Comparing two programs of cognitive training in Alzheimer's disease: a pilot study

OBJECTIVES: To evaluate the efficacy of two different procedures of individual cognitive training in mild to moderate Alzheimer's Disease (AD). MATERIAL AND METHODS: Twenty-two AD patients entered the study. We compared stimulation of procedural memory (group 1) with training of partially spared cognitive functions (group 2). Assessment included: neuropsychological tests, scales, and the Functional Living Skills Assessment (FLSA), a standardized battery built to directly evaluate patients' performance in everyday life. RESULTS: We observed a significant improvement for both groups after training in FLSA total score (P=0.005) and subscales. For group 1, we also found a slightly improved performance in two tests: Attentional Matrices (P=0.041), and Verbal Fluency for Letters (P=0.059). After 3 months, patients' results showed a tendency to regress to the pre-training level. CONCLUSION: Both AD groups showed a substantial improvement after training in a direct performance measure of everyday functioning. However, results at neuropsychological tests suggest that training activities of daily living (supported by procedural memory) may be more effective than stimulating "residual" cognitive functions.     

Distinct memory profiles in Alzheimer's disease

Memory impairment is a prominent defining feature of Alzheimer's disease (AD), yet the degree to which the profile of memory impairment is uniform across patients is not fully resolved. The study examined patterns of memory impairment in a large cohort of AD patients, with particular attention to the relationship between working and long-term declarative memory. Tests of working memory, visual and verbal recall and recognition, and recent personal memory were administered to 67 AD patients in the early to moderate stages of disease and to 30 age-matched controls. Performance on all measures was significantly poorer in patients than in controls. Factor analysis of test scores delineated five factors representing the domains of working memory, visual recall, verbal recall, recognition, and personal memory, indicating that these aspects of memory can break down separately. Cluster analysis revealed distinct memory profiles. Some patients showed predominant problems in working memory, with relatively superior long term retention, whereas other patients showed the reverse pattern. Qualitatively distinct profiles arose at comparable levels of severity. Problems in working memory, but not long term memory were associated with the presence of language and perceptuospatial deficits. The results reinforce previous findings that both working and long term memory failure contribute to the memory symptoms of AD patients, and demonstrate dissociations in memory breakdown across the cohort. The link between working memory and language performance, together with findings of posterior hemisphere abnormalities on neuroimaging, lead us to reassess the nature of working memory deficits in AD.     

Alzheimer氏病患者的日常生活能力及其相关因素分析

目的 了解Ａｌｚｈｅｉｍｅｒ氏病（ＡＤ）患者的日常生活能力及其相关因素。方法 对６０例ＡＤ患者（轻度２３例、中度２３例、重度１４例）和２０例非痴呆老人进行日常生活能力量表评定,同时对ＡＤ患者进行了日常生活能力相关因素的调查。结果 与非痴呆老人相比较,轻度ＡＤ患者主要表现为工具性日常生活能力（ＬＡＤＬ）减退,中度ＡＤ患者出现明显的躯体生活自理能力（ＰＳＭ）的减退,重度ＡＤ患者ＬＡＤＬ和ＰＳＭ均严重减     

The relationship of cerebrospinal fluid monoamine metabolites with clinical response to tetrahydroaminoacridine in patients with Alzheimer's disease

Summary The effect of tetrahydroaminoacridine (THA) on the cerebrospinal fluid (CSF) monoamine metabolites was studied in 22 patients with Alzheimer's disease in an open treatment trial. The CSF monoamine metabolites were assayed at baseline and after 4 weeks' active THA treatment with 100 mg/d. A statistically significant increase in the CSF homovanillic acid (HVA) and in 5-hydroxyindoleacetic acid (5-HIAA) content was found. The increase of the CSF 5-HIAA level correlated significantly with improvement in cognitive tests and in the Instrumental Activities of Daily Living Scale. We conclude that besides its anticholinesterase activity THA enhances also the monoaminergic neurotransmission in the brain and that the clinical improvement during THA treatment may be partly mediated through the monoaminergic system.     

