Effectiveness of Nonpharmacological Approaches in Patients with Mild Cognitive Impairment

Abstract

Background: Mild cognitive impairment (MCI) patients are at increased risk of developing dementia. There is a conflict if cognitive interventions can improve cognitive and functional performances in order to delay the development of dementia. Objectives: This study aimed to examine the effectiveness of a holistic cognitive rehabilitation program on patients with MCI. Methods: The participants, 176 MCI patients with Mini-Mental State Examination = 27.89 (1.73), were classified into 2 groups matched for age, gender, education and cognitive abilities: (1) patients (104) on nonpharmacological therapy and (2) patients (72) on no therapy at all. The effectiveness of the interventions was assessed by neuropsychological evaluation performed at baseline and at the end of the interventions. Results: Between-group difference in benefit of the experimental group was demonstrated in abilities of executive function (p = 0.004), verbal memory (p = 0.003), praxis (p ≤ 0.012), daily function (p = 0.001) and general cognitive ability (p ≤ 0.005). The experimental patients improved cognitive and functional performances, while the control patients demonstrated deterioration in daily function (p = 0.004). Conclusions: Our findings indicate that nonpharmacological therapy of the holistic approach can improve MCI patients’ cognitive and functional performances.

Cognitive Rehabilitation of Memory for Mild Cognitive Impairment: A Methodological Review and Model for Future Research

“…Given the relative lack of tests and growing importance of such measures, it is clear that the development of ecologically valid tests would benefit rehabilitation research as well as the general field of Neuropsychology. 5,7,15,16,17,18,24,25,27,30,31,33 12 Narrative memory (other) 3,23,28,30 18,23,26,33, 15,21,22,30,31,33 6 Rivermead Behavioural Memory Test (RBMT) 7,8,16,17,26,27,31,33,34 3,7,23,30,31,36 1,3,4,5,15,28,29,32 1 The ...…”

Recommendations on screening for cognitive impairment in older adults

“…10 Using ADAS-Cog to measure cognition, one trial 28 (n = 92) showed no significant differences between the intervention and control groups (mean difference −0.60, 95% CI −1.44 to 0.24 [negative scores indicate improvement of symptoms]). However, a meta-analysis of the five trials (n = 408) that used MMSE to measure cognition [26][27][28][29][30] found a statistically significant effect of the behavioural interventions (mean difference 1.01, 95% CI 0.25 to 1.77). Clinical significance on the MMSE is often defined as a change of 1.4 to 3 points; therefore, this difference is not considered clinically significant.…”

“…The systematic review identified five studies [26][27][28][29][30] (n = 408) that examined the effects on cognition of nonpharmacologic interventions (Appendix 4), including exercise, a holistic cognitive rehabilitation program and a multimodal intervention with stimulation and cognitive training sessions.…”

“…The summary of evidence for benefits of treatment is shown in Table 1. [19][20][21][22][23][24][25][26][27][28][29][30] A summary of the GRADE decision table can be found in Appendix 3 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/ cmaj.141165/-/DC1), with detailed tables provided in the accompanying evidence review. 10 The recommendation applies to communitydwelling adults 65 years of age or older who do not have noticeable symptoms suggestive of mild cognitive impairment or dementia.…”

“…The systematic review identified five studies [26][27][28][29][30] (n = 408) that examined the effects on cognition of nonpharmacologic interventions (Appendix 4), including exercise, a holistic cognitive rehabilitation program and a multimodal intervention with stimulation and cognitive training sessions. 10 Using ADAS-Cog to measure cognition, one trial 28 (n = 92) showed no significant differences between the intervention and control groups (mean difference −0.60, 95% CI −1.44 to 0.24 [negative scores indicate improvement of symptoms]).…”