263 research outputs found

    The design, evaluation, and reporting on non- pharmacological, cognition- oriented treatments for older adults: Results of a survey of experts

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    IntroductionCognitive decline and dementia significantly affect independence and quality of life in older adults; therefore, it is critical to identify effective cognition- oriented treatments (COTs; eg, cognitive training, rehabilitation) that can help maintain or enhance cognitive functioning in older adults, as well as reduce dementia risk or alleviate symptoms associated with pathological processes.MethodsThe Cognitive Intervention Design Evaluation and Reporting (CIDER), a working group from the Non- Pharmacological Interventions Professional Interest Area (NPI- PIA) of the Alzheimer’s Association conducted as survey in 2017 with experts in COTs worldwide. The survey’s aims were three- fold: (1) determine the common attitudes, beliefs, and practices of experts involved in the COTs research targeting older people; (2) identify areas of relative agreement and disagreement among experts in the field; and (3) offer a critical review of the literature, including recommendations for future research.ResultsThe survey identified several areas of agreements among experts on critical features of COTs, and on study design and outcome measures. Nevertheless, there were some areas with relative disagreement. Critically, expert opinions were not always supported by scientific evidence, suggesting that methodologic improvements are needed regarding design, implementation, and reporting of COTs. There was a clear consensus that COTs provide benefits and should be offered to cognitively unimpaired older adults, mild cognitive impairment (MCI), and mild dementia, but opinions differed for moderate and severe dementia. In addition, there is no consensus on the potential role of COTs in dementia prevention, indicating that future research should prioritize this aspect.DiscussionEvidence of COTs in older adults is encouraging, but additional evidence is needed to enhance dementia prevention. Consensus building and guidelines in the field are critical to improve and accelerate the development of high- quality evidence for COTs in cognitively unimpaired older adults, and those with MCI and dementia.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155935/1/trc212024_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155935/2/trc212024.pd

    Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer's or vascular type: a review

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    Cognitive impairments, and particularly memory deficits, are a defining feature of the early stages of Alzheimer's disease and vascular dementia. Interventions that target these cognitive deficits and the associated difficulties with activities of daily living are the subject of ever-growing interest. Cognitive training and cognitive rehabilitation are specific forms of non-pharmacological intervention to address cognitive and non-cognitive outcomes. The present review is an abridged version of a Cochrane Review and aims to systematically evaluate the evidence for these forms of intervention in people with mild Alzheimer's disease or vascular dementia. Randomized controlled trials (RCTs), published in English, comparing cognitive rehabilitation or cognitive training interventions with control conditions and reporting relevant outcomes for the person with dementia or the family caregiver (or both), were considered for inclusion. Eleven RCTs reporting cognitive training interventions were included in the review. A large number of measures were used in the different studies, and meta-analysis could be conducted for several primary and secondary outcomes of interest. Several outcomes were not measured in any of the studies. Overall estimates of the treatment effect were calculated by using a fixed-effects model, and statistical heterogeneity was measured by using a standard chi-squared statistic. One RCT of cognitive rehabilitation was identified, allowing the examination of effect sizes, but no meta-analysis could be conducted. Cognitive training was not associated with positive or negative effects in relation to any of the reported outcomes. The overall quality of the trials was low to moderate. The single RCT of cognitive rehabilitation found promising results in relation to some patient and caregiver outcomes and was generally of high quality. The available evidence regarding cognitive training remains limited, and the quality of the evidence needs to improve. However, there is still no indication of any significant benefits from cognitive training. Trial reports indicate that some gains resulting from intervention may not be captured adequately by available standardized outcome measures. The results of the single RCT of cognitive rehabilitation show promise but are preliminary in nature. Further well-designed studies of cognitive training and cognitive rehabilitation are required to provide more definitive evidence. Researchers should describe and classify their interventions appropriately by using the available terminology.AB-F is supported by funding from the Dementia Collaborative Research Centre-Early Detection and Prevention and would like to acknowledge the support of the Rosemary Foundation Travel Fellowship awarded to him by the Alzheimer’s Australia Research Foundation

    Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia (Review)

