A randomized controlled trial of brain-activating rehabilitation for elderly participants with dementia in residential care homes

Effects of cognitive stimulus therapy on middle-aged and elderly institutionalized patients with chronic schizophrenia with declined cognition

PURPOSE

This study investigates whether using group Cognitive Stimulation Therapy (CST) effectively improves functioning among middle-aged and elderly patients with chronic schizophrenia and a below-normal cognitive range.

METHODS

The study included an experimental group (N = 24), which was divided into two sub-groups to receive group CST, and a control group (N = 24), who received treatment as usual (TAU). We assessed cognitive functions using the Mini-Mental Status Examination (MMSE). We evaluated the emotional status, psychotic symptoms, and quality of life using the Geriatric Depression Scale short-form 15 (GDS-15), the Brief Psychiatric Rating Scale (BPRS), and the Dementia-Quality of Life (D-QoL) instrument. We performed all measures at three-time points: pre-CST, post-CST, and 3-month follow-up.

RESULTS

We found group CST can significantly improve cognitive performance, especially the ability to use new information, after group CST intervention. However, the experimental group did not maintain this effect at the 3-month follow-up.

RESULTS

We found group CST can significantly improve cognitive performance, especially the ability to use new information, after group CST intervention. However, the experimental group did not maintain this effect at the 3-month follow-up.

CONCLUSION

This study supports group CST can delay the degradation of some cognitive functions in long-term hospitalized patients with chronic schizophrenia for the duration of the intervention. This finding has important clinical implications for long-term institutionalized middle-aged and elderly chronic schizophrenic patients with a below-normal cognitive range in an aging society.

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

Introduction:

Dementia is a progressive syndrome that interferes with the individual’s ability to perform activities of daily living (ADL). Cognitive stimulation (CS) is a non-pharmacological approach aimed to mitigate the impact of dementia symptoms. While CS has been shown to provide benefits for cognition and quality of life, the evidence supporting its use in improving ADL outcomes is reduced. The aim of this review was to chart what is known from the literature about the use of CS in improving ADL outcomes.

Method:

A scoping review of the use of CS in improving ADL outcomes for individuals with mild-to-moderate dementia was conducted, following a scoping review methodological framework. Eight databases were searched, including all articles published up until June 2022.

Findings:

A three-step search strategy yielded 788 results. Following screening and review, 36 papers met the inclusion criteria for this review. Studies were charted and discussed in the areas of (1) cognitive stimulation therapy; (2) group CS programmes; (3) multi-component CS interventions; (4) individual CS programmes and (5) other types of CS.

Conclusion:

The review identified a range of CS programmes from across 13 countries worldwide. Multi-component CS interventions involving ADL-focused activities reported the most benefits for ADL outcomes.

The Effect of Exercise and Learning Therapy on Cognitive Functions and Physical Activity of Older People with Dementia in Indonesia

BACKGROUND

This study aims to analyze the effect of exercise and learning therapy on the cognitive functions and daily physical activities of older people with dementia in Indonesia.

METHODS

This was an experimental study with a pretest-posttest design and a control group. Samples were selected using nonrandom sampling methods and were then randomly assigned to intervention and control groups. The study population was older people with mild-to-moderate dementia, and the sample number was 90 people. The intervention group received an Indonesian physical exercise program for older people and reading therapy through 12 sessions over four weeks. The intervention was led by a community health volunteer who has been trained and certified.

RESULTS

The mean score for cognitive function in the intervention group showed significant increase between pre- and postintervention, with p value < 0.001, and there was no significant difference in the control group before and after intervention, with ap value of 0.198. Further, the Mann-Whitney test showed that there were significant differences in the mean scores for cognitive function between the intervention and control groups with p value < 0.001 and a 95% confidence level.

CONCLUSION

Based on the results, the Indonesian older people exercise program and reading aloud activity had a positive effect on the cognitive function of older people with dementia.

Towards an increased understanding of reminiscence therapy for people with dementia: A narrative analysis

AIM

Reminiscence therapy is a popular therapeutic intervention for people with dementia. This review set out to provide a better understanding of reminiscence therapy through a deeper analysis of its contents and delivery.

