Pilot Feasibility Study of an Individualized Cognitive Rehabilitation Program in Mexican Adults with Mild Dementia
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Abstract
Introduction. Dementia is a global public health problem, for which there is currently no cure. The increasing number of non-pharmacological interventions for the management of dementia challenges us to provide evidence-based care.
Objective. To evaluate the feasibility of an individualized, cognitive rehabilitation program based on the French ETNA3 trial in Mexican subjects over fifty-five with mild Alzheimer's dementia and their caregivers who live in the community.
Method. Non-randomized feasibility study. The intervention consisted of a twelve-month cognitive rehabilitation program, divided into eighteen ninety-minute sessions, administered by trained psychologists, and standardized according to the French ETNA3 program. To assess its feasibility, we determined the percentage of eligibility, acceptability, retention, and compliance and evaluated the adverse effects and degree of satisfaction in patients and their caregivers.
Results. Thirty-two people with dementia and their caregivers agreed to participate. The mean age of the participants was 80 ± 8 years, the majority (72%) were women, and 78% had had five or more years of schooling. At twelve months, twenty-eight subjects (87%) completed the program with 100% compliance with the scheduled sessions.
Discussion. This study shows the feasibility of an individualized cognitive rehabilitation program based on ETNA3 for Mexican subjects with mild dementia and their caregivers.
Conclusion. More studies are required to evaluate the importance of trained therapists and caregiver support in achieving significant cognitive and functional changes in patients.
References
Aguilar-Navarro, S. G., Mimenza-Alvarado, A. J., Palacios-García, A. A., Samudio-Cruz, A., Gutiérrez-Gutiérrez, L. A., & Ávila-Funes, J. A. (2018). Validity and Reliability of the Spanish Version of the Montreal Cognitive Assessment (MoCA) for the Detection of Cognitive Impairment in Mexico [Validez y confiabilidad del MoCA (Montreal Cognitive Assessment) para el tamizaje del deterioro cognoscitivo en México]. Revista Colombiana de Psiquiatría, 47(4), 237-243. https://doi.org/10.1016/j.rcp.2017.05.003
Alzheimer’s Association. (2016). 2016 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 12(4), 459-509. https://doi.org/10.1016/j.jalz.2016.03.001
Amieva, H., Robert, P. H., Grandoulier, A. S., Meillon, C., De Rotrou, J., Andrieu, S., Berr, C., Desgranges, B., Dubois, B., Girtanner, C., Joël, M.-E., Lavallart, B., Nourhashemi, F., Pasquier, F., Rainfray, M., Touchon, J., Chêne, G., & Dartigues, J.-F. (2016). Group and individual cognitive therapies in Alzheimer’s disease: the ETNA3 randomized trial. International Psychogeriatrics, 28(5), 707-717. https://doi.org/10.1017/s1041610215001830
Amieva, H., Robert, P. H., Grandoulier, A. S., Meillon, C., De Rotrou, J., Andrieu, S., … Dartigues, J. F. (2008, March 28 – 2013, August 1). Group and individual cognitive therapies in Alzheimer’s disease: the ETNA3 randomized trial. National Library of Medicine. Identifier NCT00646269. https://classic.clinicaltrials.gov/ct2/show/NCT00646269
Aravena, J. M., Gajardo, J., Saguez, R., Hinton, L., & Gitlin, L. N. (2022). Nonpharmacologic Interventions for Family Caregivers of People Living With Dementia in Latin-America: A Scoping Review. American Journal of Geriatric Psychiatry, 30(8), 859-877. https://doi.org/10.1016/j.jagp.2021.10.013
Bahar-Fuchs, A., Clare, L., & Woods, B. (2013). Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia. Cochrane Database of Systematic Reviews, 2013(6), CD003260. https://doi.org/10.1002/14651858.cd003260.pub2
Berg-Weger, M., & Stewart, D. B. (2017). Non-Pharmacologic Interventions for Persons with Dementia. Missouri Medicine, 114(2), 116-119.
