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Evaluation of a long term non pharmacological treatment for patients with Mild Cognitive Impairment (MCI) and Mild Alzheimer’s disease (MILD AD). Tsolaki, M., Kounti, F., Poptsi, E., Agogiatou, C., Soumbourou, A., Nikolaidou, E., Zafeiropoulou, M., Bacoglidou, E.

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Revised MCI criteria according to consensus conference, Stockholm (2003)

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Evaluation of a long term non pharmacological treatment for patients with Mild Cognitive Impairment (MCI) and Mild Alzheimer’s disease (MILD AD)

Tsolaki, M., Kounti, F., Poptsi, E., Agogiatou, C., Soumbourou, A., Nikolaidou, E., Zafeiropoulou, M., Bacoglidou, E.

1. School of Psychology,Thessaloniki

2. Medicine School, Thessaloniki

3.Greek Association of Alzheimer’s Disease


Revised MCI criteria according to consensus conference, Stockholm (2003)

  • Not normal, absence of dementia

  • Cognitive decline

    • Subjective (self report)

    • Objective (1.5 SD)

  • Some decline in function, but…

  • Preserved basic ADL/minimal impairment in complex IADLs

    Winblad et al (2004). J Intern Med. 256:240-246


Mild Alzheimer’s Disease(MILD ΑD)

Presence of both:

  • MemoryDisorder

  • Impairment in at least one additional cognitive domain

  • Impaired social function

  • Impaired performance in ADL

    (American Psychiatric Association, 2000)


BRAIN PLASTICITY

  • Environment

  • Behaviors

  • Emotions

    • Increase the risk of neural death

    • But also facilitate the regeneration of

      neurons

      (Percacclo et al, 2007. Gobbio & Marq, 2005.Mateer & Kerns, 2000)


BRAIN PLASTICITY

  • The adult brainDOES regenerate itself at least in some areas as hippocampus

    (Van Praag, Kemper & Gage, 2000 Gould, 1999. Swanson, 1982)


COGNITIVE REHABILITATION

  • Systematic and intense cognitive practice can activate regeneration in the brain

    (Steiner et al, 2006. Recanzone, 1993)

  • Targeting to the facilitation of neuronal regeneration through systematic and well structured new experience and learning

    (Percacclo et al, 2007. Nakatomi et al, 2002. Robertson & Murre, 1999)


AIMS OF COGNITIVE REHABILITATION

  • Long term changes in synaptic connectivity, as a result of behavior and experience

    (Nakatomi et al, 2002. Gobbio & Marq, 2005. Mateer & Kerns, 2000)


COGNITIVE AND PSYCHOLOGICAL REHABILITATION

HOLISTIC THERAPEUTIC APPROACH

Health is an entity:

  • Body

  • Mind

  • Emotions

    Cooperation / dynamic balance with physical and socialenvironment

    (Biderman et al., 2005)


COGNITIVE AND PSYCHOLOGICAL REHABILITATION

  • The best therapeutic choice for

    MCI and Alzheimer’s disease patients

  • are Interventions which improve spirit, body and soul

    (Ferlisi et al., 2007. Spector et al.,2000, Zanetti et al., 1999. De Vreese et al., 2001)


COGNITIVE AND PSYCHOLOGICAL REHABILITATION PROGRAM

  • Holistic Therapeutic Approach


COGNITIVE AND PSYCHOLOGICAL REHABILITATION PROGRAM

AIMS:

  • Cognitive and functional improvement of MCI patients

  • Inhibition of the progressive cognitive and functional deterioration of MILD AD patients after 4 years


PARTICIPANTS (N=57/100)

p*= between MCI groups

p!= between MILD AD groups


PARTICIPANTS

Inclusion criteria

  • Insight (awareness of the disease)

  • Absence of primary or secondary

    depression

  • Spared sensory abilities, reading and writing skills

  • Pharmacological treatment: cholinesterase

    inhibitors

  • Absence of aphasic disorders (language

    comprehension and speech production)


REHABILITATION PROGRAM

1.Practice of attention and parameters of executive function

2.Practice of Language skills

3.Cognitive Motion Therapy

4.Reality Orientation in Current

events

5.Mental imagery under relaxation


Practice of attention and parameters of executive function


Practice of Language skills


Cognitive Motion Therapy


Reality Orientation in Current events


Mental imagery under relaxation


DURATION OF REHABILITATION PROGRAM

  • 4 ½ hours sessions per week

  • 24 weeks every year under Rehabilitation therapy

  • 24 weeks without Rehabilitation therapy

  • Duration:4 years

  • Group intervention (groups of 5-6

    patients)


PSYCHOMETRIC ASSESSMENT

  • 1stassessment:just before the non pharmacological therapy

  • 2ndassessment : 3 years after the end of it

  • 3rd assessment : 4 years after the end of it


PSYCHOMETRIC ASSESSMENT

ADL:

