Rehabilitation In Alzheimer Research Articles

Awareness and cognitive rehabilitation in Alzheimer's disease and frontotemporal dementia.

Awareness influences the evolution of neurodegenerative dementias. We gathered participants' and caregivers assessments of dependence in daily activities and we studied how each score would be related to next year participant autonomy, independently of other explicative variables. We retrospectively analyzed data from mildly demented participants with a clinical diagnosis of Alzheimer's disease (AD, n = 186) and frontotemporal dementia (FTD, n = 29) and their relatives. A research tool was used to assess participant dependence in 98 daily activities and associated caregiver burden. A discrepancy score between the patient's and relative's judgment was calculated to evaluate awareness of dependence in activities at baseline. This dependence scores, as well as sex, age, education, and 1 year difference in Mini-Mental State Examination were taken as possible explicative variables for dependence in activities adapted by therapists during a 1-year cognitive rehabilitation program. Patients with FTD showed less awareness for daily dependence (discrepancy 20.9% vs. 11.8% in AD). Both groups benefited from cognitive rehabilitation (25% decrease in dependence) and subjective burden of relatives was decreased in both groups. In the AD group, there was a significant positive relationship between both caregiver (P < 0.001) and participant's (P < 0.02) evaluation of dependence in daily activities at inclusion and dependence of participants in adapted activities after 1 year. Awareness of impairment in daily activities is a clinical symptom that is more important at inclusion in FTD than in AD. However, in participants with AD who, as a group, significantly benefit from a cognitive rehabilitation program, not only caregiver's but also participant's assessment of dependence at baseline is correlated to subsequent, next year greater dependence in daily activities adapted by the therapists. Although discrepant, both caregiver and participant evaluations appear to be important variables to understand the evolution and the benefit of care in participants at early stages of dementia.

Проблемы ядерной медицины и когнитивной реабилитации

The structural-functional and cognitive development of the new Homo sapiens brain will require quantitative and qualitative provision of technologies and tools in «targeted» delivery to neurocommunicative «hard drives» of memory of nanomaterials of bioelementology and nutritiology of the brain, pharmacology and radiobiology. In studies, Romanchuk N.P. has shown that for new neurogenesis and neuroplasticity, for managing human neuroplasticity and biological age, for modern neurophysiology and neurorehabilitation of cognitive impairment and cognitive disorders, sufficient functional and energy nutrition of the brain is necessary using modern neurotechnologies of nuclear medicine. Neurogenetics, Combined and Hybrid Neural Network Neuroimaging Technologies, 5P Medicine and 5G technology, nanoradioprotectants with maximization of drug efficacy on a healthy microbiota bioplatform will ensure that «visceral and cognitive brain» work is synchronized in strategic cognitive rehabilitation activities. The author's program «ADNM-365/22/77» will allow the work of a qualified MIND, the creation and improvement of not only the cognitive potential of the BRAIN, but also the management of cognitive rehabilitation in Alzheimer's disease.

Customized Application of tDCS for Clinical Rehabilitation in Alzheimer's Disease.

Customized Application of tDCS for Clinical Rehabilitation in Alzheimer's Disease.

A Tablet App Supporting Self-Management for People With Dementia: Explorative Study of Adoption and Use Patterns.

BackgroundAssistive technology (AT) is rapidly emerging within dementia care and support. One area of AT application is support of people with dementia in compensating for cognitive symptoms and thereby promoting their self-management. There is, however, little evidence for the applicability, usability, and effectiveness of AT for people with dementia, and there is a need to identify factors that can promote adoption.ObjectiveThis study aimed to (1) evaluate the applicability and usability of an app, tailor-made for people with dementia; (2) explore factors affecting adoption; (3) explore the possible influence of caregiver involvement; and (4) contribute to process evaluation of the intervention.MethodsThe ReACT (Rehabilitation in Alzheimer's disease using Cognitive support Technology) app was designed as a holistic solution to support memory and structure in daily living. Persons with dementia had access to a personal user account, and family caregivers were given a parallel login. Written and Web-based materials were provided to support self-applied implementation. A mixed methods design was applied to explore adoption and use patterns, including background and disease-related data, qualitative data from a survey, and log data. Adoption was defined as the use of the app over a period of ≥90 days.ResultsData from 112 participants and 98 caregivers were included. Shorter time from diagnosis (U=595; P=.046; r=0.19) and caregiver activating the app (P=.02) had a significant impact on the participant adoption status. Logistic regression analysis showed that if caregivers had activated the app, the participant was five times more likely to become an adopter (odds ratio 5.1, 95% CI 1.29-19.99; P=.02). However, the overall predictive power was low, and there was a wide variation in background and disease-related characteristics among adopters. The level of experience and skills in tablet use were not significantly different between adopters and nonadopters. Adopters generally rated the app high on usefulness, satisfaction, and ease of use (rated on the USEdem questionnaire). Their scores were significantly higher compared with nonadopters (U=5.5; P=.02; r=0.64). Analysis of use patterns showed that all functionalities of the app were used among adopters.ConclusionsFor participants who became adopters, the ReACT app and the methods for self-applied implementation were applicable. However, the results were also in accordance with the well-known challenges of nonadoption and nonadherence to digital health interventions. The study provided insight into the importance of timely introduction and caregiver support for adoption of AT among people with dementia. It also underlined the high complexity of personal and contextual factors that influence adoption. These complex factors need to be considered when designing and implementing AT for people with dementia.

