A randomized cross-over controlled study on cognitive rehabilitation of instrumental activities of daily living in Alzheimer disease.

Publication Type:

Journal Article


Am J Geriatr Psychiatry, Volume 22, Issue 11, p.1188-99 (2014)


Activities of Daily Living, Aged, 80 and over, Alzheimer Disease, Cognition, Cross-Over Studies, Female, Humans, Male, Memory, Neuropsychological Tests, Quality of Life, Treatment Outcome


<p><strong>OBJECTIVE: </strong>The goal of the study was to investigate the effectiveness of a memory rehabilitation program to re-learn instrumental activities of daily living (IADLs) in patients with Alzheimer disease (AD).</p>

<p><strong>DESIGN: </strong>This was a 6-month block-randomized cross-over controlled study.</p>

<p><strong>SETTING: </strong>All evaluation and training sessions were performed at each patient's home.</p>

<p><strong>PARTICIPANTS: </strong>Twenty participants with mild to moderate AD.</p>

<p><strong>INTERVENTION: </strong>The trained IADL was chosen by the patient and his/her caregiver in order to target the patient's needs and interests. Participants were trained twice a week for 4 weeks with the errorless learning (ELL) and spaced retrieval (SR) cognitive techniques. After training, there were several follow-ups over a period of at least 3 months.</p>

<p><strong>MEASUREMENTS: </strong>Performance on the trained IADL was assessed by a Direct Measure of Training (DMT), an observational instrument adapted from a well-validated scale. General cognitive function, everyday memory functioning, quality of life, neuropsychiatric symptoms and ADL/IADL of patients, as well as the caregiver's burden were assessed as secondary outcomes.</p>

<p><strong>RESULTS: </strong>A statistical significant difference was found between the trained and untrained groups on the DMT immediately following the intervention. Improvements were maintained for a 3-month period. The training did not have effects on any other measures.</p>

<p><strong>CONCLUSIONS: </strong>The present study showed that it is possible for AD patients to relearn significant IADLs with the ELL and SR techniques and to maintain these gains during at least 3 months. The findings of this study emphasize the importance to design robust but individualized intervention tailored on patients' particular needs.</p>

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