METHOD

This review examined 22 studies from the most recent Cochrane review (Woods, B., O'Philbin, L., Farrell, E. M., Spector, A. E., & Orrell, M. (2018). Reminiscence therapy for dementia. Cochrane Database of Systematic Reviews, 3, Article 001120) and addressed the following research questions: (1) What are the components of reminiscence therapy? (2) Who delivers reminiscence therapy? (3) How is reminiscence therapy delivered? (4) Is reminiscence therapy underpinned by a theoretical framework? (5) Is reminiscence therapy delivered according to a programme/model? (6) Are there commonalities in the reminiscence therapy components utilised? Multiple and layered narrative analyses were completed.

FINDINGS

Thirteen reminiscence therapy components were identified. 'Memory triggers' and 'themes' were identified as the most common but were found not to be consistently beneficial. Reminiscence therapy was typically delivered in a care setting using a group approach; however, there was no consistency in session composition, intervention duration, as well as the training and supervision provided to facilitators. Operationalisation of theory within reminiscence therapy was not identified. Reminiscence therapy was not consistently delivered according to a programme/model. Lastly, as a result of a small number of studies, the components 'life stages', 'activities' and 'family-only sessions', showed beneficial promise. In summary, this review highlights that reminiscence therapy needs more consistency in content and delivery, in addition to a clear theoretical framework.

Effects of a group-based physical and cognitive intervention on social activity and quality of life for elderly people with dementia in a geriatric health service facility: a quasi-randomised controlled trial

BACKGROUND

The aim of this study was to assess the effects of group-based motor and cognitive-combined intervention on social activity and quality of life.

METHODS

This quasi-randomised controlled trial included 31 elderly participants with dementia in a geriatric health service facility. Participants were randomly allocated to the intervention group (n = 16) or the control group (n = 15) by stratification of cognitive function. The 8-week intervention program consisted of group exercise and cognitive stimulation twice per week for 45 min per session. Outcome measures were social activity in daily behaviour, cognitive function, apathy, muscle and grip strength, independence of activity of daily living, life-space, and objective quality of life (QOL).

RESULTS

Twenty-five participants were analysed (10 in the control group, 15 in the intervention group). Analysis of covariance with covariates of age, gender, and baseline data showed a significant difference in social activity (F = 8.67, P = 0.008; significant decline in control group vs. maintenance in intervention group) and QOL (F = 9.74, P = 0.006; maintenance in control group vs. tendency of improvement in intervention group). A Wilcoxon signed-rank test revealed that helping behaviour (P = 0.035) increased in the intervention group, whereas interest to the surrounding (P = 0.026) decreased in the control group.

CONCLUSIONS

Group-based combined intervention for dementia is effective for maintaining social activity and QOL in a geriatric health service facility.

Person-Centered Care in Persons Living with Dementia: A Systematic Review and Meta-Analysis

Background and Objectives

The concept of person-centered care has been utilized/adapted to various interventions to enhance health-related outcomes and ensure the quality of care delivered to persons living with dementia. A few systematic reviews have been conducted on the use of person-centered interventions in the context of dementia care, but to date, none have analyzed intervention effect by intervention type and target outcome. This study aimed to review person-centered interventions used in the context of dementia care and examine their effectiveness.

Research Design and Methods

A systematic review and meta-analysis were conducted. We searched through 5 databases for randomized controlled trials that utilized person-centered interventions in persons living with dementia from 1998 to 2019. Study quality was assessed using the National Institute for Health and Clinical Excellence checklist. The outcomes of interest for the meta-analysis were behavioral and psychological symptoms in dementia (BPSD) and cognitive function assessed immediately after the baseline measurement.

Results

In total, 36 studies were systematically reviewed. Intervention types were reminiscence, music, and cognitive therapies, and multisensory stimulation. Thirty studies were included in the meta-analysis. Results showed a moderate effect size for overall intervention, a small one for music therapy, and a moderate one for reminiscence therapy on BPSD and cognitive function.

