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Revised MCI criteria according to consensus conference, Stockholm (2003)

Evaluation of a long term non pharmacological treatment for patients with Mild Cognitive Impairment (MCI) and Mild Alzheimer’s disease (MILD AD). Tsolaki, M., Kounti, F., Poptsi, E., Agogiatou, C., Soumbourou, A., Nikolaidou, E., Zafeiropoulou, M., Bacoglidou, E.

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Revised MCI criteria according to consensus conference, Stockholm (2003)

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  1. Evaluation of a long term non pharmacological treatment for patients with Mild Cognitive Impairment (MCI) and Mild Alzheimer’s disease (MILD AD) Tsolaki, M., Kounti, F., Poptsi, E., Agogiatou, C., Soumbourou, A., Nikolaidou, E., Zafeiropoulou, M., Bacoglidou, E. 1. School of Psychology,Thessaloniki 2. Medicine School, Thessaloniki 3.Greek Association of Alzheimer’s Disease

  2. Revised MCI criteria according to consensus conference, Stockholm (2003) • Not normal, absence of dementia • Cognitive decline • Subjective (self report) • Objective (1.5 SD) • Some decline in function, but… • Preserved basic ADL/minimal impairment in complex IADLs Winblad et al (2004). J Intern Med. 256:240-246

  3. Mild Alzheimer’s Disease(MILD ΑD) Presence of both: • MemoryDisorder • Impairment in at least one additional cognitive domain • Impaired social function • Impaired performance in ADL (American Psychiatric Association, 2000)

  4. BRAIN PLASTICITY • Environment • Behaviors • Emotions • Increase the risk of neural death • But also facilitate the regeneration of neurons (Percacclo et al, 2007. Gobbio & Marq, 2005.Mateer & Kerns, 2000)

  5. BRAIN PLASTICITY • The adult brainDOES regenerate itself at least in some areas as hippocampus (Van Praag, Kemper & Gage, 2000 Gould, 1999. Swanson, 1982)

  6. COGNITIVE REHABILITATION • Systematic and intense cognitive practice can activate regeneration in the brain (Steiner et al, 2006. Recanzone, 1993) • Targeting to the facilitation of neuronal regeneration through systematic and well structured new experience and learning (Percacclo et al, 2007. Nakatomi et al, 2002. Robertson & Murre, 1999)

  7. AIMS OF COGNITIVE REHABILITATION • Long term changes in synaptic connectivity, as a result of behavior and experience (Nakatomi et al, 2002. Gobbio & Marq, 2005. Mateer & Kerns, 2000)

  8. COGNITIVE AND PSYCHOLOGICAL REHABILITATION HOLISTIC THERAPEUTIC APPROACH Health is an entity: • Body • Mind • Emotions Cooperation / dynamic balance with physical and socialenvironment (Biderman et al., 2005)

  9. COGNITIVE AND PSYCHOLOGICAL REHABILITATION • The best therapeutic choice for MCI and Alzheimer’s disease patients • are Interventions which improve spirit, body and soul (Ferlisi et al., 2007. Spector et al.,2000, Zanetti et al., 1999. De Vreese et al., 2001)

  10. COGNITIVE AND PSYCHOLOGICAL REHABILITATION PROGRAM • Holistic Therapeutic Approach

  11. COGNITIVE AND PSYCHOLOGICAL REHABILITATION PROGRAM AIMS: • Cognitive and functional improvement of MCI patients • Inhibition of the progressive cognitive and functional deterioration of MILD AD patients after 4 years

  12. PARTICIPANTS (N=57/100) p*= between MCI groups p!= between MILD AD groups

  13. PARTICIPANTS Inclusion criteria • Insight (awareness of the disease) • Absence of primary or secondary depression • Spared sensory abilities, reading and writing skills • Pharmacological treatment: cholinesterase inhibitors • Absence of aphasic disorders (language comprehension and speech production)

  14. REHABILITATION PROGRAM 1.Practice of attention and parameters of executive function 2.Practice of Language skills 3.Cognitive Motion Therapy 4.Reality Orientation in Current events 5.Mental imagery under relaxation

  15. Practice of attention and parameters of executive function

  16. Practice of Language skills

  17. Cognitive Motion Therapy

  18. Reality Orientation in Current events

  19. Mental imagery under relaxation

  20. DURATION OF REHABILITATION PROGRAM • 4 ½ hours sessions per week • 24 weeks every year under Rehabilitation therapy • 24 weeks without Rehabilitation therapy • Duration:4 years • Group intervention (groups of 5-6 patients)

  21. PSYCHOMETRIC ASSESSMENT • 1stassessment:just before the non pharmacological therapy • 2ndassessment : 3 years after the end of it • 3rd assessment : 4 years after the end of it

