Meeting News

Goal-oriented therapy improves quality of life, mood in early Alzheimer’s

Ola Kudlicka

Goal-oriented therapy improved mood and quality of life among individuals with early-stage Alzheimer’s disease or dementia, according to data presented at the Alzheimer’s Association International Conference.

“We know there’s a great deal that can be done to support people to live well with dementia. Our research is about finding out what matters most to individuals and working with them to find strategies to manage important tasks and maintain their interests,” study researcher Ola Kudlicka, MSc, PhD, of the University of Exeter, United Kingdom, said in a press release. “Contrary to popular belief, our trial shows that people with early-stage dementia, given the right kind of support, have the capacity to learn and to improve their skills. We aim to support them in their right to live a fulfilling and happy life and be as independent as possible.”

To assess efficacy of goal-oriented cognitive rehabilitation for early-stage Alzheimer’s disease and related dementias, researchers conducted GREAT, a multicenter, single-blind, randomized controlled trial, among 427 individuals with an ICD-10 diagnosis of Alzheimer’s disease, vascular or mixed dementia, in early stages of disease. Study participants were stable on medication if prescribed and had a family caregiver willing to participate in the study. Participants were randomly assigned to receive cognitive rehabilitation (n = 209), which included 10 therapy sessions over 3 months followed by four maintenance sessions over 6 months, or treatment as usual (n = 218). Cognitive rehabilitation was delivered in participants’ homes by occupational therapists and a nurse. Follow-up was conducted 3 months and 9 months postrandomization.

At 3 months, participants who received cognitive rehabilitation exhibited large positive effects for self-reported goal attainment (d = 0.97; 95% CI, 0.75-1.19), which was supported by caregiver ratings (d = 1.11; 95% CI, 0.89-1.34).

Linda Clare
Linda Clare

These effects remained at the 9-month follow-up for both self-reports (d = 0.94; 95% CI, 0.71-1.17) and caregiver ratings (d = 0.96; 95% CI, 0.73-1.2).

There were no group differences in secondary outcomes at 3 months. However, participants who received cognitive rehabilitation exhibited small positive effects for mood (d = 0.22; 95% CI, 0-0.44) and caregiver-rated quality of life (0.27; 95% CI, 0.05-0.49) at 9-month follow-up.

“We now know that cognitive rehabilitation effectively supports people to achieve the everyday goals that matter to them. The next step is to quantify benefits such as whether this approach delays the need for people to go into care homes by supporting them to live independently for longer. This could have important financial benefits for social care,” Linda Clare, MSc, PhD, ScD, of the University of Exeter, said in the release. “We must also assess whether the therapy can be integrated into how practitioners routinely work, so that more people can have access and are supported to live better lives with dementia.” – by Amanda Oldt

Reference:

Clare L, et al. Goal-oriented cognitive rehabilitation in early-stage Alzheimer’s and related dementias: Results from GREAT, a multi-centre single-blind randomized controlled trial. Presented at: Alzheimer’s Association International Conference; July 16-20, 2017; London.

Disclosure: Healio.com/Psychiatry could not confirm relevant financial disclosures at the time of publication.

Ola Kudlicka

Goal-oriented therapy improved mood and quality of life among individuals with early-stage Alzheimer’s disease or dementia, according to data presented at the Alzheimer’s Association International Conference.

“We know there’s a great deal that can be done to support people to live well with dementia. Our research is about finding out what matters most to individuals and working with them to find strategies to manage important tasks and maintain their interests,” study researcher Ola Kudlicka, MSc, PhD, of the University of Exeter, United Kingdom, said in a press release. “Contrary to popular belief, our trial shows that people with early-stage dementia, given the right kind of support, have the capacity to learn and to improve their skills. We aim to support them in their right to live a fulfilling and happy life and be as independent as possible.”

To assess efficacy of goal-oriented cognitive rehabilitation for early-stage Alzheimer’s disease and related dementias, researchers conducted GREAT, a multicenter, single-blind, randomized controlled trial, among 427 individuals with an ICD-10 diagnosis of Alzheimer’s disease, vascular or mixed dementia, in early stages of disease. Study participants were stable on medication if prescribed and had a family caregiver willing to participate in the study. Participants were randomly assigned to receive cognitive rehabilitation (n = 209), which included 10 therapy sessions over 3 months followed by four maintenance sessions over 6 months, or treatment as usual (n = 218). Cognitive rehabilitation was delivered in participants’ homes by occupational therapists and a nurse. Follow-up was conducted 3 months and 9 months postrandomization.

At 3 months, participants who received cognitive rehabilitation exhibited large positive effects for self-reported goal attainment (d = 0.97; 95% CI, 0.75-1.19), which was supported by caregiver ratings (d = 1.11; 95% CI, 0.89-1.34).

Linda Clare
Linda Clare

These effects remained at the 9-month follow-up for both self-reports (d = 0.94; 95% CI, 0.71-1.17) and caregiver ratings (d = 0.96; 95% CI, 0.73-1.2).

There were no group differences in secondary outcomes at 3 months. However, participants who received cognitive rehabilitation exhibited small positive effects for mood (d = 0.22; 95% CI, 0-0.44) and caregiver-rated quality of life (0.27; 95% CI, 0.05-0.49) at 9-month follow-up.

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“We now know that cognitive rehabilitation effectively supports people to achieve the everyday goals that matter to them. The next step is to quantify benefits such as whether this approach delays the need for people to go into care homes by supporting them to live independently for longer. This could have important financial benefits for social care,” Linda Clare, MSc, PhD, ScD, of the University of Exeter, said in the release. “We must also assess whether the therapy can be integrated into how practitioners routinely work, so that more people can have access and are supported to live better lives with dementia.” – by Amanda Oldt

Reference:

Clare L, et al. Goal-oriented cognitive rehabilitation in early-stage Alzheimer’s and related dementias: Results from GREAT, a multi-centre single-blind randomized controlled trial. Presented at: Alzheimer’s Association International Conference; July 16-20, 2017; London.

Disclosure: Healio.com/Psychiatry could not confirm relevant financial disclosures at the time of publication.

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