日常生活功能量表评定阿尔茨海默病患者日常生活功能的信度与效度及其应用

目的探讨ADL在评定阿尔茨海默病患者日常生活功能中的应用。方法173例阿尔茨海默病（AD）患者应用ADL进行基线期评定,脱落16例。83例在进行为期16周盐酸美金刚治疗后进行第二次评定。74例未治疗者在4周后重复评定。逐步回归分析影响ADL分值相关因素,比较治疗组患者治疗前后ADL分值的。结果逐步回归分析显示MMSE总分、年龄和性别影响ADL总分。中度AD患者在盐酸美金刚治疗16周后ADL总分及IADL分减少。两次不同测定各单项分之间ICC值为0．84—0．96,分半信度为0．91。结论ADL总分受MMSE总分、年龄和性别的影响,盐酸美金刚能够一定程度改善中度AD患者的日常生活功能。ADL具有较好的信度。     

Modified Approach to Stroke Rehabilitation (MAStR): feasibility study of a method to apply procedural memory concepts to transfer training

Objective: Training and implementation for a multidisciplinary stroke rehabilitation method emphasizing procedural memory.

Background: Current practice in stroke rehabilitation relies on explicit memory, often compromised by stroke, failing to capitalize on better-preserved procedural memory skills. Recruitment of procedural memory requires consistency and practice, characteristics difficulty to promote on inpatient rehabilitation units. We designed a method Modified Approach to Stroke Rehabilitation (MAStR) to maximize consistency and practice for transfer training with stroke patients.

Design: Phase I, single-group study. MAStR has two innovations: (1) simplification of instructions to only three words, other direction provided non-verbally; (2) having all rehabilitation staff apply the same approach for transfers. Staff training in MAStR included review of written material describing the rationale for MAStR and demonstration of a transfer using MAStR. Enrolled patients completed each transfer with MAStR in addition to standard rehabilitation therapy.

Results: The MAStR method was taught to a large, multidisciplinary rehabilitation staff (n = 31). Training and certification required 15 min per staff member. Five stroke patients were enrolled. No transfers with MAStR resulted in injury, no negative feedback was received from staff or patients. Staff reported satisfaction with the brief MAStR training and reported transfers were easier to complete with the MAStR method.

Conclusions: Feasibility was demonstrated for an innovative application of procedural memory concepts to stroke rehabilitation. All rehabilitation disciplines were successfully trained. MAStR was well-tolerated and liked by rehabilitation staff and patients. These results support pursuit of a Phase II pilot study.     

Encoding strategy training and self-reported everyday prospective memory in people with Parkinson disease: a randomized-controlled trial

Abstract

Objective

To compare the effects of laboratory-based training in implementation intentions (II; experimental strategy) and verbal rehearsal (VR; control strategy) on self-reported everyday prospective memory among people with Parkinson disease (PD) and to investigate potential correlates of change in self-reported everyday prospective memory in response to this training.     

Music as a memory enhancer in patients with Alzheimer's disease

Musical mnemonics have a long and diverse history of popular use. In addition, music processing in general is often considered spared by the neurodegenerative effects of Alzheimer's disease (AD). Research examining these two phenomena is limited, and no work to our knowledge has explored the effectiveness of musical mnemonics in AD. The present study sought to investigate the effect of music at encoding on the subsequent recognition of associated verbal information. Lyrics of unfamiliar children's songs were presented bimodally at encoding, and visual stimuli were accompanied by either a sung or a spoken recording. Patients with AD demonstrated better recognition accuracy for the sung lyrics than the spoken lyrics, while healthy older adults showed no significant difference between the two conditions. We propose two possible explanations for these findings: first, that the brain areas subserving music processing may be preferentially spared by AD, allowing a more holistic encoding that facilitates recognition, and second, that music heightens arousal in patients with AD, allowing better attention and improved memory.     

Cognitive remediation of working memory deficits: durability of training effects in severely impaired and less severely impaired schizophrenia

OBJECTIVE: To determine whether augmenting work therapy (WT) with neurocognitive enhancement therapy (NET) yields greater improvement in working memory performance than WT alone and whether there is an interaction with severity of impairment. METHOD: A total of 102 participants with schizophrenia or schizoaffective disorder were categorized as severely or less severely cognitively impaired and randomly assigned to receive NET + WT or WT alone. NET consisted of cognitive training exercises in attention, memory, executive function, and social information processing, and WT was a 6-month work program. RESULTS: Comparison on Digits Backwards from intake to follow-up revealed significantly greater improvement for participants receiving NET + WT, but there was no interaction with severity group. Follow-up 6 months after training showed that training effects endured. CONCLUSION: NET + WT improved working memory for most participants regardless of impairment severity. Intensity and duration of training may have contributed to duration of effects. Findings support continued exploration of cognitive remediation.     

