1 Memory Clinic, Department of Neurology, C.H.U. Liège, Liege, Belgium.
2 GIGA Cyclotron Research Centre, University of Liege, Liège, Belgium.
J Geriatr Psychiatry Neurol. 2019 Jan;32(1):16-23. doi: 10.1177/0891988718813724. Epub 2018 Nov 26.
The benefit of cognitive rehabilitation (CR) for patients with early-stage Alzheimer disease (AD) remains difficult to assess.
An observational, prospective study was conducted in a sample of 52 patients with AD included in a clinical, individualized CR program. Cognitive rehabilitation consisted of 1 weekly session during 3 months at home, followed by 1 monthly contact for 9 months. Rehabilitation techniques were used by experienced therapists to adapt activities important for the patient. Evaluation of patient's dependence in activities and objective and subjective caregiver's burden was performed with a research quantitative scale immediately after the intervention and at 6-month and 1-year follow-up.
Analyses with repeated measure analysis of variance showed decreased patient's dependence for adapted activities at 3 months, 6 months, and 1 year. Objective and subjective percentage of caregiver's burden was also decreased at all evaluations with our research functional scale, while there was no change on Zarit's burden scale. Global cognition slightly decreased over 1 year.
This observational study in a clinical setting is in line with the benefit of CR for patients with mild AD reported in recent randomized controlled trials. The benefit obtained for adapted activities remained after 1 year, even if global cognition declined. Moreover caregiver's burden related to all individually relevant daily activities (from a list of 98) evaluated within the CR program was decreased after 1 year. Those preliminary results emphasize the importance of choice for the measurement instrument to report CR efficacy and claim for further validation of such tools.
认知康复（CR）对早期阿尔茨海默病（AD）患者的益处仍难以评估。
对 52 例 AD 患者进行了一项观察性、前瞻性研究，这些患者被纳入临床个体化 CR 计划。认知康复包括在家中每周进行 1 次、持续 3 个月，然后在接下来的 9 个月中每月联系 1 次。康复技术由经验丰富的治疗师使用，以适应对患者重要的活动。在干预后以及 6 个月和 1 年随访时，使用研究定量量表评估患者对活动的依赖程度以及客观和主观照顾者的负担。
重复测量方差分析显示，适应性活动的患者依赖程度在 3 个月、6 个月和 1 年时均降低。使用我们的研究功能量表，客观和主观的照顾者负担百分比在所有评估中均降低，而 Zarit 负担量表则没有变化。在 1 年内，整体认知能力略有下降。
这项在临床环境中的观察性研究与最近的随机对照试验报告的轻度 AD 患者 CR 获益一致。在 1 年后，即使整体认知能力下降，适应性活动的获益仍然存在。此外，在 CR 计划中评估的与所有个人相关的日常活动（从 98 项活动列表中）相关的照顾者负担在 1 年后也降低了。这些初步结果强调了选择测量工具报告 CR 疗效的重要性，并呼吁进一步验证这些工具。