Discussion and Implications

Generally speaking, person-centered interventions showed immediate intervention effects on reducing BPSD and improving cognitive function, although the effect size and significance of each outcome differed by intervention type. Thus, health care providers should consider person-centered interventions as a vital element in dementia care.

Reminiscence therapy for dementia

BACKGROUND

This updated Cochrane Review of reminiscence therapy (RT) for dementia was first published in 1998, and last updated in 2005. RT involves the discussion of memories and past experiences with other people using tangible prompts such as photographs or music to evoke memories and stimulate conversation. RT is implemented widely in a range of settings using a variety of formats.

OBJECTIVES

To assess the effects of RT on people living with dementia and their carers, taking into account differences in its implementation, including setting (care home, community) and modality (group, individual).

SEARCH METHODS

We searched ALOIS (the Cochrane Dementia and Cognitive Improvement Group's Specialized Register) on 6 April 2017 using the search term 'reminiscence.'

SELECTION CRITERIA

We included all randomised controlled trials of RT for dementia in which the duration of the intervention was at least four weeks (or six sessions) and that had a 'no treatment' or passive control group. Outcomes of interest were quality of life (QoL), cognition, communication, behaviour, mood and carer outcomes.

DATA COLLECTION AND ANALYSIS

Two authors (LOP and EF) independently extracted data and assessed risk of bias. Where necessary, we contacted study authors for additional information. We pooled data from all sufficiently similar studies reporting on each outcome. We undertook subgroup analysis by setting (community versus care home) and by modality (individual versus group). We used GRADE methods to assess the overall quality of evidence for each outcome.

MAIN RESULTS

We included 22 studies involving 1972 people with dementia. Meta-analyses included data from 16 studies (1749 participants). Apart from six studies with risk of selection bias, the overall risk of bias in the studies was low.Overall, moderate quality evidence indicated RT did not have an important effect on QoL immediately after the intervention period compared with no treatment (standardised mean difference (SMD) 0.11, 95% confidence interval (CI) -0.12 to 0.33; I² = 59%; 8 studies; 1060 participants). Inconsistency between studies mainly related to the study setting. There was probably a slight benefit in favour of RT in care homes post-treatment (SMD 0.46, 95% CI 0.18 to 0.75; 3 studies; 193 participants), but little or no difference in QoL in community settings (867 participants from five studies).For cognitive measures, there was high quality evidence for a very small benefit, of doubtful clinical importance, associated with reminiscence at the end of treatment (SMD 0.11, 95% CI 0.00 to 0.23; 14 studies; 1219 participants), but little or no difference at longer-term follow-up. There was a probable slight improvement for individual reminiscence and for care homes when analysed separately, but little or no difference for community settings or for group studies. Nine studies included the widely used Mini-Mental State Examination (MMSE) as a cognitive measure, and, on this scale, there was high quality evidence for an improvement at the end of treatment (mean difference (MD) 1.87 points, 95% CI 0.54 to 3.20; 437 participants). There was a similar effect at longer-term follow-up, but the quality of evidence for this analysis was low (1.8 points, 95% CI -0.06 to 3.65).For communication measures, there may have been a benefit of RT at the end of treatment (SMD -0.51 points, 95% CI -0.97 to -0.05; I² = 62%; negative scores indicated improvement; 6 studies; 249 participants), but there was inconsistency between studies, related to the RT modality. At follow-up, there was probably a slight benefit of RT (SMD -0.49 points, 95% CI -0.77 to -0.21; 4 studies; 204 participants). Effects were uncertain for individual RT, with very low quality evidence available. For reminiscence groups, evidence of moderate quality indicated a probable slight benefit immediately (SMD -0.39, 95% CI -0.71 to -0.06; 4 studies; 153 participants), and at later follow-up. Community participants probably benefited at end of treatment and follow-up. For care home participants, the results were inconsistent between studies and, while there may be an improvement at follow-up, at the end of treatment the evidence quality was very low and effects were uncertain.Other outcome domains examined for people with dementia included mood, functioning in daily activities, agitation/irritability and relationship quality. There were no clear effects in these domains. Individual reminiscence was probably associated with a slight benefit on depression scales, although its clinical importance was uncertain (SMD -0.41, 95% CI -0.76 to -0.06; 4 studies; 131 participants). We found no evidence of any harmful effects on people with dementia.We also looked at outcomes for carers, including stress, mood and quality of relationship with the person with dementia (from the carer's perspective). We found no evidence of effects on carers other than a potential adverse outcome related to carer anxiety at longer-term follow-up, based on two studies that had involved the carer jointly in reminiscence groups with people with dementia. The control group carers were probably slightly less anxious (MD 0.56 points, 95% CI -0.17 to 1.30; 464 participants), but this result is of uncertain clinical importance, and is also consistent with little or no effect.

