Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: a multi-centre randomised controlled trial (the GREAT trial)
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In: International Journal of Geriatric Psychiatry, Vol. 34, No. 5, 05.2019, p. 709-721.
Research output: Contribution to journal › Article › peer-review
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T1 - Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: a multi-centre randomised controlled trial (the GREAT trial)
AU - Clare, Linda
AU - Kudlicka, Aleksandra
AU - Oyebode, J.R.
AU - Jones, Roy W
AU - Bayer, A.
AU - Leroi, Iracema
AU - Kopelman, M.
AU - James, Ian
AU - Culverwell, Alison
AU - Pool, J.
AU - Brand, Andrew
AU - Henderson, Catherine
AU - Hoare, Zoe
AU - Knapp, Martin
AU - Woods, Robert
N1 - National Institute for Health, Health Technology Assessment Programme, Grant/Award Number: 11/15/04 © 2019 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd.
PY - 2019/5
Y1 - 2019/5
N2 - ObjectivesTo determine whether individual goal‐oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild‐to‐moderate dementia.Design and methodsParallel 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.ResultsWe 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.ConclusionsCR enables people with early‐stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.
AB - ObjectivesTo determine whether individual goal‐oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild‐to‐moderate dementia.Design and methodsParallel 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.ResultsWe 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.ConclusionsCR enables people with early‐stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.
KW - Activities of Daily Living
KW - Alzheimer Disease
KW - Disability
KW - Goal-setting
KW - Nonpharmacological intervention
KW - Person-centred
KW - Problem Solving
KW - reablement
KW - vascular dementia
U2 - 10.1002/gps.5076
DO - 10.1002/gps.5076
M3 - Article
VL - 34
SP - 709
EP - 721
JO - International Journal of Geriatric Psychiatry
JF - International Journal of Geriatric Psychiatry
SN - 0885-6230
IS - 5
ER -