Work

Goal-oriented Cognitive Rehabilitation in Early-stage Dementia: Results From the Great Trial

Year: 2017

Type: conference-abstract

Abstract: Cognitive rehabilitation (CR) is an individualised intervention for people with early-stage dementia. CR aims to improve management of everyday activities and reduce functional disability through identifying personal goals, applying a problem-solving approach and implementing evidence-based rehabilitative strategies. We tested this approach in the multi-centre GREAT trial. Participants had early stage Alzheimer’s, vascular or mixed dementia (ICD-10 criteria, MMSE score ≥ 18) and a family carer willing to contribute. All participants identified goals before being randomised to receive either treatment as usual (TAU) or home-delivered CR (10 therapy sessions over 3 months followed by 4 maintenance sessions over 6 months). Participants were followed up 3 and 9 months post-randomisation, with assessments conducted by a researcher blind to group allocation. The primary outcome was self-reported and carer-reported goal attainment at 3 months. Secondary outcomes were participant quality of life, mood, self-efficacy and cognition, and carer stress, health status and quality of life. We randomised 475 participants, of whom 427 completed the trial (CR=209, TAU=218). There were statistically-significant large positive effects at 3-month follow-up for participant-rated goal attainment (d=.97, 95%CI .75-1.19), corroborated by carers (d=1.11, 95%CI .89-1.34). These effects were maintained at 9-month follow-up for both participant (d=.94, 95%CI .71–1.17) and carer ratings (d=.96, 95%CI .73-1.2). There were no significant differences in secondary outcomes. This major randomised controlled trial demonstrates that CR is effective in supporting functional ability in early-stage Alzheimer’s, vascular or mixed dementia. CR offers a means of enabling people with early-stage dementia to maintain independence and engagement in everyday activities.

Source: Innovation in Aging

DOI: 10.1093/geroni/igx004.1527