Cognitive rehabilitation in Alzheimer′s disease

Cognitive rehabilitation has been defined as a comprehensive program aiming to cognitive enhancement. It has been developed as a method of rehabilitation for people with cognitive impairment of various etiologies such as traumatic brain injury, cerebral vascular accident, cerebral palsy, Down syndrome, Alzheimer’s disease, attention deficit hyperactivity disorder, and developmental disorders. Cognitive rehabilitation is a non-interventional, non-pharmaceutical personalized treatment. Due to the low efficacy of pharmacological approaches to the day, cognitive rehabilitation is expected to play an important role in the treatment of Alzheimer’s disease. The aim of this review is to present cognitive rehabilitation as a mental enhancement strategy in Alzheimer’s disease and to state the worth of cognitive rehabilitation in patients with Alzheimer’s disease, the benefits and drawbacks, the cost and the overall implementation, as well as the optimal future approach of the strategy.

Cognitive Rehabilitation in Alzheimer's Disease: A Controlled Intervention Trial.

Cognitive Rehabilitation for Alzheimer's disease (AD) is an integrative multimodal intervention. It aims to maintain autonomy and quality of life by enhancing the patients' abilities to compensate for decreased cognitive functioning. We evaluated the feasibility of a group-based Cognitive Rehabilitation approach in mild AD dementia and assessed its effect on activities of daily living (ADL). We included 16 patients with AD dementia in a controlled partial-randomized design. We adapted the manual-guided Cognitive Rehabilitation program (CORDIAL) to a group setting. Over the course of three months, one group received the Cognitive Rehabilitation intervention (n = 8), while the other group received a standardized Cognitive Training as an active control condition (n = 8). ADL-competence was measured as primary outcome. The secondary outcome parameters included cognitive abilities related to daily living, functional cognitive state, and non-cognitive domains, e.g., quality of life. For each scale, we assessed the interaction effect 'intervention by time', i.e., from pre-to post-intervention. We found no significant interaction effect of intervention by time on the primary outcome ADL-competence. The interaction effect was significant for quality of life (Cohen's d: -1.43), showing an increase in the intervention group compared with the control group. Our study demonstrates the feasibility of a group-based Cognitive Rehabilitation program for patients with mild AD dementia. The Cognitive Rehabilitation showed no significant effect on ADL, possibly reflecting a lack of transfer between the therapy setting and real life. However, the group setting enhanced communication skills and coping mechanisms. Effects on ADL may not have reached statistical significance due to a limited sample size. Furthermore, future studies might use an extended duration of the intervention and integrate caregivers to a greater extent to increase transfer to activities of daily living.

Language Rehabilitation in Alzheimer's Disease-Verbal Fluency Clusters

Verbal Fluency (VF) is a neuropsychological tool in which the participant is asked to produce as many items (animals, fruits, vegetables and others) as quickly as possible, in 60 secs. In the present study, semantic verbal fluency animals (VFa) and fruits (VFf) were compared using clustering strategies in Mild Alzheimer Disease (MAD) subjects (100) and controls (CG) subjects (201). Results demonstrated that spoken clustering items on VFa were directed by semantic similarities in CG. On the other hand, VFf spontaneously generated phonological clusters neglecting semantic similarities. For VFa CG had the search mode component of executive function only under the premise of semantic features, leaving articulatory and phonological aside. MAD group had the search mode component under the premise of phonological features or none. Language rehabilitation in MAD should start early, considering articulatory and semantic approach to achieve greater reliability of efficacy.

Editorial: ICT for Assessment and Rehabilitation in Alzheimer's Disease and Related Disorders.