AUTHORS' CONCLUSIONS

The effects of reminiscence interventions are inconsistent, often small in size and can differ considerably across settings and modalities. RT has some positive effects on people with dementia in the domains of QoL, cognition, communication and mood. Care home studies show the widest range of benefits, including QoL, cognition and communication (at follow-up). Individual RT is associated with probable benefits for cognition and mood. Group RT and a community setting are associated with probable improvements in communication. The wide range of RT interventions across studies makes comparisons and evaluation of relative benefits difficult. Treatment protocols are not described in sufficient detail in many publications. There have been welcome improvements in the quality of research on RT since the previous version of this review, although there still remains a need for more randomised controlled trials following clear, detailed treatment protocols, especially allowing the effects of simple and integrative RT to be compared.

Cognitive Stimulation for People with Dementia in Long-Term Care Facilities: Baseline Cognitive Level Predicts Cognitive Gains, Moderated by Depression

BACKGROUND

Increasing evidence demonstrates the efficacy of cognitive stimulation (CS) in individuals with dementia. However, conducting studies in nursing homes engenders specific challenges that have limited the data gathered on this topic so far.

OBJECTIVE

The aim of this randomized controlled trial was to investigate the effects of CS on cognition, quality of life (QoL), behavioral symptoms, and activities of daily life in persons with dementia living in nursing homes. We further aimed to identify predictors of the intervention's benefits.

METHODS

Seventy-one persons with mild to moderate dementia were randomly allocated to the experimental group (EG; n = 36) that visited a CS program twice weekly for eight weeks or to the control group (CG; n = 35) that was receiving usual care. Neuropsychological tests were conducted before and after the intervention period and at six-week follow-up.

RESULTS

There were no significant interaction effects Time×Group for the outcome measures. However, regression analysis revealed that a low cognitive baseline level predicted cognitive improvements. Furthermore, a low baseline level of QoL predicted a QoL benefit. For both findings, depression was a significant moderator, meaning that persons with fewer depressive symptoms had a higher probability of showing improvements.

CONCLUSION

This study provides data on profiles of patients who are most likely to profit from CS intervention in nursing-home settings and demonstrates that treatment of depression is of the utmost relevance for a positive outcome of CS. Living conditions will have to be considered more thoroughly in future research.

Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis

BACKGROUND

Previous reviews and meta-analyses demonstrated effects of cognitive interventions in dementia, but none specifically considered residents with dementia in long-term care (LTC) facilities.

OBJECTIVE

To analyse the efficacy of cognitive interventions in institutionalised individuals with dementia.

METHODS

After identifying 27 articles, a systematic review was performed. A meta-analysis was calculated for 15 studies of the randomized controlled trials regarding effects on relevant outcomes. Fixed-effects meta-analyses were conducted using standardized mean differences (SMD) of changes from baseline pooled using the inverse variance method.

RESULTS

When comparing cognitive interventions to passive control groups, the meta-analysis revealed significant moderate effects on global cognition (SMD=0.47, 95% CI 0.27-0.67), autobiographical memory (0.67, 0.02-1.31), and behavioral and psychological symptoms in dementia (BPSD; 0.71, 0.06-1.36). Significant small effects were detected for quality of life (QoL; 0.37, 0.05-0.70). Moderate effects on activities of daily living (0.28; -0.02 to 0.58) failed to reach significance; no effects were found on depression (0.22; -0.08 to 0.51). Significant moderate effects of global cognition (0.55; 0.22-0.89) and depression (0.64; 0.21-1.07) were also found for cognitive interventions contrasting active control groups. No harmful events related to the participation in the interventions were observed.