  • Functional Cognitive Assessment Scale (FUCAS)

  • Functional Rating Scale of Symptoms of Dementia (FRSSD)

    Cognitive Function:

  • Mini Mental State Examination (MMSE)

  • Montreal Cognitive Assessment (MοCA)

  • CAMCOG

  • WAIS-R

  • Verbal Fluency (FAS)

  • TRAIL MAKING A, B


PSYCHOMETRIC ASSESSMENT

Cognitive Function:

  • Rey Auditory-Verbal Learning Test (RAVLT)

  • PYRAMIDS AND PALM TREES (PPT)

  • Rivermead Behavioural Memory Test (RBMT)

  • Test of Every Day Attention (ΤΕΑ)

  • Rey Ostereith Complex Figure Test (ROCFT)

  • STROOP

  • Βoston Naming Test (BNT)

    Emotional performance:

  • Geriatric Depression Scale (GDS)


RESULTS

  • Statistics

    • SPSS

    • Non parametric tests

    • Wilcoxon for two related samples

    • Mann Whitney for two independent samples


RESULTS

Comparison between experimental / controls with MCI after 3 years

3 years later

Significant difference in cognitive functions:

  • Attention, CAMCOG (p= .008)

  • Delayed recall, CAMCOG (p=. 018)

  • Memory function, CAMCOG (p=. 042)

  • Visual recall, CAMCOG (p=. 004)

  • Naming, CAMCOG (p=. 034)

  • General Cognitive performance, MMSE (p= .014)

  • Experimental group had better scores


RESULTS

Comparison between experimental / controls with MCIafter 3 years

3 years later

Significant difference in ADL:

  • Socialresponse,FRSSD (p= .010)

  • Attention, FRSSD (p= .047)

  • ADL, FRSSD (p= .006)

  • Emotional performance, GDS (p= .039)

  • Experimental group had better scores


Performance of experimental and controls with MCI before the Rehabilitation therapy & 3 years later


RESULTS

Comparison between experimental and controls with MILD ADafter 3 years

Significant difference in:

  • Recall of recent events,GAMCOG (p= .018)

  • General memory function, CAMCOG (p= .025)

  • Written recall, CAMCOG (p= .021)

  • Ideatic praxis, CAMCOG (p= .009)

  • Praxis,CAMCOG (p= .009)

  • Visual perception, CAMCOG (p= .014)

  • Visual shape perception,CAMCOG (p= .011)

  • Abstract thinking,CAMCOG (p= .001)

  • Experimental group had better scores


RESULTS

Comparison between experimental and controls with MILD AD after 4 years

4 years later Significant difference in :

  • Recall of recent events,GAMCOG (p= .015)

  • Repetition,CAMCOG(p= .021)

  • Visual perception, CAMCOG(p= .042)

  • Abstract thinking,CAMCOG(p= .008)

  • Experimental group had better scores


RESULTS

Comparison before the Rehabilitation Therapy and3 years later of the experimental group with MCI

3 years laterbetter performance in:

  • Attention (p ≤ .047)

  • Verbal memory (p = .005)

  • Visual memory (p ≤ .032)

  • Language (p ≤ .014)

  • Executive function (p ≤ .047)

  • Global Cognitive performance,MMSE(p= .002)

  • Global Cognitive performance,CAMCOG (p= .001)

  • Cognitive performance,MOCA(p= .015)

  • Emotional performance,GDS(p= .047)


RESULTS

Comparison before the Rehabilitation Therapy and4 years later, of the experimental group with MCI

4 years laterbetter performance in:

  • Attention,CAMCOG, TEA, (p= .032)

  • Visual memory, (p≤ .031)

  • Language, (p≤ .040)

  • Executive function, (p≤ .047)

  • Global Cognitive performance,CAMCOG (p= .016)


RESULTS

Comparison before the Rehabilitation Therapy and3 years later, of the experimental group with MILD AD

3 years laterbetter performance in:

  • Verbalsemantic memory with phonological help,BNT(p= .031)

  • Stability in the rest of cognitive functions


RESULTS

Comparison before the Rehabilitation Therapy and 4 years later of the experimental group with MILD AD

4 years later

  • Cognitive and functional stabilization


RESULTS

MCI experimental group

  • Cognitive performance was still improving after 4 years in patients on Rehabilitation program

  • Almost all cognitive functions had been improved

  • Cognitive improvement was transferred to ADL

  • MCI experimental patients 4 years later were diagnosed as healthy elderly


RESULTS

MILD AD experimental group

  • Stabilization of cognitive, emotional and functional performance for a period of 4 years after the beginning of the Rehabilitation therapy


CONCLUSIONS

  • Long term Rehabilitation therapy improved cognitive, emotional and functional performance

  • In MCI patients who were healthy elderly after 4 years therapy

  • The progressive impairment of AD patients, characteristic of the disease process, was inhibited for at least 4 years


THANK YOU!!!


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