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  • Linda Clare
    University of Exeter Medical School
  • Aleksandra Kudlicka
    University of Exeter
  • J.R. Oyebode
  • Roy W Jones
  • A. Bayer
  • Iracema Leroi
    Manchester Academic Health Sciences Centre
  • M. Kopelman
  • Ian James
    Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne
  • Alison Culverwell
    Kent and Medway Mental Health and Social Care Partnership Trust, United Kingdom
  • J. Pool
  • Andrew Brand
  • Catherine Henderson
  • Zoe Hoare
  • Martin Knapp
    London School of Economics and Political Science
  • Robert Woods
Objectives
To determine whether individual goal‐oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild‐to‐moderate dementia.
Design and methods
Parallel group multicentre single‐blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD‐10 diagnosis of Alzheimer, vascular or mixed dementia, and mild‐to‐moderate cognitive impairment (Mini‐Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self‐reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant‐reported goal attainment, quality of life, mood, self‐efficacy, and cognition and study partner stress and quality of life.
Results
We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant‐rated goal attainment (d = 0.97; 95% CI, 0.75‐1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89‐1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71‐1.17) and informant (d = 0.96; 95% CI, 0.73‐1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes.
Conclusions
CR enables people with early‐stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.

Keywords

  • Activities of Daily Living, Alzheimer Disease, Disability, Goal-setting, Nonpharmacological intervention, Person-centred, Problem Solving, reablement, vascular dementia
Original languageEnglish
Pages (from-to)709-721
Number of pages13
JournalInternational Journal of Geriatric Psychiatry
Volume34
Issue number5
Early online date6 Feb 2019
DOIs
Publication statusPublished - May 2019

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