COGNITIVE REHABILITATION OF INSTRUMENTAL ACTIVITES OF DAILY LIVING IN ALZHEIMER’S DISEASE: A CASE REPORT

Abstract

In a previous randomized controlled trial (RCT), a cognitive rehabilitation program (CR) using errorless learning (EL) and spaced retrieval (SR) was efficient to relearn an instrumental activity of daily living (IADL) in patients with Alzheimer's disease (AD). However, CR did not improve quality of life (QoL). It was hypothesized that: 1) the improvement of only one IADL was insufficient to ameliorate QoL; 2) the measure of QoL wasn't sensitive enough, and 3) CR of IADLs might have greater impact on self-esteem and contentment than on QoL. To investigate the tolerability and preliminary effectiveness of CR to improve two IADL, self-esteem, contentment and QoL in AD. The participant was an 84-year old woman with mild AD. The participant received a CR program of two sessions/week during six weeks. Each session lasted 45–60 minutes and included repeated practices of an IADL using EL, SR, and a gradual reduction of level of assistance. The participant was trained for watching TV (IADL-1) and playing card games on her computer (IADL-2). CR was administered at weeks 1–3 (IADL-1) and at weeks 4–6 (IADL-2). The Direct Measure of Training was administered at baseline (BL), at the beginning of each training session, and at 1-week follow-up to assess the participant's ability to complete and maintain the task. IADL-1: At BL, the participant completed M= 55 % (7.07) of the task. After 54 practices realised over 6 sessions, the participant completed 100 % of the task. Ameliorations were maintained at 1-week (100 %) and 1-month follow-up (90 %). IADL-2: At BL, the participant completed M = 64 % (9.89) of the task. After 34 practices realised over 6 sessions, the participant completed 100 % of the task. Ameliorations were maintained at 1-week follow-up. For both IADLs, Percentage of Nonoverlapping Data (effect size) = 1. Self-esteem and contentment increased post-intervention, while QoL remained unchanged. The patient attended all sessions, and reported increased energy and activity.