Efficacy of Cognitive Rehabilitation Versus Usual Treatment at Home in Patients With Early Stages of Alzheimer Disease

Abstract

Introduction: Assessing the benefit of cognitive rehabilitation (CR) remains difficult. Method: An observational study was conducted in 33 patients with early-stage Alzheimer disease and their caregiver included in a clinical CR program at home, compared to 17 patients who received usual treatment. Evaluation of patient’s dependence and objective and subjective caregiver’s burden was performed by the caregiver with a research tool focusing on impairment in daily activities related to cognitive deficits. Results: Repeated measures analysis of variance showed a time by group interaction ( P < .05), with decreased patient’s dependence for adapted activities at 1 year in the CR group. Lawton scale for daily activities showed also a time by group interaction ( P < .05), with increased dependence at 1 year in the control group. There was a significant decrease in Mini-Mental State Examination scores in both groups at 1-year follow-up ( P < .05). Concerning caregiver’s subjective burden, there was a trend for the time by group interaction ( P = .07), and post hoc Tukey test showed that subjective burden was decreased in the CR group ( P < .05). This was confirmed by nonparametric Mann-Whitney analysis on differences between follow-up and baseline evaluation ( P < .05). Conclusion: This observational study in a clinical setting is in line with the benefit of CR reported in recent randomized controlled trials. The benefit obtained for adapted daily activities remained after 1 year, even if global cognition declined. Moreover, caregiver’s subjective burden related to all relevant daily activities evaluated within the CR program was decreased after 1 year in our clinical setting.