Goal-Oriented Cognitive Rehabilitation for People With Early-Stage Alzheimer Disease: A Single-Blind Randomized Controlled Trial of Clinical Efficacy
Goal-Oriented Cognitive Rehabilitation for People With Early-Stage Alzheimer Disease: A Single-Blind Randomized Controlled Trial of Clinical Efficacy
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DOI：
10.1097/jgp.0b013e3181d5792a
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发表时间：
2010-10-01
影响因子：
7.2
通讯作者：
Rugg, Michael D.
中科院分区：
文献类型：
--
作者：
Clare, Linda;Linden, David E. J.;Rugg, Michael D.
目的：为认知康复治疗早期阿尔茨海默病(AD)的临床疗效提供依据。设计：单盲随机对照试验，比较CR、放松疗法和不治疗。环境：以社区为基础的门诊环境。对象：69例(女性41例，男性28例；平均年龄77.78岁，标准差6.32，范围56~89)，被诊断为阿尔茨海默病或混合性阿尔茨海默病和血管性痴呆，简易智力状态检查评分在18分以上，并接受稳定剂量的乙酰胆碱酯酶抑制药物治疗。44名家庭照顾者也做出了贡献。干预：CR每周举行八次个人会议，包括个人化干预，以解决个别相关的目标，并由涉及实用辅助和战略的组成部分、学习新信息的技术、保持注意力和注意力的实践以及压力管理技术提供支持。测量：主要结果是目标绩效和满意度，使用加拿大职业绩效衡量标准进行评估。还进行了评估情绪、生活质量和照顾者压力的问卷调查，并进行了简短的神经心理测试。一部分参与者接受了功能磁共振成像(FMRI)。结果：CR组的得分和满意度显著提高，而其他两组得分无明显变化。CR组的行为变化得到了一部分参与者的fMRI数据的支持。结论：CR治疗早期AD的临床疗效显著。CR提供了一种帮助早期AD患者及其家人管理病情影响的手段。(《老年精神病学杂志》2010；18：928-939)
Objectives: To provide evidence regarding the clinical efficacy of cognitive rehabilitation (CR) in early-stage Alzheimer disease (AD). Design: Single-blind randomized controlled trial comparing CR with relaxation therapy and no treatment. Setting: Outpatient, community-based setting. Participants: Sixty-nine individuals (41 women, 28 men; mean age 77.78 years, standard deviation 6.32, range = 56-89) with a diagnosis of AD or mixed AD and vascular dementia and a Mini-Mental State Examination score of 18 or above, and receiving a stable dose of acetylcholinesterase-inhibiting medication. Forty-four family carers also contributed. Intervention: Eight weekly individual sessions of CR consisting of personalized interventions to address individually relevant goals supported by components addressing practical aids and strategies, techniques for learning new information, practice in maintaining attention and concentration, and techniques for stress management. Measurements: The primary outcomes were goal performance and satisfaction, assessed using the Canadian Occupational Performance Measure. Questionnaires assessing mood, quality of life and carer strain, and a brief neuropsychological test battery were also administered. A subset of participants underwent functional magnetic resonance imaging (fMRI). Results: CR produced significant improvement in ratings of goal performance and satisfaction, whereas scores in the other two groups did not change. Behavioral changes in the CR group were supported by fMRI data for a subset of participants. Conclusions: The findings support the clinical efficacy of CR in early-stage AD. CR offers a means of assisting people with early-stage AD and their families in managing the effects of the condition. (Am J Geriatr Psychiatry 2010; 18:928-939)