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    BACKGROUND: Cognitive impairments, particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific interventional approaches designed to address difficulties with memory and other aspects of cognitive functioning. The present review is an update of previous versions of this review. OBJECTIVES: The main aim of the current review was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation for people with mild Alzheimer's disease or vascular dementia in relation to important cognitive and non-cognitive outcomes for the person with dementia and the primary caregiver in the short, medium and long term. SEARCH METHODS: The CDCIG Specialized Register, ALOIS, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS and many other clinical trial databases and grey literature sources, was most recently searched on 2 November 2012. SELECTION CRITERIA: Randomised controlled trials (RCTs), published in English, comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting relevant outcomes for the person with dementia and/or the family caregiver, were considered for inclusion. DATA COLLECTION AND ANALYSIS: Eleven RCTs reporting cognitive training interventions were included in the review. A large number of measures were used in the different studies, and meta-analysis could be conducted for 11 of the primary and secondary outcomes of interest. Several outcomes were not measured in any of the studies. The unit of analysis in the meta-analysis was the change from baseline score. Overall estimates of treatment effect were calculated using a fixed-effect model, and statistical heterogeneity was measured using a standard Chi2 statistic. One RCT of cognitive rehabilitation was identified, allowing examination of effect sizes, but no meta-analysis could be conducted. MAIN RESULTS: Cognitive training was not associated with positive or negative effects in relation to any reported outcomes. The overall quality of the trials was low to moderate. The single RCT of cognitive rehabilitation found promising results in relation to a number of participant and caregiver outcomes, and was generally of high quality. AUTHORS' CONCLUSIONS: Available evidence regarding cognitive training remains limited, and the quality of the evidence needs to improve.However, there is still no indication of any significant benefit derived fromcognitive training. Trial reports indicate that some gains resulting fromintervention may not be captured adequately by available standardised outcome measures. The results of the single RCT of cognitive rehabilitation show promise but are preliminary in nature. Further, well-designed studies of cognitive training and cognitive rehabilitation are required to obtainmore definitive evidence. Researchers should describe and classify their interventions appropriately using available terminology.Dementia Collaborative Research CentresNHMRC (National Health and Medical Research Council of Australia

    Cognitive training for people with mild to moderate dementia (protocol)

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    This is the final version of the article. Available from Cochrane Collaboration / Wiley via the DOI in this record.The review version is in ORE at: http://hdl.handle.net/10871/36870This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects of cognitive training on cognitive and non-cognitive outcomes for people with mild to moderate dementia and their caregivers. To compare the effects of cognitive training with those of other non-pharmacological interventions, including cognitive stimulation or rehabilitation. To identify and explore factors related to intervention and trial design that may be associated with the efficacy of cognitive training.Internal sources • Cochrane Incentive Award, UK. External sources • NIHR, UK. This protocol was supported by the National Institute for Health Research (NIHR), via Cochrane Incentive funding Cochrane to the Cochrane Dementia and Cognitive Improvement group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, National Health Service or the Department of Health • National Health and Medical Research Council of Australia, Australi

    Cognitive rehabilitation for people with mild to moderate dementia (Protocol)

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    This is the final version. Available from the publisher via the DOI in this record.This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effects of cognitive rehabilitation on everyday functioning and other outcomes for people with mild to moderate dementia, and on outcomes for caregivers To identify and explore factors that may be associated with the efficacy of cognitive rehabilitation.National Institute for Health Research (NIHR

    Cognitive training for people with mild to moderate dementia (review)

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    This is the final version. Available from Cochrane Collaboration / Wiley via the DOI in this recordThe protocol version is in ORE at: http://hdl.handle.net/10871/33809Background Cognitive impairment, a defining feature of dementia, plays an important role in the compromised functional independence that characterises the condition. Cognitive training (CT) is an approach that uses guided practice on structured tasks with the direct aim of improving or maintaining cognitive abilities. Objectives To assess effects of CT on cognitive and non-cognitive outcomes for people with mild to moderate dementia and their caregivers. To compare effects of CT with those of other non-pharmacological interventions, including cognitive stimulation or rehabilitation, for people with mild to moderate dementia and their caregivers. To identify and explore factors related to intervention and trial design that may be associated with the efficacy of CT for people with mild to moderate dementia and their caregivers. Search methods We searched ALOIS, the Cochrane Dementia and Cognitive ImprovementGroup Specialised Register, on 5 July 2018. ALOIS contains records of clinical trials identified through monthly searches of several major healthcare databases and numerous trial registries and grey literature sources. In addition to this, we searched MEDLINE, Embase, PsycINFO, CINAHL, LILACS, Web of Science Core Collection, ClinicalTrials.gov, and the World Health Organization's trials portal, ICTRP, to ensure that searches were comprehensive and up-to-date. Selection criteria We included randomised controlled trials (RCTs) that described interventions for peoplewithmild tomoderate dementia and compared CT versus a control or alternative intervention. Data collection and analysis We extracted relevant data from published manuscripts and through contact with trial authors if required.We assessed risk of bias using the Cochrane 'Risk of bias' tool.We divided comparison conditions into active or passive control conditions and alternative treatments. We used a large number of measures and data to evaluate 19 outcomes at end of treatment, as well as 16 outcomes at follow-up in the medium term; we pooled this information in meta-analyses. We calculated pooled estimates of treatment effect using a random-effects model, and we estimated statistical heterogeneity using a standard Chi statistic. We graded the evidence using GradePro. Main results The 33 included trials were published between 1988 and 2018 and were conducted in 12 countries; most were unregistered, parallelgroup, single-site RCTs, with samples ranging from 12 to 653 participants. Interventions were between two and 104 weeks long. We classified most experimental interventions as 'straight CT', but we classified some as 'augmented CT', and about two-thirds as multi-domain interventions. Researchers investigated 18 passive and 13 active control conditions, along with 15 alternative treatment conditions, including occupational therapy, mindfulness, reminiscence therapy, and others. The methodological quality of studies varied, but we rated nearly all studies as having high or unclear risk of selection bias due to lack of allocation concealment, and high or unclear risk of performance bias due to lack of blinding of participants and personnel. We used data from 32 studies in the meta-analysis of at least one outcome. Relative to a control condition, we found moderate-quality evidence showing a small to moderate effect of CT on our first primary outcome, composite measure of global cognition at end of treatment (standardised mean difference (SMD) 0.42, 95% confidence interval (CI) 0.23 to 0.62), and high-quality evidence showing a moderate effect on the secondary outcome of verbal semantic fluency (SMD 0.52, 95% CI 0.23 to 0.81) at end of treatment, with these gains retained in the medium term (3 to 12 months post treatment). In relation to many other outcomes, including our second primary outcome of clinical disease severity in the medium term, the quality of evidence was very low, so we were unable to determine whether CT was associated with any meaningful gains. When compared with an alternative treatment, we found that CT may have little to no effect on our first primary outcome of global cognition at end of treatment (SMD 0.21, 95% CI-0.23 to 0.64), but the quality of evidence was low. No evidence was available to assess our second primary outcome of clinical disease severity in the medium term.We found moderate-quality evidence showing that CT was associated with improved mood of the caregiver at end of treatment, but this was based on a single trial. The quality of evidence in relation to many other outcomes at end of treatment and in the medium term was too low for us to determine whether CT was associated with any gains, but we are moderately confident that CT did not lead to any gains in mood, behavioural and psychological symptoms, or capacity to perform activities of daily living. Authors' conclusions Relative to a control intervention, but not to a variety of alternative treatments, CT is probably associated with small to moderate positive effects on global cognition and verbal semantic fluency at end of treatment, and these benefits appear to be maintained in the medium term. Our certainty in relation to many of these findings is low or very low. Future studies should take stronger measures to mitigate well-established risks of bias, and should provide long-term follow-up to improve our understanding of the extent to which observed gains are retained. Future trials should also focus on direct comparison of CT versus alternative treatments rather than passive or active control conditions.National Institute for Health Research (NIHR)National Health and Medical Research Council of Australi

    A 12-week multidomain intervention versus active control to reduce risk of Alzheimer’s disease: study protocol for a randomized controlled trial

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    Background: Disappointing results from clinical trials of disease-modifying interventions for Alzheimer’s dementia (AD), along with reliable identification of modifiable risk factors in mid life from epidemiological studies, have contributed to calls to invest in risk-reduction interventions. It is also well known that AD-related pathological processes begin more than a decade before the development of clinical signs. These observations suggest that lifestyle interventions might be most effective when targeting non-symptomatic adults at risk of AD. To date, however, the few dementia risk-reduction programs available have targeted individual risk factors and/or were restricted to clinical settings. The current study describes the development of an evidence-based, theoreticallydriven multidomain intervention to reduce AD risk in adults at risk. Method: The design of Body Brain Life (BBL) is a randomized controlled trial (RCT) to evaluate a 12-week online AD risk-reduction intervention. Eligible participants with several modifiable risk factors on the Australian National University (ANU) AD Risk Index (ANU-ADRI) are randomly allocated to an online only group, an online and face-toface group, or an active control group. We aim to recruit 180 participants, to undergo a comprehensive cognitive and physical assessment at baseline, post-intervention, and 6-month follow-up assessment. The intervention comprises seven online modules (dementia literacy, risk factor education, engagement in physical, social, and cognitive lifestyles, nutrition, and health monitoring) designed using contemporary models of health behavior change. Discussion: The BBL program is a novel online intervention to reduce the risk of AD in middle-aged adults at risk. The trial is currently under way. It is hypothesized that participants in the intervention arms will make lifestyle changes in several domains, and that this will lead to a reduction in their AD risk profile. We also expect to show that health behavior change is underpinned by changes in psychological determinants of behavior. If successful, the findings will contribute to the development of further dementia risk reduction interventions, and thus contribute to the urgent need to lower dementia risk factors in the population to alter future projections of disease prevalence. Longer follow-up of BBL participants and replications using large samples are required to examine whether reduction in AD risk factors will be associated with reduced prevalence.BBL is funded by the National Health and Medical Research Council as part of the Dementia Collaborative Research Centres. Anstey and Cherbuin are funded by NHMRC Fellowships 1002560 and 471501

    Olfactory identification testing as a predictor of the development of Alzheimer's dementia: A systematic review

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    Objectives/Hypothesis: To evaluate the utility of olfactory identification tests as prognostic instruments for Alzheimer's dementia (AD). Study Design: Systematic review. Methods: In accordance with PRISMA guidelines, PubMed and Ovid MEDLINE, EMBASE, ISI Web of Science, PsycINFO, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched to determine the quality and quantity of longitudinal and cross‐sectional research on this topic. Results: Two prospective longitudinal cohort studies and 30 cross‐sectional studies met inclusion criteria. The prospective longitudinal studies evaluated subjects with or without mild cognitive impairment (MCI) while also using olfactory identification testing as part of a neurocognitive evaluation. The first study reported an increased risk of later onset of AD in subjects with baseline hyposmia, whereas the second study suggested a possible relationship between decreased olfaction in participants with MCI and conversion to AD but was inconclusive due to low follow‐up rates. Wide variability in the type of olfactory identification test used and the reporting of results precluded meta‐analysis. The cross‐sectional studies demonstrated a positive association between poorer performance on olfactory identification testing and AD. Conclusions: Although there is evidence suggesting an association between decreased olfaction and AD, rigorously designed longitudinal cohort studies are necessary to clarify the value of olfactory identification testing in predicting the onset of AD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92127/1/23365_ftp.pd

    Increasing autonomy through improved care: effects of a professional care-giver training programme on the functional status of older adults

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    This work was supported by the Ministry of Education, Government of Spain (grant number FPU15/03966).The aim of the present research was to evaluate the effectiveness of a care-giver training programme that trains professional care-givers in cognitive stimulation strategies for functional maintenance in care-dependent older adults. The sample contained 69 older adults (37 in the treatment group, 32 control group) assessed with the Barthel Index, the Mini-Mental State Examination and the Clifton Assessment Procedure for the Elderly (Cognitive Scale). Participants in the treatment group were treated by professional care-givers who were trained with the programme CUIDA-2 in communication and cognitive stimulation strategies. The results from the Barthel Index showed significant differences in the post-intervention assessment and in the follow-up assessment, where the treatment group obtained higher scores, and there were significant differences within the treatment group between the initial assessment and the post-treatment assessment, as well as between the initial assessment and the follow-up. The data obtained reflect that a training programme to train professional care-givers produced functional benefits in the older adults, and these improvements persisted over time. Moreover, the care-givers saw themselves as more competent and more satisfied with their work.Ministry of Education, Government of Spain FPU15/0396

    Psychosocial interventions for people with dementia: a synthesis of systematic reviews

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    Objectives: Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works. Methods: A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted. Results: Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews. Conclusion: There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change
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