CONCLUSION

Cognitive interventions are safe and effective for residents with dementia in LTC. However, while it seems clear that cognitive benefits can specifially be assigned to these forms of intervention, further research is necessary to clarify whether the effects on BPSD and QoL reflect unspecific changes due to additional attention. Furthermore, future studies will have to determine which intervention type yields the largest benefits.

Effectiveness of cognition-focused interventions in activities of daily living performance in people with dementia: A systematic review

Introduction

Dementia affects cognitive functions and has a direct impact on the ability to perform activities of daily living. Studies have focused on the impact of cognition-focused interventions on cognitive functions, but less on the daily functionality of people with dementia. The aim of this study was to review systematically evidence of the effectiveness of cognition-focused interventions on the ability of people with dementia to perform activities of daily living.

Method

A search of randomised controlled trials was performed in 10 databases to find all available evidence on the subject. Two reviewers independently selected articles based on predetermined inclusion criteria. The articles had to describe randomised controlled trials involving cognition-focused interventions in people with some form of dementia, aged 65 years or over, and specify their score on the Mini-Mental State Examination or the Clinical Dementia Rating. Eleven articles met the inclusion criteria for the review.

Results

Cognitive rehabilitation through functional tasks led to maintenance or improvement in everyday tasks in some cases. In cognitive stimulation studies the subjects maintained their performance in activities of daily living with respect to the control condition, but this was not the case in reminiscence stimulation groups. Subjects who underwent cognitive training of cognitive functions did not show significant improvements in activities of daily living.

Conclusion

The evidence on the effectiveness of cognition-focused interventions suggests that multi-component programmes that include cognitive rehabilitation or cognitive stimulation could maintain or improve functionality in people with dementia.

Comparison between group and personal rehabilitation for dementia in a geriatric health service facility: single-blinded randomized controlled study

AIM

The aim of this study was to compare the effects of rehabilitation involving group and personal sessions on demented participants.

METHODS

This single-blinded randomized controlled trial included 60 elderly participants with dementia in a geriatric health service facility, or R oken. Staff members, who did not participate in the intervention, examined cognitive function, mood, communication ability, severity of dementia, objective quality of life, vitality, and daily behaviour. After a baseline assessment, participants were randomly divided into three groups: (i) group intervention; (ii) personal intervention; and (iii) control. The 1-h group intervention (3-5 subjects) and 20-min personal intervention (one staff member per participant) were performed twice a week for 12 weeks (24 total sessions). The cognitive rehabilitation programme consisted of reminiscence, reality orientation, and physical exercise, and it was based on five principles of brain-activating rehabilitation; (i) pleasant atmosphere; (ii) communication; (iii) social roles; (iv) praising; and (v) errorless support. Data were analyzed after the second assessment.

RESULTS

Outcome measures were analyzed in 43 participants-14 in the control group, 13 in group intervention, and 16 in personal intervention. Repeated measure ancova showed a significant interaction for cognitive function score (Mini-Mental State Examination) between group intervention and controls ( F  = 5.535, P = 0.029). In the post-hoc analysis, group intervention showed significant improvement (P = 0.016). Global severity of dementia tended to improve (P = 0.094) in group intervention compared to control (Mann-Whitney U -test). There were no significant interactions or improvements for other measurements.

CONCLUSIONS

Group rehabilitation for dementia is more effective for improving cognitive function and global severity of dementia than personal rehabilitation in Roken.

Effects of a Cooking Program Based on Brain-activating Rehabilitation for Elderly Residents with Dementia in a Roken Facility: A Randomized Controlled Trial

Objective

Rehabilitation for dementia is important in Roken Geriatric Health Service Facilities in Japan. This study evaluated the effects of a cooking program as rehabilitation for elderly residents with dementia.

