reduce the functional disability resulting from damage to the brain. Recent studies suggest that this kind of treatment is effective, but it is not yet possible to demonstrate that leads to changes in behavior or in the patient’s lifestyle. The present work investigates the impact and the effectiveness of an information and communications technology platform able to allow the cognitive stimulation practice within a domestic environment. The platform is made up of a set-top-box connected to a TV monitor, a Microsoft Kinect sensor and a (optional) smart garment for clinical signs detection. Preliminary results, achieved after the tests performed on patients with mild to moderate Alzheimer, demonstrates that the aforementioned platform is a very useful tool able to increase the neuropsychiatric and cognitive state of the patient.
Conference Paper
The aim of this work is the design and the development of an ICT platform integrating advanced Natural User Interface technologies for multi-domain Cognitive Rehabilitation without the direct physician involvement to the rehabilitation session. The platform is made up of a set-top-box connected to a TV monitor, a Microsoft Kinect RGB-D sensor and a (optional) WWS Smartex e-shirt for clinical signs monitoring. Customized algorithms for calibration, people segmentation, body skeletonization and hands tracking through the RGB-D sensor have been implemented in order to infer knowledge about the reaction of the end-user to the Graphical User Interface designed for specific cognitive domains. For proper interaction, gestures of Alzheimer Disease’s patients are acquired by Microsoft Kinect in the nominal functioning range, allowing 100% hands detection rate, useful for an error free human-machine interaction.
Chapter
Technological projects and products developed in the scope of Ambient Assisted Living provide a wide range of solutions for the elderly’s and their caregivers’ needs, but typically focused to single aspects of care and assistance. There are systems for monitoring of health signs, along with home automation or home assistance request systems. Multiple needs may therefore lead to adopt multiple systems at the user’s premises, making it more difficult for the elderly and their circle of support to manage their usage and fully benefit from the advantages of technologies. The OMNIACARE platform brings along an innovative concept of integration and adaptation to users’ needs. It comprises different modules, developed in ad-hoc projects, to cover different sides of home care and assistance with one interface in one single system.
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This study concerns the effectiveness of procedural memory training in mild and mild-moderate probable Alzheimer's disease (AD) patients. Eleven patients with AD (age: 78 - 8.4 years; MMSE score: 20 - 3.4; education: 5.7 - 2.7 years) attending a day hospital, were individually trained, for three consecutive weeks (one hour/day; five days/week), in 13 basic and instrumental activities of daily living such as personal hygiene, using the telephone, dressing, reading, writing, etc. Seven AD patients (age: 74 - 12 years; MMSE score: 19 - 4.2; education: 5.3 - 3.2 years) constituted the control group. Patients in both groups underwent baseline and follow up assessment (four months later) recording the total mean time employed to perform the 13 activities of daily living. The training group showed a significant reduction (p < .025) in the time necessary to perform the activities, while the control group showed a non-significant increase. Our results support the view that procedural memory in mild and mild-moderate AD is relatively well preserved and that training of activities of daily living constitutes a realistic goal for rehabilitation programmes.
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Memory rehabilitation is a sadly misrepresented area of applied research in Alzheimer's disease. To gather and evaluate recent evidence for the clinical effectiveness or ecologically validity of memory rehabilitation for mild to moderate Alzheimer's patients. Computerised searches and some handsearching were conducted spanning the last five years, from 1995 to 2000, inclusively. Criteria for inclusion in this overview involved the use of a precise memory rehabilitation technique within an experimental study design applied to Alzheimer's patients with pre- and post-treatment evaluation. Three potential levels of memory rehabilitation procedures with proven clinical or pragmatic efficacy were identified. The first level bears on the facilitation of residual explicit memory with structured support both at encoding and at subsequent recall; the second level of memory rehabilitation exploits the relatively intact implicit memory system (priming and procedural memory); the last deals with finding ways of coping with the patient's limited explicit memory capacities through the use of external memory aids. A proposal of suggestions for good practice and future research in memory rehabilitation is also offered with the hope to spur further development in this rapidly expanding area of applied research. The available evidence shows that alternative and innovative ways of memory rehabilitation for Alzheimer's patients can indeed be clinically effective or pragmatically useful with a great potential for use within the new culture of a more graded and proactive type of Alzheimer's disease care.
