Summary: Preliminary results of a large trial of cognitive rehabilitation for people with Alzheimer's are encouraging. Cognitive rehabilitation could help keep people with mild Alzheimer's functioning in the community and at home.
Another great presentation in the "Psychosocial Issues and Neuropsychology" session at ICAD 2008 was Dr. David Loewenstein's update on a clinical trial of cognitive rehabilitation for people with Alzheimer's. Dr. Loewenstein is Director of Research and Neuropsychology at the Wien Center for Alzheimer's Disease and Memory Disorders, and professor of Psychiatry and Behavioral Sciences at the University of Miami's Miller School of Medicine.
The value of cognitive rehabilitation is well-established for people with brain injuries and for older adults in general, he said. But for people with Alzheimer's, it's a bit more complicated. This is because rehabilitation must be designed to work even as the disease may be progressing, and because the parts of the brain affected in Alzheimer's make it hard to use standard rehabilitation methods.
Dr. Loewenstein and colleagues started with a small trial that showed systematic cognitive rehabilitation can help people with mild Alzheimer's disease carry out specific tasks [see my previous post for details]. Now they're conducting a larger trial as part of the Florida Alzheimer's Disease Research Center, he said, with funding from the U.S. National Institute on Aging.
Although he is still recruiting for the trial, and follow-up testing of current participants is ongoing, preliminary results are encouraging. During the trial, some participants are assigned to the cognitive rehabilitation program, while others are assigned to a mental stimulation program (interactive computer programs involving memory, concentration and problem-solving skills). So far, those who received cognitive rehabilitation are much better at associating names with faces and at navigating telephone menu systems than those who received mental stimulation.
The trial is also designed to test cognitive rehabilitation for people with Mild Cognitive Impairment, and to test the effect of "booster" or refresher sessions after rehabilitation. It's too early to know what the results of these portions of the trial will be.
Cognitive rehabilitation is a promising approach to keeping people with mild Alzheimer's functioning in the community and at home. It may be easier to simply give a patient a pill, Dr. Loewenstein said, but psychosocial treatments such as cognitive rehabilitation can be more effective than the Alzheimer's drugs available today. When more effective drugs become available, the combination of those drugs and cognitive rehabilitation could dramatically increase quality of life for people with memory loss and their caregivers.