Abstract
Alzheimer’s disease (AD) is the most frequent cause of dementia and cholinesterase inhibitors are the available treatment in the mild stage. However cognitive rehabilitation has shown satisfactory results when combined with pharmacological treatment. Behavioral alteration is common in AD patients, which burdens caregivers and raises the risk of institutionalization. Providing caregivers guidance may enable them to assure better quality of life for patient and caregiver and lower institutionalization rates.ObjectiveTo evaluate the effects of a neuropsychological rehabilitation program (NRP) combined with pharmacological treatment in early stage AD patients.MethodsWe studied 12 AD patients (6 women), average age 75.42 (6.22) with 9.58 (5.6) years education in use of stable doses of cholinesterase inhibitors. Cognitive performance was evaluated using Mini-Mental State Examination (MMSE) and Alzheimer´s Disease Assessment Scale-cognitive (ADAS-Cog). Caregivers responded to Neuropsychiatric Inventory (NPI) and Functional Activities Questionnaire (FAQ) at initial evaluation (T1), and after 8 months of rehabilitation program (T2). The program comprised two sessions every week and family guidance every fortnight.ResultsMMSE (T1:23.25 (1.82)/T2:23.42 (2.81); ADAS-Cog (T1:17.11 (6.73)/T2:21.2 (8.59); NPI (T1:23.42 (23.38)/T2:19.83 (17.73); FAQ (T1:10.67 (7.24)/T2: 13.92 (6.92).ConclusionsThese results show the importance of providing guidance and support for caretakers. Study limitations were the small number of patients and absence of a control group with only drug treatment to compare with combined pharmacological and rehabilitation treatments.
Highlights
Subjects were recruited at the Universidade Federal de São Paulo (UNIFESP)/ EPM hospital complex (Hospital São Paulo and Hospital Santa Marcelina)
Family-member caregivers were informed of the research goal and procedure and provided signed consent for patient’s participation in the study, promised to take part in the orientation program, and were told that after three consecutive absences the patient and family-member caregiver would be removed from the study
It is important to note that patients in this study were submitted to individual and group intervention which may explain the stable cognitive, functional and behavioral scores from first to second evaluation
Summary
Verify the effect of a family guidance program by administering questionnaires containing and functional and behavioral scales to caregivers of mild AD patients. Our research findings corroborate those in the literature on behavior alteration in early-stage AD patients and suggest that non-pharmacological treatment may delay onset of behavioral and mood disturbances and enhance quality of life for these patients and their caregivers and reduce institutionalization[16,17,18].
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