Blampied, N. M. (1999). A legacy neglected: Restating the case for single-case research in cognitive-behaviour therapy. Behaviour Change, 16(2), 89-104. https://doi.org/10.1375/bech.16.2.89
Choi, J., & Twamley, E. W. (2013). Cognitive Rehabilitation Therapies for Alzheimer’s Disease: A Review of Methods to Improve Treatment Engagement and Self-Efficacy. Neuropsychology Review, 23(1), 48-62. https://doi.org/10.1007/s11065-013-9227-4
Clare, L., Wilson, B. A., Carter, G., Roth, I., & Hodges, J. R. (2004). Awareness in Early-Stage Alzheimer’s Disease: Relationship to Outcome of Cognitive Rehabilitation. Journal of Clinical and Experimental Neuropsychology, 26(2), 215-226. https://doi.org/10.1076/jcen.26.2.215.28088
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308-2314. https://doi.org/10.1212/wnl.44.12.2308
Custodio, N., Lira, D., Herrera-Perez, E., Nuñez Del Prado, L., Parodi, J., Guevara-Silva, E., Castro-Suarez, S., Mar, M., Montesinos, R., & Cortijo, P. (2014). Informal caregiver burden in middle-income countries: Results from Memory Centers in Lima-Peru. Dementia & Neuropsychologia, 8(4), 376-383. https://doi.org/10.1590/S1980-57642014DN84000012
DeTure, M. A., & Dickson, D. W. (2019). The neuropathological diagnosis of Alzheimer’s disease. Molecular Neurodegeneration, 14(1), 32. https://doi.org/10.1186/s13024-019-0333-5
Dexter, F. (2013). Wilcoxon-Mann-Whitney test used for data that are not normally distributed. Anesthesia and Analgesia, 117(3), 537-538. https://doi.org/10.1213/ANE.0b013e31829ed28f
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198. https://doi.org/10.1016/0022-3956(75)90026-6
Freitas, S., Simões, M. R., Alves, L., & Santana, I. (2013). Montreal cognitive assessment: validation study for mild cognitive impairment and Alzheimer disease. Alzheimer Disease and Associated Disorders, 27(1), 37-43. https://doi.org/10.1097/WAD.0b013e3182420bfe
Gebrie, M. H., & Ford, J., (2019). Depressive symptoms and dietary non-adherence among end stage renal disease patients undergoing hemodialysis therapy: systematic review. BMC Nephrology, 20(1), 429. https://doi.org/10.1186/s12882-019-1622-5
Gélinas, I., Gauthier, L., McIntyre, M., & Gauthier, S. (1999). Development of a Functional Measure for Persons With Alzheimer’s Disease: The Disability Assessment for Dementia. The American Journal of Occupational Therapy, 53(5), 471-481. https://doi.org/10.5014/ajot.53.5.471
Hachinski, V., Oveisgharan, S., Romney, A. K., & Shankle, W. R. (2012). Optimizing the Hachinski Ischemic Scale. Archives of Neurology, 69(2), 169-175. https://doi.org/10.1001/archneurol.2011.1698
Huang, H. C., Chen, Y. T., Chen, P. Y., Huey-Lan Hu, S., Liu, F., Kuo, Y. L., & Chiu, H. Y. (2015). Reminiscence Therapy Improves Cognitive Functions and Reduces Depressive Symptoms in Elderly People With Dementia: A Meta-Analysis of Randomized Controlled Trials. Journal of the American Medical Directors Association, 16(12), 1087-1094. https://doi.org/10.1016/j.jamda.2015.07.010
Hubbard, G., O’Carroll, R., Munro, J., Mutrie, N., Haw, S., Mason, H., & Treweek, S. (2016). The feasibility and acceptability of trial procedures for a pragmatic randomised controlled trial of a structured physical activity intervention for people diagnosed with colorectal cancer: findings from a pilot trial of cardiac rehabilitation versus usual care (no rehabilitation) with an embedded qualitative study. Pilot and Feasibility Studies, 2, 51. https://doi.org/10.1186/s40814-016-0090-y
Jeong, J. H., Na, H. R., Choi, S. H., Kim, J., Na, D. L., Seo, S. W., Chin, J., Park, S. A., Kim, E.-J., Han, H. J., Han, S.-H., Yoon, S. J., Lee, J.-H., Park, K. W., Moon, S. Y., Park, M. H., Choi, M. S., Han, I.-W., Lee, J. H., ... Kim, J. Y. (2016). Group- and Home-Based Cognitive Intervention for Patients with Mild Cognitive Impairment: A Randomized Controlled Trial. Psychotherapy and Psychosomatics, 85(4), 198-207. https://doi.org/10.1159/000442261
Kurth, S., Wojtasik, V., Lekeu, F., Quittre, A., Olivier, C., Godichard, V., Bastin, C., & Salmon, E. (2021). Efficacy of Cogitive Rehabilitation Versus Usual Treatment at Home in Patients With Early Stages of Alzheimer Disease. Journal of Geriatric Psychiatry and Neurology, 34(3), 209-215. https://doi.org/10.1177/0891988720924721
Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., Omar, R. Z., Katona, C., & Cooper, C. (2014). Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. British Journal of Psychiatry, 205(6), 436-442. https://doi.org/10.1192/bjp.bp.113.141119