The Editorial on the Research Topic ICT for Assessment and Rehabilitation in Alzheimer’s Disease and Related Disorders As depicted by the cover image, this special issue unites seemingly disparate items and objects. However, importantly, all these items are related to the theme, “ICT for Assessment and Rehabilitation in Alzheimer’s Disease and Related Disorders.” Under this rubric, our special issue addresses four subtopics: assessment, rehabilitation, virtual reality (VR), and education. In the last decade, there has been a growing interest in employing information and communication technologies (ICTs) with the aging population, as well as with people living with Alzheimer’s disease (AD) and related disorders. This interest has manifested in several ways. For example, there has been a notable increase in the amount of research funding dedicated to projects related to the theme of ICT and aging at the level of private, national, and international funding agencies. Furthermore, there has been a significant growth in the number of academic journals and publications dedicated to the topic with a resulting explosion in the number and quality of research, policy, and clinically related publications. Finally, there has been a welcome proliferation of national and international conferences/workshops themed on ICT and aging, as well as strong representation in the topics and themes of the most important AD- and dementia-related conferences. One of the peculiarities, and indeed fascinating aspects, of this domain is that it is intrinsically interdisciplinary and is dependent on the tight collaboration among professionals from diverse backgrounds, including researchers, clinicians, engineers, and business people. Those involved are driven by the thrill of innovation and the potential to apply exciting new technologies to some of the most basic aspects of older people’s daily lives. The ultimate aim of these endeavors is to improve quality of life, enhance independence, and promote healthy living in the older population. Yet this work can be accompanied by complications, snags and hitches, not the least of which is the necessity for all the players to develop a common language. The need to span the boundaries among disciplines has resulted in some unique professional pairings, such as is exemplified by the recently launched team of CoBTek, the Cognition, Behavior and Technology Unit of the University of Nice Sophia Antipolis, which has arisen from the collaboration of the Nice Memory Clinic and INRIA. CoBTek is now working with “Innovation Alzheimer” Association in France to host and deliver annual interdisciplinary workshops devoted to developing recommendations for the use of ICT in people with AD and related disorders (Robert et al., 2013; Robert et al.). The inspiration behind the present research topic was one of the successful outputs of the workshops and was intended to bring together international researchers and professionals working in this new field to provide new insights into the current use of ICT in healthy and pathological aging. The aim also included the need to identify challenges and new perspectives in the field, gather recommendations for the application of ICT in AD and related disorders in clinical practice, and showcase cutting edge clinical research.

A natural user-interface based platform for cognitive rehabilitation in Alzheimer’s disease patients

A natural user-interface based platform for cognitive rehabilitation in Alzheimer’s disease patients

Virtual reality for the assessment of frontotemporal dementia, a feasibility study

Purpose: Behavioral variant frontotemporal dementia (bvFTD) is a non-Alzheimer dementia characterized by difficulty in documenting social-emotional changes. Few investigations have used virtual reality (VR) for documentation and rehabilitation of non-Alzheimer dementias. Methods: Five bvFTD patients underwent insight interviews while immersed in a virtual environment. They were interviewed by avatars, their answers were recorded, and their heart rates were monitored. They were asked to give ratings of their stress immediately at the beginning and at the end of the session. Results: The patients tolerated the head-mounted display and VR without nausea or disorientation, heart rate changes, or worsening stress ratings. Their insight responses were comparable to real world interviews. All bvFTD patients showed their presence in the VR environment as they moved their heads to face and respond to each avatar’s questions. The bvFTD patients tended to greater verbal elaboration of answers with larger mean length of utterances compared to their real world interviews. Conclusions: VR is feasible and well-tolerated in bvFTD. These patients may have VR responses comparable to real world performance and they may display a presence in the virtual environment which could even facilitate assessment. Further research can explore the promise of VR for the evaluation and rehabilitation of dementias beyond Alzheimer's disease. Implications for Rehabilitation Clinicians need effective evaluation and rehabilitation strategies for dementia, a neurological syndrome of epidemic proportions and a leading cause of disability. Memory and cognitive deficits are the major disabilities and targets for rehabilitation in Alzheimer's disease, the most common dementia. In contrast, social and emotional disturbances are the major disabilities and targets for rehabilitation in behavioral variant frontotemporal dementia (bvFTD), an incompletely understood non-Alzheimer dementia. Virtual reality is a technology that holds great promise for the evaluation and rehabilitation of patients with bvFTD and other non-Alzheimer dementias, and preliminary evidence suggests that this technology is feasible in patients with bvFTD.

Cognitive rehabilitation: Literature review based on levels of evidence.

