The Effectiveness of GRADIOR: A Neuropsychological Rehabilitation Program for People with Mild Cognitive Impairment and Mild Dementia. Results of a Randomized Controlled Trial After 4 and 12 Months of Treatment

Abstract

Background: Computer-based cognitive training programs have been developed with promising results on the maintenance/improvement of cognitive performance in people with dementia. Objective: The objective was to evaluate the effectiveness of the cognitive rehabilitation program “GRADIOR” in people with mild cognitive impairment and mild dementia. Method: This study was a single-blind multicenter randomized clinical trial. Participants were recruited from hospitals/day centers. The experimental group (EG) and control group (CG) received computer-based cognitive training (CCT) and routine daily care, respectively. Outcome measures at T0: baseline, T1: at 4 months, T2: at 12 months were compared within and between-groups. Results: Significant differences or important effect sizes were detected at the intragroup and intergroup level for most variables, observing a trend of improvement and/or maintenance at 4 months by Visual Reasoning of Cambridge Cognitive Examination (CAMCOG), Digit and Arithmetic of WAIS-III, Semantic Verbal Fluency, Mini-Mental State Exam (MMSE), Trail Making Test (TMT)-A-Mistakes and at 12 months by Visual Reasoning of CAMCOG, Digit Symbol of WAIS-III, TMT-B-mistakes, Visual Memory of Rivermead Behavioural Memory Test, Lexical Verbal Fluency-P, Yesavage’s Geriatric Depression Scale (GDS), TMT-A-time scales whose objective was to evaluate some executive functions and/or the memory. The CG presented a worsening trend for most of the measures towards 12 months. There was also a significant interaction between “time and group” for MMSE (F = 8.971; p = 0.03; η 2 = 0.019) and the GDS (F = 3.414; p = 0.04; η 2 = 0.041), as well as small effect sizes for TMT-A-time (F = 1.641; p = 0.21; η 2 = 0.021) and TMT-A-mistakes (F = 0.908; p = 0.41; η 2 = 0.019). Conclusion: CCT with GRADIOR has been proved to benefit cognitive functions (ISRCTN:15742788).

Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives

“…Diaz Baquero et al performed an RCT study on 43 patients with MCI and mild dementia, highlighting good adherence to treatment, good acceptability, and potential efficacy of the device ( 8 ). Another RCT performed by the same authors on 89 people with MCI and dementia demonstrated the benefit of this training on several cognitive domains ( 48 ). These promising results were confirmed by Gongora Alonso et al, who observed good acceptability of the tool in patients with severe and prolonged mental illness ( 49 ).…”

Determinants of Adherence to a “GRADIOR” Computer-Based Cognitive Training Program in People with Mild Cognitive Impairment (MCI) and Mild Dementia

“…In this order of ideas, our findings indicated how some executive functions (EF) such as attention, WM, numerical reasoning, and verbal fluency, evaluated by Arithmetic, Digit Symbol and LVF-R test are involved in adherence to a CCT program such as GRADIOR. Additionally, our previous study on the effectiveness of GRADIOR indicated a trend of improvement in these cognitive processes after 4 months of intervention in the EG [ 21 ].…”

“…Carrying out this study as part of an RCT presented a series of drawbacks in (1) the process of selecting the sample of older people and (2) its maintenance throughout the 4-month CCT. The above is due to different characteristics, which could negatively influence these two scenarios, such as the following: high mortality rate of the sample, mobility alterations, emotional alterations, the stigma of the disease, the start of a pandemic, little financing, and the high cost of resources [ 21 ].…”

“…This study was part of a multicenter simple-blind, randomized clinical trial (RCT) on the effectiveness of the GRADIOR cognitive rehabilitation program in people with MCI and mild dementia [ 20 , 21 ]. This trial was registered at (ISRCTN: 15742788) [ 22 ] and was approved by the Drug Research Ethics Committee of the Zamora Health Area (Number: 387-E.C).…”

An improved strategy for identification and annotation of easily in‐sourced dissociation diterpene lactones from plant natural products: Taking Andrographis paniculata (Burm. f.) as an example

“…1 Modern pharmacological studies have shown that DLs in plants serve a variety of biological activities. For example, DLs in Ginkgo biloba exhibit regulatory benefits in cardiovascular diseases, 2 cerebral neurotransmitter/ receptor activities, 3 and cognitive function improvement 4 ; DLs in Daphne genkwa Sieb. et Zucc.…”