Group and individual cognitive therapies in Alzheimer's disease: the ETNA3 randomized trial
Group and individual cognitive therapies in Alzheimer's disease: the ETNA3 randomized trial
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DOI：
10.1017/s1041610215001830
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发表时间：
2016-05-01
影响因子：
7
通讯作者：
Dartigues, Jean-Francois
中科院分区：
文献类型：
--
作者：
Amieva, Helene;Robert, Philippe H.;Dartigues, Jean-Francois
背景：尽管非药物干预措施广泛用于阿尔茨海默病患者，但涉及长期干预和几种认知导向方法的大规模随机试验很少进行。 ETNA3 试验比较了认知训练、回忆疗法和个性化认知康复计划对阿尔茨海默病的治疗效果与常规护理的效果。 方法：这是一项多中心（40 个法国临床中心）随机、平行组试验，通过两年随访比较接受标准化认知训练（小组会议）、回忆疗法（小组会议）、个性化疗法的标准化计划的各组。 认知康复计划（个别疗程）和常规护理（参考组）。招募了 653 名患有阿尔茨海默病的门诊患者。主要疗效结果是两年内无中重度至重度痴呆的生存率。次要结局是认知障碍、功能障碍、行为障碍、冷漠、生活质量、抑郁、照顾者的负担和资源利用。结果：没有证据表明对主要疗效指标有影响。对于两组干预措施（即认知训练和回忆），次要结果与常规护理没有差异。个体化认知康复具有更大的效果，其中功能障碍显着降低，两年后住院治疗延迟六个月。结论：这些发现对阿尔茨海默氏症患者目前的管理实践提出了挑战。虽然以认知为导向的团体疗法越来越受欢迎，但这项试验并没有显示出患者的情况有所改善。个体化认知康复干预提供了具有临床意义的结果。应考虑采取个体干预措施来延迟阿尔茨海默病的住院治疗。
Background: Although non-drug interventions are widely used in patients with Alzheimer's disease, few large scale randomized trials involving a long-term intervention and several cognitive-oriented approaches have been carried out. ETNA3 trial compares the effect of cognitive training, reminiscence therapy, and an individualized cognitive rehabilitation program in Alzheimer's disease to usual care.Methods: This is a multicenter (40 French clinical sites) randomized, parallel-group trial, with a two-year follow-up comparing groups receiving standardized programs of cognitive training (group sessions), reminiscence therapy (group sessions), individualized cognitive rehabilitation program (individual sessions), and usual care (reference group). Six hundred fifty-three outpatients with Alzheimer's disease were recruited. The primary efficacy outcome was the rate of survival without moderately severe to severe dementia at two years. Secondary outcomes were cognitive impairment, functional disability, behavioral disturbance, apathy, quality of life, depression, caregiver's burden, and resource utilization.Results: No impact on the primary efficacy measure was evidenced. For the two group interventions (i.e. cognitive training and reminiscence), none of the secondary outcomes differed from usual care. The larger effect was seen with individualized cognitive rehabilitation in which significantly lower functional disability and a six-month delay in institutionalization at two years were evidenced.Conclusions: These findings challenge current management practices of Alzheimer's patients. While cognitive-oriented group therapies have gained popularity, this trial does not show improvement for the patients. The individualized cognitive rehabilitation intervention provided clinically significant results. Individual interventions should be considered to delay institutionalization in Alzheimer's disease.