NEW COGNITIVE TREATMENT FOR EARLY ALZHEIMER'S DISEASE

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DESCRIPTION (from the application): Cognitive Rehabilitation has been shown to be effective in treating a variety of neurological disorders including traumatic brain injury and stroke. Until recently, there has been a paucity of research investigating the utility of this therapeutic modality with mildly impaired AD patients because of the assumption that any gains would be offset by progressive deterioration associated with the degenerative disease process. There is, however, data that suggest that techniques such as spaced retrieval" and other techniques which rely on procedural knowledge and implicit memory, motor learning and the provision of cognitive support at both encoding and retrieval of information can be beneficial to mildly impaired AD patients. The recently introduced cholinesterase inhibitors such as Donepezil (Aricept) have been empirically shown to slow the cognitive progression of AD to the point that they may enhance the efficacy of cognitive rehabilitation interventions when introduced early in the course of the illness. The potential synergistic effects of combined cognitive rehabilitation with pharmacological agents in AD is exciting, given the promise of newer and more effective pharmacological agents for this condition in the future. This has important implications for optimizing and maintaining the patient's cognitive and functional independence for the longest period of time. The proposed study is an evaluation of a new systematic cognitive retraining program for enhancing and maintaining the cognitive and functional status of AD patients receiving a cholinesterase inhibitor (Donepezil). In addition to its state of the-art cognitive approaches, the present theory-driven paradigm is unique in two other ways: its incorporation of a strong functional component and its use of the primary caregiver as a therapy extender to promote generalization and maintenance of gains attained in the clinical setting to the patient's everyday life. While prior efforts have included one or two of these elements in isolation, no previous program has offered this type of integrated approach in the treatment of AD among individuals who are receiving an effective pharmacological agent. In addition to the direct benefit to AD patients, the proposed cognitive rehabilitation intervention is also expected to reduce the caregiver's perceived burden and psychological distress.