DOI QR코드

DOI QR Code

The Effect of Cognitive Intervention on Cognitive Improvement in Patients with Dementia

  • Jo, Kyunghwa (Department of Psychiatry, Kangwon National University Hospital) ;
  • Jhoo, Jin Hyeong (Department of Psychiatry, Kangwon National University Hospital) ;
  • Mun, Young-Ju (Gangwon Provincial Dementia Center) ;
  • Kim, Yeon Mi (Gangwon Provincial Dementia Center) ;
  • Kim, Sung Keun (Department of Neurology, Kangwon National University Hospital) ;
  • Kim, Seongheon (Department of Neurology, Kangwon National University Hospital) ;
  • Lee, Seung-Hwan (Department of Neurology, Kangwon National University Hospital) ;
  • Jang, Jae-Won (Department of Neurology, Kangwon National University Hospital)
  • Received : 2017.09.29
  • Accepted : 2017.11.28
  • Published : 2018.03.31

Abstract

Background and Purpose: The effect of cognitive intervention in patients with dementia is inconsistent. This study sought to find out the effect of cognitive intervention by measuring interval change between before and after intervention. Methods: We evaluated cognitive changes according to clinical diagnostic group across Gangwon province for 940 patients with dementia diagnosed at hospital clinics and 2,975 subjects without dementia. All subjects were treated with cognitive intervention. They underwent a cognitive and mood assessment before and after intervention. We used interval change of Mini-Mental State Examination (MMSE) scores as a primary measure of interventional outcome. Results: Changes in mean MMSE score were significantly different between the non-dementia group and the dementia group (p=0.016), with changes of $0.7{\pm}2.4$ and $1.0{\pm}3.7$ points (${\pm}standard$ deviation), respectively. Cognitive improvement regarding completion of session was significantly higher in the dementia group (p=0.001), with changes of $0.41{\pm}4.51$ for uncompleted group and $1.30{\pm}3.22$ points for completed ones. Lower initial MMSE scores, lower age, and type of intervention were found to be independent predictive factors of subsequent cognitive changes as indicated by mean MMSE scores. Conclusions: These findings suggest that cognitive intervention might be useful for patients with dementia. Their response to treatment might be related to the type of intervention.

