title: Combination of intensive cognitive rehabilitation and donepezil therapy in Alzheimer's disease (AD).
abstract: Acetylcholinesterase inhibitors (AchEIs) are extensively used in Alzheimer's disease (AD) while reality orientation therapy (ROT) is a cognitive rehabilitation indicated for mentally deteriorated patients. We aimed to evaluate the efficacy of the combination of donepezil with an intensive ROT with active participation of the caregiver. Patients with AD (n=100, mean age 78.4±4.3 years) initiated treatment with donepezil, 5mg/day; 62 of them underwent a 3-week, daily ROT and physical reactivation training with the caregiver (Group A); 38 participants received only donepezil therapy (Group B). All subjects were tested for cognitive and functional abilities at baseline, at the end of the training program, and after 2 months of follow-up. There was a significant improvement in mini-mental state examination (MMSE) score (p<0.001) and the AD assessment scale-cognitive (ADAS-Cog) subscale (p<0.001), without changes in impaired activity of daily living (ADL) and instrumental ADL (IADL) after intensive ROT training in Group A. MMSE was maintained after 2 months in-home ROT continuation. There were no significant changes in MMSE in drug-only treated patients (Group B) after 3 weeks, with a non-significant tendency to improvement in ADAS-Cog. Our results suggest benefit of an intensive ROT program in dementia patients receiving donepezil that seems to be maintained as far as ROT is continued by the caregiver.
authors.affiliation: Alzheimer Center, Division of Geriatrics, Ospedale Ingrassia, ASP di Palermo, Palermo, Via La Loggia 5, 90100 Palermo, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Giordano
authors.forename: Ligia J
authors.initials: LJ
authors.lastname: Dominguez
authors.forename: Teresa
authors.initials: T
authors.lastname: Vitrano
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Curatolo
authors.forename: Anna
authors.initials: A
authors.lastname: Ferlisi
authors.forename: Anna
authors.initials: A
authors.lastname: Di Prima
authors.forename: Mario
authors.initials: M
authors.lastname: Belvedere
authors.forename: Mario
authors.initials: M
authors.lastname: Barbagallo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology / Q000628:therapy*; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D000077265:Donepezil; D005260:Female; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008297:Male; D010880:Piperidines / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil