Management of Cognitive Deficits in Patients with Alzheimer's Disease

Recently, an increasing number of studies has shown that some aspects of cognitive functions in Alzheimer patients may be selectively affected by Alzheimer's disease (AD) while others are preserved. They have also demonstrated the heterogeneity of cognitive deficits within AD patients. Furthermore, several researches put into evidence optimizing factors for the cognitive performance of demented patients. Such a cognitive approach to AD has allowed a renewal of rehabilitation strategies, taking daily difficulties into consideration. It mainly consists of optimizing the patient functioning at every stage of the disease course, by exploiting preserved abilities and performance enhancing factors. For example, the clinical management of memory problems in AD patients could be centered on three directions: 1. Temporary facilitation of information encoding or retrieval by the use of optimizing factors shown during detailed cognitive examinations; 2. New knowledge teaching by the use of preserved memory abilities; 3. Arrangement of the patient surroundings with external cues and use of physical supports to compensate for defective functions (e.g. an external memory aid, such as a diary), so as to reduce the impact of cognitive deficits in daily living activities. Such a management of cognitive problems naturally implies the active participation of a caregiver both during the evaluation and the rehabilitation. The caregiver can be of help at different stages: arranging the patient daily environment according to his/her cognitive deficits, and removing sources of confusion; helping the patient with the use of external aids; favoring optimizing factors and preserved abilities utilization; interacting with the patient in good conditions, preventing the call to impaired capacities. Therefore, adapted structures should be put into place to allow these interventions and an enlightenment of caregiver burden, for example day care centers reproducing real life environment, where optimizing strategies could be specifically trained

Penser autrement le vieillissement

Les prédictions concernant le nombre de personnes âgées qui souffriront de démence en 2050 suscitent de fréquentes annonces alarmistes, prévoyant un « tsunami » de cas qui submergerait les familles et les soignants et qui imposerait un fardeau économique insupportable à la société. Afin de prévenir cette « crise de la démence », la position biomédicale dominante considère qu’il faut placer un maximum de moyens sur la recherche neurobiologique, le diagnostic et les traitements pharmacologiques, afin d’essayer de différer et, finalement, de guérir la démence. Ce livre vise tout d’abord à expliquer le contexte social et culturel dans lequel s’est développée cette approche biomédicale de la démence, qui a conduit à une médicalisation croissante du vieillissement. Il a également pour objectif de décrire les limites de cette approche et de montrer en quoi le vieillissement cérébral et cognitif semble être modulé par de multiples facteurs (biomédicaux, psychologiques, sociaux, culturels, etc.), intervenant tout au long de la vie. Les implications de ce changement de perspective sont ensuite identifiées. Pour les auteurs, il convient d’allouer davantage de ressources à la prévention et de développer des pratiques d’évaluation et d’intervention psychosociales qui prennent en compte les personnes âgées dans leur individualité. L’objectif ? Aider ces personnes à maintenir un sens à leur vie, un sentiment de bien-être et de dignité, ainsi qu’une véritable place dans la société. Ils préconisent également un changement de culture dans les structures d’hébergement à long terme pour personnes âgées. Cet ouvrage engagé, qui défend une approche humaniste du vieillissement, se termine par un ensemble de réflexions sur les droits et la citoyenneté des personnes âgées

A life-course and multifactorial approach to Alzheimer’s disease: Implications for research, clinical assessment and intervention practices

According to the dominant biomedical view, Alzheimer’s disease (AD) has a precise, necessary and unifying neurobiological cause, which distinguishes it from other neurodegenerative diseases and normal ageing. However, different types of evidence specifically lead to questioning the foundations of this essentialist and category-based approach to AD. It seems more and more evident that AD represents a heterogeneous state, determined by multiple factors and mechanisms that interact and intervene throughout life. This other way of conceiving AD not only requires a change of research objectives, but also a profound modification of clinical assessment and intervention practices. It also appeals to follow the path of prevention. © The Author(s) 2016

Memory systems and memory disorders

peer reviewedRecent cognitive models suggest that memory has a complex structure, composed of several independent systems (working memory, and four long-term memory systems: episodic memory, semantic memory, perceptual representation system, and procedural memory). Furthermore, neuropsychological studies show that a brain lesion can selectively impair some systems or some particular process in a system, while others are spared. In this theoretical context, the objective of assessment is to detect the impaired memory systems and processes as well as those, which remain intact. To do this, the clinician has to use various tests specifically designed to assess the integrity of each memory system and process

A cognitive and ecological approach to neuropsychological assessment in Alzheimer's disease

The role of neuropsychology is central to the early diagnosis of AD, but the identification of the disease at this stage can be difficult for the specialist, as is the staging and tracking of the disease's progression. Early Alzheimer's disease has first to be differentiated from normal aging, and from other dementia types. From a neuropsychological point of view, recent studies have demonstrated that specific tests of episodic memory and executive functions increase the likelihood of identifying incident AD despite the heterogeneity of the disease. This can also be achieved by a combination of cognitive factors and other risk factors (such as subjective complaints, informant report, genetics, neuroimaging techniques). The cognitive approach to AD has also allowed the development of new rehabilitation strategies, which consist mainly of exploiting preserved abilities and performance enhancing factors. For example, the following three procedures could be used for the clinical management of memory problems in AD patients: (1) temporary facilitation of information encoding or retrieval by the use of optimizing factors revealed by detailed cognitive examinations; (2) new knowledge teaching by the use of preserved (implicit) memory abilities; (3) adaptation of the patient's environment with the help of external cues to compensate for impaired functions. Suggestions are put forward in regard to the assessment of both neuropsychological and pharmacological treatment effect

Exploration des processus contrôlés et automatiques chez des patients atteints de la maladie d'Alzheimer à un stade débutant par le biais de la procédure de dissociation des processus de Jacoby

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