Effects of a Cognitive Rehabilitation Programme on the Independence Performing Activities of Daily Living of Persons with Dementia—A Pilot Randomized Controlled Trial

Abstract

Background: In all types of dementia, cognitive abilities are affected, behaviour is altered and functional capacity is progressively lost. This cognitive deterioration manifests in the decrease of abilities required to perform the activities of daily living (ADL). The objective of this pilot study was to assess the effect of an Occupational Therapy programme based on the training of ADL through cognitive stimulation on the independence of ADL of persons with dementia. Methods: Institutionalized older adults with major neurocognitive disorder or dementia (N = 58) were randomly allocated to receive either the Occupational Therapy ADL cognitive stimulation programme or conventional Occupational Therapy. The cognitive level and the independence level performing ADL were measured at baseline (week 0), after 5 weeks of treatment (week 5) and after 6 weeks of follow up (week 12). A value of p < 0.05 and α = 0.0025 (Bonferroni correction) was considered as statistically significant. Results: The results obtained showed improvements in the level of independence performing ADLs in the intervention group compared to the control group (p = 0.006). The improvements were seen in relation to feeding (p = 0.001), dressing (p = 0.005) and bladder and bowel incontinence (p = 0.003), the changes observed in feeding are statistically significant. However, those improvements were not maintained after the follow up period. There were no significant changes in relation to the cognitive level (p = 0.741). Conclusions: Occupational Therapy based on ADL cognitive stimulation can have a positive effect, increasing the independence of subjects with major neurocognitive disorder or dementia who are institutionalised.

Cognitive stimulation and activities of daily living for individuals with mild-to-moderate dementia: A scoping review

“…Two articles studied an occupational therapy-based CS intervention (Ávila et al, 2018; Jiménez-Palomares et al, 2021). A double-blind RCT ( N = 58) evaluated the effect of an occupational therapy programme based on the training of ADL through CS (Jiménez-Palomares et al, 2021).…”

“…Two articles studied an occupational therapy-based CS intervention (Ávila et al, 2018; Jiménez-Palomares et al, 2021). A double-blind RCT ( N = 58) evaluated the effect of an occupational therapy programme based on the training of ADL through CS (Jiménez-Palomares et al, 2021). Standard approaches to CS including reality orientation and discussion were combined with ADL-focused identification and categorisation activities.…”

“…Sessions were conducted for 5 weeks. While CS was central to Jiménez-Palomares et al’s (2021) study, Ávila et al (2018) incorporated CS into a wider multi-component occupational therapy approach consisting of CS, meaningful activities, psychomotor and sensory skills activation, caregiver counselling and ADL training. Ninety-minute sessions were delivered for 12 weeks, twice weekly, with an additional 8 weeks of sessions implemented after a 1.5-month intervention withdrawal.…”

“…The limited evidence available to support the use of CS for ADLs calls into question the widespread use of CST by occupational therapists with the dementia population. However, a pilot RCT ( N = 58) investigating the effects of an occupational therapy CS programme on ADL skills reported significant improvements in the ADLs of feeding, dressing, continence and stair mobility (Jiménez Palomares et al, 2021). These results are promising, indicating more research is needed to investigate whether CS is more effective for occupational therapy goals when used as part of an ADL-focused, multi-faceted intervention (Dolan et al, 2022).…”

Rehabilitation in dementia: CST and Sonas group interventions for people with moderate cognitive impairment. A pilot study

“…OTs needs to consider similar group interventions such as ADL focused CS rehabilitation interventions with people with MCI and dementia. Jiménez Palomares (2021) conducted a pilot randomised controlled trial on the effects of a cognitive rehabilitation programme on independence in performing ADL with 58 participants over 60 years of age with dementia. The results found improved scores in the Barthel assessment, showing a significant improvement ( p = 0.006) for those allocated to an OT CS ADL based program in comparison with a group receiving conventional OT for management of ADL deficits who showed a deterioration.…”