Neuropsychological rehabilitation of memory deficits and activities of daily living in patients with Alzheimer's disease: a pilot study

Abstract

Patients with Alzheimer's disease (AD) gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training -motor movements, verbal association, and categorization -and activities of daily living (ADL) training was tested in a sample of 5 elderly out-patients (mean age: 77.4 ± 2.88 years), with mild AD (Mini-Mental State Examination score: 22.20 ± 2.17) and their caregivers. All patients had been taking rivastigmine (6-12 mg/day) for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04), and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

A controlled clinical trial on the effects of exercise on neuropsychiatric disorders and instrumental activities in women with Alzheimer's disease

“…Experimental studies with groups of patients with dementia have shown that non-pharmacological interventions can have a positive influence on affective variables and neuropsychiatric disorders, and this has a direct reflection on the quality of life of these patients [31][32][33][34][35] . The analysis of the ES showed that the exercise program may have positive effects for this population.…”

“…However, other studies analyzed by Heyn, Abreu and Ottenbacher 16 in another meta-analysis did not support conclusions about the benefits of regular exercise for cognition and behavior in demented patients. A possible explanation for this could be attributed to the assessment scales, which may not have been sensitive enough to reflect these benefits [31][32][33]35 .…”

Enriquecimento ambiental como estratégia para promover a neurogênese na doença de Alzheimer: possível participação da fosfolipase A2

“…É interessante notar que o sinal de colina é constituído de metabóli-tos da fosfatidilcolina (principal substrato da PLA 2 ), especialmente glicerofosfocolina, fosfocolina e colina livre 85 . Treinamento cognitivo também tem sido realizado clinicamente e tem sido eficaz na melhora da função de memória em sujeitos idosos com comprometimento cognitivo leve [33][34][35] e DA inicial [36][37][38] .…”

“…Em vista dessa hipótese, os principais objetivos deste trabalho foram revisar a literatura sobre a ocorrência de neurogênese endógena no cérebro de sujeitos com DA e modelos animais de DA, bem como os efeitos de atividade cognitiva sobre a neurogênese em animais experimentais. Esse segundo objetivo se baseia em estudos mostrando que treinamento cognitivo tem sido realizado clinicamente e tem sido eficaz na melhora da função de memória em sujeitos idosos com comprometimento cognitivo leve [33][34][35] e DA inicial [36][37][38] . Com base em estudos recentes de nosso laboratório mostrando que treinamento de memória aumenta a atividade da enzima fosfolipase A 2 (PLA 2 ) em animais experimentais 39,40 e sujeitos idosos sadios 41 , um terceiro objetivo deste trabalho foi revisar a literatura sobre a relação entre a PLA 2 e a neurogênese.…”

Tratamento da doença de Alzheimer: recomendações e sugestões do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Os auxílios mnemônicos externos ( c a l e n d á r i o s , diários, cadernos de memória) são estratégias da reabilitação que necessitam de estudos bem cont rolados em DA, havendo evidências que pare c e m apontar na melhora do funcionamento dos pacientes 90,94 . Dois trabalhos publicados recentemente no Brasil demonstraram efeitos positivos da re a b i l itação, tendendo à relativa estabilização da prog ressão da DA, em pacientes em uso de anticolinesterásicos 95,96 .…”