Methods

We carried out a 12-week cooking program based on the five principles of brain-activating rehabilitation (BAR): fostering a pleasant atmosphere, interactive communication, establishing social roles, giving and receiving praise, and errorless learning. The program was carried out in small groups and consisted of 90-min classes once a week. Participants were 36 elderly residents with dementia (mean 85.4 ± 6.5 years) who were randomly divided into intervention (n = 18) and control (n = 18) groups. The control group participated in recreation and both groups received individual conventional rehabilitation twice a week for 30 min. The effects of intervention were evaluated using nine outcome measures.

Results

A total of 29 participants were included in the analysis (two-way analysis of variance). The attendance rate was 86.6% in the intervention group (n = 13). The Yamaguchi Kanji Symbol Substitution Test (executive function) showed significant interaction (F(1, 27) = 4.305, P = 0.048) between the two groups: the control group (n = 16) showed significant deterioration (pre 4.9 ± 5.6 to post 3.0 ± 4.9; P = 0.032). The dementia behavior disturbance scale also showed significant interaction (F(1, 29) = 13.298, P = 0.001): the intervention group (n = 16) showed significant improvement (pre 21.6 ± 12.2 to post 11.4 ± 11.5; P < 0.001). No significant differences were observed in the other outcome measures.

Conclusions

Our findings suggest that a cooking program based on BAR can reduce the behavioral and psychological symptoms of dementia and maintain executive function.

A Quasi-Randomized Controlled Trial of Brain-Activating Rehabilitation in an Acute Hospital

We aimed to confirm the effectiveness of brain-activating rehabilitation (BAR) performed in the day care setting at an acute hospital. Brain-activating rehabilitation is based on 5 principles: developing a pleasant atmosphere, promoting communication, praising patients, giving patients a social role, and providing supportive care. A total of 48 patients with dementia or cognitive impairment were selected and randomly divided into the intervention and control groups. The BAR-based intervention was conducted for 1 hour, 3 times a week. The patients' score of the Multidimensional Observation Scale for Elderly Subjects (MOSES) were used as outcome measures. Repeated-measures analysis of covariance detected a significant interaction between the MOSES disorientation (F = 4.437, P = .041) and the withdrawal (F = 5.052, P = .030) subscales. A BAR-based intervention performed at our acute hospital was effective at maintaining and improving the cognitive and psychosocial functioning of patients with dementia or cognitive impairment.

Group Intensive Cognitive Activation in Patients with Major or Mild Neurocognitive Disorder

Background: No standard protocols are available for cognitive rehabilitation (CR) in conditions like Major or Mild Neurocognitive disorder (M-NCD or m-NCD, respectively); however, preliminary data seem to indicate that such interventions might have cost-effective beneficial effects and are free from side effect or adverse events. Three basic approaches are known: cognitive stimulation (CS), cognitive training (CT), and CR.

Objective: Aim of this study was to assess the efficacy of a protocol of group intensive cognitive activation (g-ICA) in patients with both M-NCD and m-NCD; the protocol was specifically arranged in our Research Institute, based on the principles of the central role of the patient and the mediation pedagogy.

Subjects and Methods: Sixteen patients with M-NCD and fifteen patients with m-NCD were enrolled, as well as eleven patients with M-NCD who were used as a control group (CG). The intervention was carried-out by a clinical neuropsychologist with daily group sessions over a period of 2 months. Neuropsychological assessment was performed at baseline and after the completion of the rehabilitative intervention.

Results: General cognitive functioning, attention, ideomotor praxis and visual memory scores were found to be significantly increased in all patients. Beneficial and significant effects were also found for constructive praxis in M-NCD and for executive functioning in m-NCD. All areas of the language function were significantly ameliorated in m-NCD, while this happened only for verbal repetition and syntax-grammar comprehension in M-NCD. No changes were detected for long- and short-term verbal memory, which were found to be worsened in controls without activation.

Conclusion: Our findings seem to indicate that g-ICA might be effective in inducing beneficial changes on the general cognitive functioning and other specific functions in patients with both m-NCD and M-NCD. Moreover, the specific protocol proposed, even if susceptible of important improvement, is easy to carry out within hospital facilities and cost-effective.

Prevention of cognitive and physical decline by enjoyable walking-habituation program based on brain-activating rehabilitation

AIM

Evaluating effects of an enjoyable walking-habituation program.

