None listed
Conditions
Brief summary
Recent advances in neuropathology of cognitive reserves provide hypotheses on effects of cognitive training among patients with dementia. Executive functioning may be affected in later stages of dementia after prefrontal areas of brain becoma affected. Executive functions are the brain functions needed to manage our daily functioning, our emotions and our behavior in pursuit of our goals. Efficient executive functioning might compensate other cognitive disorders, e.g. memory decline. Thus, rehearsing dementia patients' executive functioning may improve daily functioning and lead to compensation of impaired cognitive domains. The aim this study is to investigate the efficacy of cognitive training (CoTr) focusing on executive functioning among community-dwelling patients with mild to severe dementia with a 24 months follow-up. The aim of this large RCT is to clarify the effects of CoTr on their global cognition, various domains of executive functioning and cognition, participants' daily functioning, HrQOL and use of health and social services. In a parallel substudy with RCT design we aim to explore in detail the effects of CoTr among mild to moderate AD patients in fMRI.
Interventions
Cognitive training.
Cognitive training intervention uses tasks mainly focusing on executive functioning (cognitive flexibility, planning, speed of processing, reasoning and attention) thus stimulating presumably more frontal areas of the brain. The cognitive training program will be a clinically and neuropsychologically relevant modification of the cognitive remediation therapy (CRT) , which is a training based intervention aimed to improve cognitive processes on psychiatric patients (Wykes et
Cognitive training. Cognitive training intervention uses tasks mainly focusing on executive functioning (cognitive flexibility, planning, speed of processing, reasoning and attention) thus stimulating presumably more frontal areas of the brain. The cognitive training program will be a clinically and neuropsychologically relevant modification of the cognitive remediation therapy (CRT) , which is a training based intervention aimed to improve cognitive processes on psychiatric patients (Wykes et al 1999). The tasks will be tailored according to the participants' level of cognitive abilities, interests and adherence. The cognitive training takes place twice a week in Helsinki day centres in groups of 1-5 participants. Participants perform predetermined paper and pencil tasks for 45-60 min/day. Their work is directed, supported and assessed by a day centre trained assistant who will be trained by a neuropsychologist. Participants will be transferred to day centres by taxis and they will be provided also the normal day centre program. The whole day care will take approximately 4-6 hours and it includes also socializing with other participants. The intervention lasts 12 weeks.
Sponsors
Kaisu Pitkala
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
0 to No maximum
Healthy volunteers
No
Inclusion criteria
Dementia accoding to Clinical dementia rating (mild to moderate: 0.5 to 3). Participating day center activities 2x /wk in Helsinki day care center. Volunteer. Finnish speaking, not at terminal stage, ability to see, hear, read and write, and living at home. If at moderate or severe stage, caregiver's consent is required. In substudy to fMRI: Alzheimer diagnosis (undergone detailed diagnostics for AD), mild to moderate dementia (CDR 0.5 to 2);
Exclusion criteria
No dementia, not participating in day center twice/wk; other native language but Finnish, not able to see or hear, read or write sufficiently to participate cognitive training. Exclusion criteria for fMRI substudy: Key exclusion criteria in fMRI: Subjects with any kind of metal fragments in the body should not have an MR scan without further safety controls. This includes e.g. any electronic, magnetic or mechanical implants (such as a cardiac pacemaker, infusion pumps or cochlear implants), aneurysm clips in the brain or other surgical clips, or prostheses (such as artificial heart valves or dentures).
Outcome results
None listed