title: Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy.
abstract: OBJECTIVE
  To provide evidence regarding the clinical efficacy of cognitive rehabilitation (CR) in early-stage Alzheimer disease (AD).
  
  
  METHODS
  Single-blind randomized controlled trial comparing CR with relaxation therapy and no treatment.
  
  
  METHODS
  Outpatient, community-based setting.
  
  
  METHODS
  Sixty-nine individuals (41 women, 28 men; mean age 77.78 years, standard deviation 6.32, range = 56-89) with a diagnosis of AD or mixed AD and vascular dementia and a Mini-Mental State Examination score of 18 or above, and receiving a stable dose of acetylcholinesterase-inhibiting medication. Forty-four family carers also contributed.
  
  
  METHODS
  Eight weekly individual sessions of CR consisting of personalized interventions to address individually relevant goals supported by components addressing practical aids and strategies, techniques for learning new information, practice in maintaining attention and concentration, and techniques for stress management.
  
  
  METHODS
  The primary outcomes were goal performance and satisfaction, assessed using the Canadian Occupational Performance Measure. Questionnaires assessing mood, quality of life and career strain, and a brief neuropsychological test battery were also administered. A subset of participants underwent functional magnetic resonance imaging (fMRI).
  
  
  RESULTS
  CR produced significant improvement in ratings of goal performance and satisfaction, whereas scores in the other two groups did not change. Behavioral changes in the CR group were supported by fMRI data for a subset of participants.
  
  
  CONCLUSIONS
  The findings support the clinical efficacy of CR in early-stage AD. CR offers a means of assisting people with early-stage AD and their families in managing the effects of the condition.
authors.affiliation: Bangor University, United Kingdom. l.clare@bangor.ac.uk
authors.forename: Linda
authors.initials: L
authors.lastname: Clare
authors.forename: David E J
authors.initials: DE
authors.lastname: Linden
authors.forename: Robert T
authors.initials: RT
authors.lastname: Woods
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Whitaker
authors.forename: Suzannah J
authors.initials: SJ
authors.lastname: Evans
authors.forename: Caroline H
authors.initials: CH
authors.lastname: Parkinson
authors.forename: Jorien
authors.initials: J
authors.lastname: van Paasschen
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Nelis
authors.forename: Zoe
authors.initials: Z
authors.lastname: Hoare
authors.forename: Kenneth S L
authors.initials: KS
authors.lastname: Yuen
authors.forename: Michael D
authors.initials: MD
authors.lastname: Rugg
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology / Q000534:rehabilitation*; D001921:Brain / Q000503:physiopathology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006040:Goals; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method