METHODS

We carried out a 12-week intervention, consisting of an enjoyable walking-habituation program based on five principles of brain-activating rehabilitation: pleasant atmosphere, interactive communication, social roles, praising each other and errorless support. The program, once a week for 90 min, was carried out in small groups. Participants were 71 community-dwelling people (72.2 ± 4.3) without dementia. Cognitive function was evaluated in five cognitive domains: memory, executive function, word fluency, visuospatial abilities and sustained attention. Additionally, quality of life, depressive state, functional capacity, range of activities, social network and subjective memory complaints were assessed using questionnaires. Motor function was also evaluated. Measurement was carried out before the observation period, after observation and after intervention.

RESULTS

A total of 63 participants were included in the analysis. Daily steps, executive function, subjective memory complaints, functional capacity and 5-m maximum walking time significantly improved during the intervention period (after observation to after intervention) compared with the observation period (before the observation period to after observation). No significant differences were seen in other evaluations. At 6 months after the intervention, 52 of 63 participants (82.5%) continued to walk once a week or more, and all of them were confident about continuing to walk in the future. Furthermore, all participants were satisfied with our walking-habituation program and all replied that they felt delighted.

CONCLUSION

The intervention program, based on the five principles of brain-activating rehabilitation, resulted in improvement of some cognitive and physical functions, as well as a high walking-habituation rate at 6 months' follow up. Geriatr Gerontol Int 2015; ●●: ●●-●●.

Patients with moderate Alzheimer's disease engage in verbal reminiscence with the support of a computer-aided program: a pilot study

This study focused on the assessment of a program recently developed for helping patients with moderate Alzheimer’s disease engage in computer-mediated verbal reminiscence (Lancioni et al., 2014a). Sixteen participants were involved in the study. Six of them used the original program version with the computer showing a virtual partner posing questions and providing attention and guidance. The other 10 used a slightly modified program version with the computer presenting photos and videos and providing encouragements to talk as well as attention and guidance. Participants were exposed to brief program sessions individually. The results showed that 15 participants (five of those using the first version and all of those using the second version) had a clear and lasting increase in verbal engagement/reminiscence during the intervention sessions with the program. Those 15 participants had mean percentages of intervals with verbal engagement/reminiscence below 10 during baseline and between about 45 and 75 during the intervention. The results’ implications and the need for new research were discussed.

A computer-aided program for helping patients with moderate Alzheimer's disease engage in verbal reminiscence

This study assessed a simple computer-aided program for helping patients with moderate Alzheimer's disease engage in verbal reminiscence. In practice, the program was aimed at fostering the patient's verbal engagement on a number of life experiences/topics previously selected for him or her and introduced in the sessions through a friendly female, who appeared on the computer screen. The female asked the patient about the aforementioned experiences/topics, and provided him or her with positive attention, and possibly verbal guidance (i.e., prompts/encouragements). Eight patients were involved in the study, which was carried out according to non-concurrent multiple baseline designs across participants. Seven of them showed clear improvement during the intervention phase (i.e., with the program). Their mean percentages of intervals with verbal engagement/reminiscence ranged from close to zero to about 15 during the baseline and from above 50 to above 75 during the intervention. The results were discussed in relation to previous literature on reminiscence therapy, with specific emphasis on the need for (a) replication studies and (b) the development of new versions of the technology-aided program to improve its impact and reach a wider number of patients.

Implication of the nutritional and nonnutritional factors in the context of preservation of cognitive performance in patients with dementia/depression and Alzheimer disease

It has been postulated that Alzheimer disease (AD) is a systemic process, which involves multiple pathophysiological factors. A combination of pharmacotherapy and nonpharmacological interventions has been proposed to treat AD and other dementia. The nonpharmacological interventions include but are not limited to increasing sensory input through physical and mental activities, in order to modify cerebral blood flow and implementing nutritional interventions such as diet modification and vitamins and nutraceuticals therapy to vitalize brain functioning. This article highlights the recent research findings regarding novel treatment strategies aimed at modifying natural course of the disease and delaying cognitive decline through simultaneous implementation of pharmacological and nonpharmacological modulators as standardized treatment protocols.