Logsdon, R. G., & Teri, L. (2018). Qualityof life in dementia: Conceptualization, measurement, and psychosocial treatment implications. In G. E. Smith & S. T. Farias (Eds.). APA Handbook of Dementia (pp. 237-248). https://doi.org/10.1037/0000076-012
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J., & DeKosky, S. (2002). Prevalence of Neuropsychiatric Symptoms in Dementia and Mild Cognitive Impairment: results from the cardiovascular health study. JAMA, 288(12), 1475-1483. https://doi.org/10.1001/jama.288.12.1475
McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack, C. R., Kawas, C. H., Klunk, W. E., Koroshetz, W. J., Manly, J. J., Mayeux, R., Mohs, R. C., Morris, J. C., Rossor, M. N., Scheltens, P., Carrillo, M. C., Thies, B., Weintraub, S., & Phelps, C. H. (2011). 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. Alzheimer’s & Dementia, 7(3), 263-269. https://doi.org/10.1016/j.jalz.2011.03.005
Meyer, C., & O’Keefe, F. (2018). Non-pharmacological interventions for people with dementia: A review of reviews. Dementia, 19(6), 1927-1954. https://doi.org/10.1177/1471301218813234
Nichols, E., Steinmetz, J. D., Vollset, S. E., Fukutaki, K., Chalek, J., Abd-Allah, F., Abdoli, A., Abualhasan, A., Abu-Gharbieh, E., Akram, T. T., Al Hamad, H., Alahdab, F., Alanezi, F. M., Alipour, V., Almustanyir, S., Amu, H., Ansari, I., Arabloo, J., Ashraf, T., ... Vos, T. (2022). Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. The Lancet Public Health, 7(2), e105-e125. https://doi.org/10.1016/s2468-2667(21)00249-8
Nitrini, R., Barbosa, M. T., Dozzi-Brucki, S. M., Yassuda, M. S., & Caramelli, P. (2020). Current trends and challenges on dementia management and research in Latin America. Journal of Global Health, 10(1), 010362. https://doi.org/10.7189/jogh.10.010362
Orsmond, G. I., & Cohn, E. S. (2015). The Distinctive Features of a Feasibility Study: Objectives and Guiding Questions. OTJR: Occupation, Participation and Health, 35(3), 169-177. https://doi.org/10.1177/1539449215578649
Petriwskyj, A., Parker, D., Brown-Wilson, C., & Gibson, A. (2016). Evaluation of Subscription-based Culture Change Models in Care Settings: Findings From a Systematic Review. The Gerontologist, 56(4), e46-e62. https://doi.org/10.1093/geront/gnw012
Ralph, S. J., & Espinet, A. J. (2018). Increased All-Cause Mortality by Antipsychotic Drugs: Updated Review and Meta-Analysis in Dementia and General Mental Health Care. Journal of Alzheimer’s Disease Reports, 2(1), 1-26. https://doi.org/10.3233/adr-170042
Sachdev, P. S., Blacker, D., Blazer, D. G., Ganguli, M., Jeste, D. V., Paulsen, J. S., & Petersen, R. C. (2014). Classifying neurocognitive disorders: the DSM-5 approach. Nature Reviews Neurology, 10(11), 634-642. https://doi.org/10.1038/nrneurol.2014.181
Shigihara, Y., Hoshi, H., Shinada, K., Okada, T., & Kamada, H. (2020). Non-pharmacological treatment changes brain activity in patients with dementia. Scientific Reports, 10(1), 6744. https://doi.org/10.1038/s41598-020-63881-0
Thomas, G. (2011). A typology for the case study in social science following a review of definition, discourse, and structure. Qualitative Inquiry, 17(6), 511-521. https://doi.org/10.1177/1077800411409884
Trivedi, R. B., Szarka, J. G., Beaver, K., Brousseau, K., Nevins, E., Yancy, W. S., Slade, A., & Voils, C. I. (2013). Recruitment and retention rates in behavioral trials involving patients and a support person: A systematic review. Contemporary Clinical Trials, 36(1), 307-318. https://doi.org/10.1016/j.cct.2013.07.009
Wang, L. Y., Pei, J., Zhan, Y. J., & Cai, Y. W. (2020). Overview of Meta-Analyses of Five Non-pharmacological Interventions for Alzheimer’s Disease. Frontiers in Aging Neuroscience, 12, 594432. https://doi.org/10.3389/fnagi.2020.594432
Wigfield, A., & Eccles, J. S. (2000). Expectancy–Value Theory of Achievement Motivation. Contemporary Educational Psychology, 25(1), 68-81. https://doi.org/10.1006/ceps.1999.1015
Wilson, B. A. (2002). Towards a comprehensive model of cognitive rehabilitation. Neuropsychological Rehabilitation, 12(2), 97-110. https://doi.org/10.1080/09602010244000020
Yesavage, J. A., Brink, T., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49. https://doi.org/10.1016/0022-3956(82)90033-4
Zarit, S. H., Todd, P. A., & Zarit, J. M. (1986). Subjective Burden of Husbands and Wives as Caregivers: A Longitudinal Study. The Gerontologist, 26(3), 260-266. https://doi.org/10.1093/geront/26.3.260