Keywords

Acknowledgement

Supported by : Public Health Policy Division of Gangwon Provincial Government

References

  1. Prince M, Guerchet M, Prina M. The Global Impact of Dementia 2013-2050: Policy Brief for Heads of Government. London: Alzheimer's Disease International; 2013.
  2. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging- Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011;7:263-269. https://doi.org/10.1016/j.jalz.2011.03.005
  3. Ertel KA, Glymour MM, Berkman LF. Effects of social integration on preserving memory function in a nationally representative US elderly population. Am J Public Health 2008;98:1215-1220. https://doi.org/10.2105/AJPH.2007.113654
  4. Dourado MC, Mograbi DC, Santos RL, Sousa MF, Nogueira ML, Belfort T, et al. Awareness of disease in dementia: factor structure of the assessment scale of psychosocial impact of the diagnosis of dementia. J Alzheimers Dis 2014;41:947-956. https://doi.org/10.3233/JAD-140183
  5. Golde TE, Schneider LS, Koo EH. Anti-$A{\beta}$ therapeutics in Alzheimer's disease: the need for a paradigm shift. Neuron 2011;69:203-213. https://doi.org/10.1016/j.neuron.2011.01.002
  6. Bae NL, Lee KH, Lee K, Kwak KP. Efficacy of cognitive training in community-dwelling elderly. J Korean Geriatr Psychiatry 2015;19:91-96.
  7. Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer's or vascular type: a review. Alzheimers Res Ther 2013;5:35. https://doi.org/10.1186/alzrt189
  8. Huckans M, Hutson L, Twamley E, Jak A, Kaye J, Storzbach D. Efficacy of cognitive rehabilitation therapies for mild cognitive impairment (MCI) in older adults: working toward a theoretical model and evidence-based interventions. Neuropsychol Rev 2013;23:63-80. https://doi.org/10.1007/s11065-013-9230-9
  9. Orgeta V, Qazi A, Spector AE, Orrell M. Psychological treatments for depression and anxiety in dementia and mild cognitive impairment. Cochrane Database Syst Rev 2014:CD009125.
  10. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet 2017;390:2673-2734. https://doi.org/10.1016/S0140-6736(17)31363-6
  11. Moyer VAU.S. Preventive Services Task Force. Screening for cognitive impairment in older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014;160:791-797. https://doi.org/10.7326/M14-0496
  12. Bond KS, Jorm AF, Kitchener BA, Kelly CM, Chalmers KJ. Development of guidelines for family and non-professional helpers on assisting an older person who is developing cognitive impairment or has dementia: a Delphi expert consensus study. BMC Geriatr 2016;16:129. https://doi.org/10.1186/s12877-016-0305-3
  13. Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 1993;269:2386-2391. https://doi.org/10.1001/jama.1993.03500180078038
  14. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198. https://doi.org/10.1016/0022-3956(75)90026-6
  15. Teresi J, Lawton MP, Ory M, Holmes D. Measurement issues in chronic care populations: dementia special care. Alzheimer Dis Assoc Disord 1994;8 Suppl 1:S144-S183.
  16. Cavallo M, Zanalda E, Johnston H, Bonansea A, Angilletta C. Cognitive training in a large group of patients affected by early-stage Alzheimer's disease can have long-lasting effects: a case-control study. Brain Impair 2016;17:182-192. https://doi.org/10.1017/BrImp.2016.2
  17. Clare L, Jones RS. Errorless learning in the rehabilitation of memory impairment: a critical review. Neuropsychol Rev 2008;18:1-23. https://doi.org/10.1007/s11065-008-9051-4
  18. Waldemar G, Dubois B, Emre M, Georges J, McKeith IG, Rossor M, et al. Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline. Eur J Neurol 2007;14:e1-e26.
  19. Birks J, Harvey RJ. Donepezil for dementia due to Alzheimer's disease. Cochrane Database Syst Rev 2006:CD001190.
  20. Jeong JH, Na HR, Choi SH, Kim J, Na DL, Seo SW, et al. Group- and home-based cognitive intervention for patients with mild cognitive impairment: a randomized controlled trial. Psychother Psychosom 2016;85:198-207. https://doi.org/10.1159/000442261
  21. Orrell M, Yates L, Leung P, Kang S, Hoare Z, Whitaker C, et al. The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: a randomised controlled trial. PLoS Med 2017;14:e1002269. https://doi.org/10.1371/journal.pmed.1002269
  22. Orgeta V, Leung P, Yates L, Kang S, Hoare Z, Henderson C, et al. Individual cognitive stimulation therapy for dementia: a clinical effectiveness and cost-effectiveness pragmatic, multicentre, randomised controlled trial. Health Technol Assess 2015;19:1-108.
  23. Logsdon RG, Pike KC, McCurry SM, Hunter P, Maher J, Snyder L, et al. Early-stage memory loss support groups: outcomes from a randomized controlled clinical trial. J Gerontol B Psychol Sci Soc Sci 2010;65:691-697.
  24. Marshall A, Spreadbury J, Cheston R, Coleman P, Ballinger C, Mullee M, et al. A pilot randomised controlled trial to compare changes in quality of life for participants with early diagnosis dementia who attend a “Living Well with Dementia” group compared to waiting-list control. Aging Ment Health 2015;19:526-535. https://doi.org/10.1080/13607863.2014.954527
  25. Snyder L, Jenkins C, Joosten L. Effectiveness of support groups for people with mild to moderate Alzheimer's disease: an evaluative survey. Am J Alzheimers Dis Other Demen 2007;22:14-19. https://doi.org/10.1177/1533317506295857
  26. Capotosto E, Belacchi C, Gardini S, Faggian S, Piras F, Mantoan V, et al. Cognitive stimulation therapy in the Italian context: its efficacy in cognitive and non-cognitive measures in older adults with dementia: cognitive stimulation therapy-Italy (CST-IT). Int J Geriatr Psychiatry 2017;32:331-340. https://doi.org/10.1002/gps.4521
  27. Ashford JW, Shan M, Butler S, Rajasekar A, Schmitt FA. Temporal quantification of Alzheimer's disease severity: “time index” model. Dementia 1995;6:269-280.
  28. Spencer RJ, Wendell CR, Giggey PP, Katzel LI, Lefkowitz DM, Siegel EL, et al. Psychometric limitations of the mini-mental state examination among nondemented older adults: an evaluation of neurocognitive and magnetic resonance imaging correlates. Exp Aging Res 2013;39:382-397. https://doi.org/10.1080/0361073X.2013.808109
  29. Aguirre E, Hoare Z, Streater A, Spector A, Woods B, Hoe J, et al. Cognitive stimulation therapy (CST) for people with dementia--who benefits most? Int J Geriatr Psychiatry 2013;28:284-290. https://doi.org/10.1002/gps.3823
  30. Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012:CD005562.
  31. Arevalo-Rodriguez I, Smailagic N, Roque I, Figuls M, Ciapponi A, Sanchez-Perez E, et al. Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2015:CD010783.
  32. Fava GA, Guidi J, Rafanelli C, Sonino N. The clinical inadequacy of evidence-based medicine and the need for a conceptual framework based on clinical judgment. Psychother Psychosom 2015;84:1-3.

Cited by

  1. How Does Participation in Formal Education or Learning for Older People Affect Wellbeing and Cognition? A Systematic Literature Review and Meta-Analysis vol.7, pp.None, 2018, https://doi.org/10.1177/2333721420986027
  2. Enriched gardens improve cognition and independence of nursing home residents with dementia: a pilot controlled trial vol.13, pp.1, 2018, https://doi.org/10.1186/s13195-021-00849-w