Cognitive remediation therapy for older adults

Abstract

There is a large body of research on cognitive interventions for older adults the review which suggests the following: (1) Cognition remediation therapy is indicated for healthy elderly, and in mild cognitive impairment (MCI), early dementia, brain disease and injury, and severe mental illness (SMI). (2) Studies on healthy elderly demonstrate that with cognitive training (CT), cognitive stimulation (CS), and/or cognitive rehabilitation (CR) age-related cognitive decline can be reversed, at least partially if not fully, even in advanced age, with improved social functioning and quality of life. Better results are obtained if cognitive remediation therapy (CRT) is combined with vocational/psychosocial rehabilitation. Generalization of training to activities of daily living (ADL) and to secondary outcome measures such as quality of life and self-esteem are issues that need to be addressed in older adults. (3) Research in MCI has indicated that CRT, especially memory training, has some role. Future studies should place focus on the assessment of dose-response relationship, training generalization, and ecologically relevant approaches. (4) Findings of earlier work in early-stage dementia were frustrating, more recent work, especially randomized controlled trials of high quality, has provided a ray of rope with respect to effectiveness of CT and CR. Further well-designed studies are required to provide more definitive evidence. (5) Significant therapeutic effects of CR have been observed on cognitive function and ADL in the elderly patients with stroke. Routine screening for stroke patients and those with brain injury for cognitive impairment is recommended. (6) Available research provides evidence that cognitive remediation benefits people with SMI, and when combined with psychiatric rehabilitation this benefit generalizes to functioning. Elderly with SMI need special focus. Further needs to be carried out on older people with SMI.