Improving memory in Parkinson's disease: A healthy brain ageing cognitive training program

This study aimed to evaluate the efficacy of a multifactorial ‘healthy brain ageing cognitive training program’ for Parkinson's disease. Using a single‐blinded waitlist control design, 50 participants with Parkinson's disease were recruited from the Brain & Mind Research Institute, Sydney, Australia. The intervention encompassed both psychoeducation and cognitive training; each component lasted 1‐hour. The 2‐hour sessions were delivered in a group format, twice‐weekly over a 7‐week period. Multifactorial psychoeducation was delivered by a range of health professionals. In addition to delivering cognitive strategies, it targeted depression, anxiety, sleep, vascular risk factors, diet, and exercise. Cognitive training was computer‐based and was conducted by clinical neuropsychologists. The primary outcome was memory. Secondary outcomes included other aspects of cognition and knowledge pertaining to the psychoeducation material. Results demonstrated that cognitive training was associated with significant improvements in learning and memory corresponding to medium to large effect sizes. Treatment was also associated with medium effect size improvements in knowledge. Although the study was limited by the lack of randomized allocation to treatment and control groups, these findings suggest that a healthy brain ageing cognitive training program may be a viable tool to improve memory and/or slow cognitive decline in people with Parkinson's disease. It also appeared successful for increasing awareness of adaptive and/or compensatory cognitive strategies, as well as modifiable risk factors to optimize brain functioning. © 2013 Movement Disorder Society     

Semantic knowledge in mild cognitive impairment and mild Alzheimer's disease

The aim of this study was to investigate memory in patients with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). Ten patients with MCI, 11 with AD and a group of age and education matched healthy control participants were assessed on a comprehensive battery of semantic memory tests, including traditional semantic memory measures and a non-verbal test of knowledge of object use. The MCI group was impaired on tests of category fluency and all three conditions of an object knowledge test (matching to recipient, function and action), plus a difficult object-naming test. The mild AD group showed additional impairments on traditional measures of semantic memory, including naming high frequency items, comprehension and semantic association. Together these findings suggest that semantic memory impairments occur early in the course of AD, more specifically in patients with "amnesic" MCI, and provide further evidence that impaired category fluency reflects semantic breakdown.     

Automatic and controlled uses of memory in Alzheimer's disease

This study used the process-dissociation procedure (Jacoby, 1991) to examine the contribution of automatic and controlled uses of memory to a stem completion task in 16 patients with Alzheimer's disease (AD) and a matched group of healthy elderly subjects (EC). In an inclusion task subjects attempted to use a studied word to complete three-letter word stems, in an exclusion task they were instructed to complete stems with unstudied words. Relative to patients with AD, EC subjects produced more target word completions under inclusion conditions, and less target word completions under exclusion conditions. The probability of the AD group using studied words to complete stems was invariant across inclusion and exclusion conditions. Estimates derived from the process-dissociation calculations, showed that the performance of the AD patients was mediated entirely by automatic uses of memory, whereas for EC subjects controlled and automatic processes codetermined task performance. Both estimates of controlled and to a lesser extent automatic uses of memory were greater for the EC than the AD subjects, indicating that the stem completion impairment in AD may not be entirely attributable to a deficiency in controlled memory processes but also due to reduced automatic processing.     

Retrieval cue and delay interval influence the relationship between prospective memory and activities of daily living in older adults

Objective: Older adults commonly experience mild declines in everyday functioning and the strategic aspects of prospective memory (PM). This study used multiprocess theory to examine whether the strategic demands of retrieval cue type (event vs. time based) and delay interval length (2 vs. 15 min) influence the relationship between PM and activities of daily living (ADLs) in older adults. Method: Participants included 97 community-dwelling older adults recruited from the Western Australia Participant Pool. Participants were administered the Memory for Intentions Screening Test (MIST) and Prospective and Retrospective Memory Questionnaire (PRMQ) as part of a larger neurocognitive assessment. A knowledgeable informant completed the Activities of Daily Living Questionnaire (ADLQ), from which a cutpoint of ≥1 was used to classify participants into “ADL normal” (n = 37) or “mild ADL problems” (n = 60) groups. Repeated measures multivariate analysis of variance (MANOVA) controlling for age was conducted with ADL group as the between-subjects factor and either MIST or PRMQ cue and delay scores as the within-subjects factors. Results: We observed a significant ADL group by PM interaction on the MIST, with pair-wise analyses showing that the mild ADL problems group performed worse than ADL normal participants on the 15-min time-based scale (p < .001, Cohen’s d = 0.71). No other MIST or PRMQ cue–delay variable differed between the two ADL groups (ps > .10). Conclusion: Findings indicate that decrements in strategically demanding cue monitoring and detection over longer PM delays may partly explain older adults’ mild problems in everyday functioning. Findings may inform neuropsychological interventions aimed at maintaining ADL independence and enhancing quality of life in older adults.     