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Cholinesterase inhibitors have been available for the treatment of Alzheimer’s disease since 1993. They have significantly positive effects on cognitive functioning and other domains of functional capacity, such as activities of daily life in terms of efficacy, but the clinical value of these effects are under discussion. Cholinesterase inhibitors may also influence behavioural and psychological symptoms in Alzheimer’s disease. Cholinesterase inhibitors are also regarded as rather expensive and, therefore, the question of cost effectiveness is essential. Pharmacoeconomic evaluations of cholinesterase inhibitors have so far been conducted in retrospect on efficacy data from prospective randomised clinical trials combined with economic data from other sources. There are no published specific cost-effectiveness studies of cholinesterase inhibitors which prospectively collected empirical data on costs and outcomes. There is only one published randomised clinical trial with such empirical data with a cost consequence analysis design, indicating cost neutrality. Several types of models to describe the long-term effects have been published, indicating cost effectiveness. However, due to methodological considerations, the validity of these models is difficult to judge. A research agenda for the cost effectiveness of cholinesterase inhibitors is proposed, including long-term studies with empirical data on resource use, costs and outcomes, studies on quality of life, informal care and behavioural and psychological symptoms, combination and comparative studies on mild cognitive impairment.
Article
Memory difficulties are a defining feature of Alzheimer's disease (AD), with significant implications for people with AD and family members. Interventions aimed at helping with memory difficulties, therefore, may be important in reducing excess disability and improving well-being. There is a long tradition of cognition-focused intervention in dementia care. In this review we offer broad definitions and descriptions of three approaches to cognition-focused intervention for people with dementia—cognitive stimulation, cognitive training and cognitive rehabilitation—and attempt to clarify the underlying concepts and assumptions associated with each. Cognitive training and cognitive rehabilitation are the main approaches used with people who have early-stage AD. We review a range of studies describing the implementation of these two approaches, and evaluate the evidence for their effectiveness. With regard to cognitive training, the evidence currently available does not provide a strong demonstration of efficacy, but findings must be viewed with caution due to methodological limitations. It is not possible at present to draw firm conclusions about the efficacy of individualised cognitive rehabilitation interventions for people with early-stage dementia, due to the lack of any randomised controlled trials (RCTs) in this area, although indications from single-case designs and small group studies are cautiously positive. Further research is required that takes account of the conceptual and methodological issues outlined here.
Article
No evidence of efficacy of reminiscence therapy for people with dementia This review examines the effectiveness of Reminiscence Therapy (RT) for people with dementia. RT involves the vocal or silent recall of events in a person's life, either alone, or with another person or group of people. RT groups are often assisted by aids such as videos, pictures and archives, as a means of communicating and reflecting upon life experiences. After searching the literature, only one suitable randomized controlled trial looking at RT for dementia was found. Results were insignificant, due to the lack of evidence, yet other data suggests that RT can be beneficial. Hence the review highlights the urgent need for more quality research in the field, for a conclusive systematic review.
Article
Reality Orientation (RO) was first described as a technique to improve the quality of life of confused elderly people, although its origins lie in an attempt to rehabilitate severely disturbed war veterans, not in geriatric work. It operates through the presentation of orientation information (eg time, place and person-related) which is thought to provide the person with a greater understanding of their surroundings, possibly resulting in an improved sense of control and self-esteem. There has been criticism of RO in clinical practice, with some fear that it has been applied in a mechanical fashion and has been insensitive to the needs of the individual. There is also a suggestion that constant relearning of material can actually contribute to mood and self-esteem problems. There is often little consistent application of psychological therapies in dementia services, so a systematic review of the available evidence is important in order to identify the effectiveness of the different therapies. Subsequently, guidelines for their use can be made on a sound evidence base. To assess the evidence of effectiveness for the use of Reality Orientation (RO) as a classroom-based therapy on elderly persons with dementia. Computerised databases were searched independently by 2 reviewers entering the terms 'Reality Orientation, dementia, control, trial or study'. Relevant web sites were searched and some hand searching was conducted by the reviewer. Specialists in the field were approached for undocumented material, and all publications found were searched for additional references. All randomised controlled trials (RCTs), and all controlled trials with some degree of concealment, blinding or control for bias (second order evidence) of Reality Orientation as an intervention for dementia were included. The criteria for inclusion/exclusion involved systematic assessment of the quality of study design and the risk of bias, using a standard data extraction form. A measure of cognitive and/or behavioural change was needed. Data were extracted independently by both reviewers, using a previously tested data extraction form. Authors were contacted for data not provided in the papers. Psychological scales measuring cognitive and behavioural changes were examined. 6 RCTs were entered in the analysis, with a total of 125 subjects (67 in experimental groups, 58 in control groups). Results were divided into 2 subsections: cognition and behaviour. Change in cognitive and behavioural outcomes showed a significant effect in favour of treatment. There is some evidence that RO has benefits on both cognition and behaviour for dementia sufferers. Further research could examine which features of RO are particularly effective. It is unclear how far the benefits of RO extend after the end of treatment, but and it appears that a continued programme may be needed to sustain potential benefits.