Effectiveness of an Innovative Cognitive Treatment and Telerehabilitation on Subjects With Mild Cognitive Impairment: A Multicenter, Randomized, Active-Controlled Study.

Rosa Manenti,Ambra Macis,Sonia Di Tella,Clarissa Ferrari,Elena Gobbi,Placido Bramanti,Ilaria Pagnoni,Maria Cotelli,Francesca Baglio,Federica Rossetto,Sandro Iannaccone,Federica Alemanno,Giuliano Binetti,Stefano F Cappa,Vincenzo Cimino

doi:10.3389/fnagi.2020.585988

Abstract

BackgroundIn recent years, the potential usefulness of cognitive training procedures in normal aging and mild cognitive impairment (MCI) have received increased attention.ObjectiveThe main aim of this study was to evaluate the efficacy of the face-to-face cognitive virtual reality rehabilitation system (VRRS) and to compare it to that of face-to-face cognitive treatment as usual for individuals with MCI. Moreover, we assessed the possibility of prolonging the effects of treatment with a telerehabilitation system.MethodsA total of 49 subjects with MCI were assigned to 1 of 3 study groups in a randomized controlled trial design: (a) those who received face-to-face cognitive VRRS (12 sessions of individualized cognitive rehabilitation over 4 weeks) followed by telerehabilitation (36 sessions of home-based cognitive VRRS training, three sessions for week); (b) those who received face-to-face cognitive VRRS followed by at-home unstructured cognitive stimulation (36 sessions of home-based unstructured cognitive stimulation, three sessions for week); and (c) those who received face-to-face cognitive treatment as usual (12 sessions of face-to-face cognitive treatment as usual).ResultsAn improvement in memory, language and visuo-constructional abilities was observed after the end of face-to-face VRRS treatment compared to face-to-face treatment as usual. The application of home-based cognitive VRRS telerehabilitation seems to induce more maintenance of the obtained gains than home-based unstructured stimulation.DiscussionThe present study provides preliminary evidence in support of individualized VRRS treatment and telerehabilitation delivery for cognitive rehabilitation and should pave the way for future studies aiming at identifying optimal cognitive treatment protocols in subjects with MCI.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT03486704.

Highlights

In recent years, there has been growing interest in the use of telerehabilitation methods in patients with neurodegenerative diseases (Cherney and van Vuuren, 2012; Cotelli et al, 2019).Given the limited effectiveness of pharmacological treatments, there is a critical need to develop novel interventions aimed at preventing or delaying the onset of Alzheimer’s disease (AD), and mild cognitive impairment (MCI) might represent a potential target for intervention trials (Kidd, 2008; Hong et al, 2015; Janoutova et al, 2015).Traditional cognitive training involves intensive in-person sessions that may not prove to be feasible and cost-effective in the case of large-scale implementation
Concerning the clinic-VRRS + Tele@H-VRRS group, all 18 participants completed the 12 sessions of face-to-face VRRS treatment, 6 participants completed all 36 sessions of at-home VRRS training, whereas all other subjects completed more than 70% of the telerehabilitation sessions
All 14 participants in the clinic-VRRS + Tele@H-UCS group completed the 12 sessions of face-to-face VRRS treatment, 7 subjects completed the 36 sessions of at-home unstructured cognitive stimulation, and the other subjects completed more than 70% of the at-home unstructured cognitive stimulation sessions

Summary

Introduction

There has been growing interest in the use of telerehabilitation methods in patients with neurodegenerative diseases (Cherney and van Vuuren, 2012; Cotelli et al, 2019).Given the limited effectiveness of pharmacological treatments, there is a critical need to develop novel interventions aimed at preventing or delaying the onset of Alzheimer’s disease (AD), and mild cognitive impairment (MCI) might represent a potential target for intervention trials (Kidd, 2008; Hong et al, 2015; Janoutova et al, 2015).Traditional cognitive training involves intensive in-person sessions that may not prove to be feasible and cost-effective in the case of large-scale implementation. The growing demand and the need to contain the costs of health care will dictate the need to reorganize the services dedicated to people at risk of developing cognitive impairment by taking advantage of technological developments (Bharucha et al, 2009; Astell, 2019; Moyle, 2019). Telerehabilitation technologies allow to provide services remotely in patients’ homes or other environments, allowing access to health care to patients living in rural settings or with mobility difficulties (Brennan et al, 2002, 2009, 2011; Forducey et al, 2003; Mashima and Doarn, 2008; Zampolini et al, 2008; Hailey et al, 2011; Peretti et al, 2017). The potential usefulness of cognitive training procedures in normal aging and mild cognitive impairment (MCI) have received increased attention

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Conclusion