The aim of this study was to review the scientific publications on cognitive rehabilitation in Alzheimer’s disease by year published and methodology employed. The principles of systematic review by the Brazilian Cochrane Center were used. Reviews conducted by this Center were identified together with those held on the LILACS and Medline scientific databases. Nine levels of evidence were considered for analysis and a total of 37 articles were found. The results showed a growing number of publications from 2001 onwards, with majority being published early this decade. Few studies have been published on cognitive rehabilitation, with an average of three articles published per year during the study period (1985–2008). The highest levels of evidence were observed in the more recently published studies. Cognitive rehabilitation can yield greater benefits in rehabilitating patients when associated with other forms of intervention. The latest studies demonstrating greater scientific evidence concluded that results remain limited and that further studies on the topic are needed.

Memory rehabilitation in Alzheimer's disease: a review of progress.

Memory rehabilitation is a sadly misrepresented area of applied research in Alzheimer's disease. To gather and evaluate recent evidence for the clinical effectiveness or ecologically validity of memory rehabilitation for mild to moderate Alzheimer's patients. Computerised searches and some handsearching were conducted spanning the last five years, from 1995 to 2000, inclusively. Criteria for inclusion in this overview involved the use of a precise memory rehabilitation technique within an experimental study design applied to Alzheimer's patients with pre- and post-treatment evaluation. Three potential levels of memory rehabilitation procedures with proven clinical or pragmatic efficacy were identified. The first level bears on the facilitation of residual explicit memory with structured support both at encoding and at subsequent recall; the second level of memory rehabilitation exploits the relatively intact implicit memory system (priming and procedural memory); the last deals with finding ways of coping with the patient's limited explicit memory capacities through the use of external memory aids. A proposal of suggestions for good practice and future research in memory rehabilitation is also offered with the hope to spur further development in this rapidly expanding area of applied research. The available evidence shows that alternative and innovative ways of memory rehabilitation for Alzheimer's patients can indeed be clinically effective or pragmatically useful with a great potential for use within the new culture of a more graded and proactive type of Alzheimer's disease care.

Alzheimer rehabilitation by students: Interventions and outcomes

This article advocates proactive Alzheimer treatment, describes rehab interventions implemented by students, and reports positive first year outcomes for 11 mild to moderate Alzheimer's disease (AD) patients who experienced these interventions in a longitudinal Alzheimer rehabilitation research programme. Students supervised physical fitness training and volunteer work sessions for all participants and administered specific memory and language stimulation exercises to 7 of them (experimental group). Outcomes were measured by standardised and project-related tests before and after two semesters (about 28 weeks) of participation. It was hypothesised that (1) the experimental group would outperform the control group at post-testing on standardised and project-specific cognitive and language measures; that both the experimental and control group would (2) maintain or improve the quality of their spontaneous discourse, (3) improve on measures of mood, and (4) improve on measures of physical fitness. Hypothesis 1 was only partially supported. The experimental group improved significantly from pre- to post-test on two measures, substantially on one measure, and showed no change on eleven measures. The control group declined significantly on three measures and showed no change on eleven measures. However, between group differences were only significant on one measure. Hypotheses 2, 3, and 4 were supported. The major conclusion was that: multi-modal interventions by students can temporarily maintain or improve cognitive, language, social, and physical functioning of Alzheimer's patients.

Potential for rehabilitation in Alzheimer's disease, by Morris F. Friedell

Potential for rehabilitation in Alzheimer's disease, by Morris F. Friedell

Volunteers in partnership: An Alzheimer's rehabilitation program delivered by students

This article describes a “partnered volunteering,” student-delivered language, and memory stimulation program for Alzheimer patients that is easy to replicate and administer low in cost, and beneficial to the patients, students, family members, and participating community agencies involved. The program took place during two consecutive semesters at the University of Arizona. Positive pre- to post-test patient language changes and improvements on memory test performance are reported. Twelve early stage Alzheimer patients-six each semester-were matched with 12 undergraduate speech and hearing and psychology students. The pairs were each assigned to 10 one-hour weekly sessions of volunteer service or other community activity meaningful to the patient. During each session, students engaged partners in 30 to 40 minutes of structured conversation-stimulating activities. During the second semester, four patients also worked with biographical memory tapes and quizzes produced and administered by their student partners.1-2 Parallel discourse samples were taken of subjects before and after participation. Small to massive gains in number of substantive on-topic statements produced were achieved by seven out of 11 subjects who completed the program: 9 percent, 14 percent, 48 percent, 58 percent, 93 percent, 161 percent, and 238 percent over baseline, respectively. Eight subjects improved on picture description and eight on proverb interpretation tasks. Three of the four patients who worked with biographical memory tapes substantially improved performance from pre- to post-training. All participants-patients, students, and caregivers-benefited effectively and socially.