Personal computer‐based cognitive training in Parkinson's disease: a case study

Parkinson's disease (PD) is a neurodegenerative disorder that is best managed by a combination of medication and regular physiotherapy. PD's main symptoms involve the motor system, but cognitive disorders can be very severe as well. The aim of this study was to evaluate the effects of the computerized rehabilitative tool Esercizi di Riabilitazione Cognitiva (ERICA) in the cognitive recovery of a patient with PD. The patient was a 65‐year‐old man affected by PD with motor complications and severe cognitive and behavioural alterations. He underwent two different types of intensive rehabilitation training: standard cognitive rehabilitation alone and in combination with specific personal computer (PC)‐based cognitive training. We evaluated his neuropsychological profile before and after the two types of training by using a specific psychometric battery. Only at the end of the PC training did we observe improvement in cognitive function as well as mood stabilization. When used in addition to standard cognitive rehabilitation, PC‐based cognitive training may be a valuable tool in improving cognitive skills, with regard to attention, memory process, and executive functions. PC‐based cognitive training may be able to help optimize managing the symptoms of PD.     

A qualitative study on becoming cared for in Alzheimer's disease: the effects to women's sense of identity

Objective: To explore the lived experience of becoming cared for and the impact this has on the identity and sense of self of women with Alzheimer's disease.

Method: Eight women with mild-to-moderate Alzheimer's disease were interviewed in Northamptonshire, England, on two separate occasions about their experiences relating to needing assistance with instrumental activities of daily living (IADL) tasks. Interpretative phenomenological analysis was the approach used to underpin this research.

Results: Changes in the women's identity affected by the increased need for assistance with IADL tasks were expressed in terms of: who I am; unhappy being me; fighting to remain me; I'm not the same, but it doesn't worry me; and acceptance and contentment.

Conclusion: This study offers an alternative perspective to the view that all women with Alzheimer's disease experience becoming cared for as a negative event in their lives. Some factors universally perceived as being a result of Alzheimer's disease may be a normal part of the life course.     

扩瞳试验对阿尔茨海默病的预测效应

目的利用扩瞳试验对轻度认知功能损害(Mild cognitive impairment,MCI)患者进行研究,了解MCI、阿尔茨海默病(AD)与正常老年人在扩瞳试验结果之间的差异,分析MCI与AD之间的关系,并探讨扩瞳试验是否能作为MCI发展成AD的预测指标。方法收集AD患者30例、MCI患者28例以及健康对照34例。分别进行神经心理学测验和扩瞳试验。比较三组的神经心理学测验和扩瞳试验结果之间的差异。计算扩瞳试验在诊断AD和MCI时的敏感性和特异性。结果MCI组的神经心理学测验都显著好于AD组(P<0.001),但都明显不如正常对照组(P<0.001)。AD患者和MCI患者在滴入扩瞳剂后,瞳孔直径明显扩大,与NC组有显著差异(P值分别为P<0.05,P<0.001),而AD组与MCI组之间则无统计学上的差异(P>0.05)。扩瞳试验诊断AD的敏感性和特异性分别为60.0%和67.65%,诊断MCI的敏感性和特异性分别为71.43%和67.65%。结论扩瞳试验可以将MCI患者和AD患者、与正常老年人区别开来,可以作为MCI和AD的一个筛选诊断标志。MCI是AD与正常衰老之间的过渡状态;MCI患者是AD的高危人群...     

Cognitive training in Alzheimer's disease: a meta-analysis of the literature

OBJECTIVE: To systematically review the literature and summarize the effect of cognitive training (CT) for Alzheimer's disease (AD) patients on multiple functional domains. METHOD: Effect sizes (Cohen's d) were calculated for 17 controlled studies identified through a comprehensive literature review. RESULTS: An overall effect size of 0.47 was observed for all CT strategies across all measured outcomes. Mean effect sizes were higher for restorative (0.54) than for compensatory (0.36) strategies. Domain-specific effect sizes ranged from 2.16 (verbal and visual learning) to -0.38 (visuospatial functioning). Data are also presented on the relative impact of restorative and compensatory strategies for each domain of functioning. CONCLUSION: CT evidenced promise in the treatment of AD, with primarily medium effect sizes for learning, memory, executive functioning, activities of daily living, general cognitive problems, depression, and self-rated general functioning. Restorative strategies demonstrated the greatest overall effect on functioning. Several limitations of the published literature are discussed.