Department of Neurology, Memory Clinic, Liège, Belgium.
GIGA Cyclotron Research Centre, 26658University of Liege, Liège, Belgium.
J Geriatr Psychiatry Neurol. 2021 May;34(3):209-215. doi: 10.1177/0891988720924721. Epub 2020 May 11.
Assessing the benefit of cognitive rehabilitation (CR) remains difficult.
An observational study was conducted in 33 patients with early-stage Alzheimer disease and their caregiver included in a clinical CR program at home, compared to 17 patients who received usual treatment. Evaluation of patient's dependence and objective and subjective caregiver's burden was performed by the caregiver with a research tool focusing on impairment in daily activities related to cognitive deficits.
Repeated measures analysis of variance showed a time by group interaction ( .05), with decreased patient's dependence for adapted activities at 1 year in the CR group. Lawton scale for daily activities showed also a time by group interaction ( < .05), with increased dependence at 1 year in the control group. There was a significant decrease in Mini-Mental State Examination scores in both groups at 1-year follow-up ( .05). Concerning caregiver's subjective burden, there was a trend for the time by group interaction ( = .07), and post hoc Tukey test showed that subjective burden was decreased in the CR group ( < .05). This was confirmed by nonparametric Mann-Whitney analysis on differences between follow-up and baseline evaluation ( < .05).
This observational study in a clinical setting is in line with the benefit of CR reported in recent randomized controlled trials. The benefit obtained for adapted daily activities remained after 1 year, even if global cognition declined. Moreover, caregiver's subjective burden related to all relevant daily activities evaluated within the CR program was decreased after 1 year in our clinical setting.
评估认知康复（CR）的益处仍然具有挑战性。
本研究对 33 名处于早期阿尔茨海默病阶段的患者及其照顾者进行了一项观察性研究，这些患者在家中参加了临床 CR 项目，与接受常规治疗的 17 名患者进行了比较。通过研究工具，照顾者对与认知缺陷相关的日常生活活动中的损伤，对患者的依赖程度以及客观和主观照顾者的负担进行评估。
重复测量方差分析显示，存在时间与组间的交互作用（.05），CR 组在 1 年内患者对适应活动的依赖性降低。日常生活活动的 Lawton 量表也显示出时间与组间的交互作用（ <.05），对照组在 1 年内依赖性增加。两组在 1 年随访时的 Mini-Mental State Examination 评分均显著降低（.05）。关于照顾者的主观负担，存在时间与组间的交互作用的趋势（ =.07），事后 Tukey 检验显示 CR 组的主观负担降低（ <.05）。这通过对随访和基线评估之间差异的非参数 Mann-Whitney 分析得到了证实（ <.05）。
本临床观察性研究与最近的随机对照试验报告的 CR 益处一致。在 1 年后，即使认知功能整体下降，适应性日常生活活动的益处仍然存在。此外，在我们的临床环境中，在 CR 项目中评估的与所有相关日常活动相关的照顾者的主观负担在 1 年后降低。