  22. PSYCHOMETRIC ASSESSMENT ADL: • Functional Cognitive Assessment Scale (FUCAS) • Functional Rating Scale of Symptoms of Dementia (FRSSD) Cognitive Function: • Mini Mental State Examination (MMSE) • Montreal Cognitive Assessment (MοCA) • CAMCOG • WAIS-R • Verbal Fluency (FAS) • TRAIL MAKING A, B

  23. PSYCHOMETRIC ASSESSMENT Cognitive Function: • Rey Auditory-Verbal Learning Test (RAVLT) • PYRAMIDS AND PALM TREES (PPT) • Rivermead Behavioural Memory Test (RBMT) • Test of Every Day Attention (ΤΕΑ) • Rey Ostereith Complex Figure Test (ROCFT) • STROOP • Βoston Naming Test (BNT) Emotional performance: • Geriatric Depression Scale (GDS)

  24. RESULTS • Statistics • SPSS • Non parametric tests • Wilcoxon for two related samples • Mann Whitney for two independent samples

  25. RESULTS Comparison between experimental / controls with MCI after 3 years 3 years later Significant difference in cognitive functions: • Attention, CAMCOG (p= .008) • Delayed recall, CAMCOG (p=. 018) • Memory function, CAMCOG (p=. 042) • Visual recall, CAMCOG (p=. 004) • Naming, CAMCOG (p=. 034) • General Cognitive performance, MMSE (p= .014) • Experimental group had better scores

  26. RESULTS Comparison between experimental / controls with MCIafter 3 years 3 years later Significant difference in ADL: • Socialresponse,FRSSD (p= .010) • Attention, FRSSD (p= .047) • ADL, FRSSD (p= .006) • Emotional performance, GDS (p= .039) • Experimental group had better scores

  27. Performance of experimental and controls with MCI before the Rehabilitation therapy & 3 years later

  28. RESULTS Comparison between experimental and controls with MILD ADafter 3 years Significant difference in: • Recall of recent events,GAMCOG (p= .018) • General memory function, CAMCOG (p= .025) • Written recall, CAMCOG (p= .021) • Ideatic praxis, CAMCOG (p= .009) • Praxis,CAMCOG (p= .009) • Visual perception, CAMCOG (p= .014) • Visual shape perception,CAMCOG (p= .011) • Abstract thinking,CAMCOG (p= .001) • Experimental group had better scores

  29. RESULTS Comparison between experimental and controls with MILD AD after 4 years 4 years later Significant difference in : • Recall of recent events,GAMCOG (p= .015) • Repetition,CAMCOG(p= .021) • Visual perception, CAMCOG(p= .042) • Abstract thinking,CAMCOG(p= .008) • Experimental group had better scores

  30. RESULTS Comparison before the Rehabilitation Therapy and3 years later of the experimental group with MCI 3 years laterbetter performance in: • Attention (p ≤ .047) • Verbal memory (p = .005) • Visual memory (p ≤ .032) • Language (p ≤ .014) • Executive function (p ≤ .047) • Global Cognitive performance,MMSE(p= .002) • Global Cognitive performance,CAMCOG (p= .001) • Cognitive performance,MOCA(p= .015) • Emotional performance,GDS(p= .047)

  31. RESULTS Comparison before the Rehabilitation Therapy and4 years later, of the experimental group with MCI 4 years laterbetter performance in: • Attention,CAMCOG, TEA, (p= .032) • Visual memory, (p≤ .031) • Language, (p≤ .040) • Executive function, (p≤ .047) • Global Cognitive performance,CAMCOG (p= .016)

  32. RESULTS Comparison before the Rehabilitation Therapy and3 years later, of the experimental group with MILD AD 3 years laterbetter performance in: • Verbalsemantic memory with phonological help,BNT(p= .031) • Stability in the rest of cognitive functions

  33. RESULTS Comparison before the Rehabilitation Therapy and 4 years later of the experimental group with MILD AD 4 years later • Cognitive and functional stabilization

  34. RESULTS MCI experimental group • Cognitive performance was still improving after 4 years in patients on Rehabilitation program • Almost all cognitive functions had been improved • Cognitive improvement was transferred to ADL • MCI experimental patients 4 years later were diagnosed as healthy elderly

  35. RESULTS MILD AD experimental group • Stabilization of cognitive, emotional and functional performance for a period of 4 years after the beginning of the Rehabilitation therapy

  36. CONCLUSIONS • Long term Rehabilitation therapy improved cognitive, emotional and functional performance • In MCI patients who were healthy elderly after 4 years therapy • The progressive impairment of AD patients, characteristic of the disease process, was inhibited for at least 4 years

  37. THANK YOU!!!

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