title: Group and individual cognitive therapies in Alzheimer's disease: the ETNA3 randomized trial.
abstract: BACKGROUND
  Although non-drug interventions are widely used in patients with Alzheimer's disease, few large scale randomized trials involving a long-term intervention and several cognitive-oriented approaches have been carried out. ETNA3 trial compares the effect of cognitive training, reminiscence therapy, and an individualized cognitive rehabilitation program in Alzheimer's disease to usual care.
  
  
  METHODS
  This is a multicenter (40 French clinical sites) randomized, parallel-group trial, with a two-year follow-up comparing groups receiving standardized programs of cognitive training (group sessions), reminiscence therapy (group sessions), individualized cognitive rehabilitation program (individual sessions), and usual care (reference group). Six hundred fifty-three outpatients with Alzheimer's disease were recruited. The primary efficacy outcome was the rate of survival without moderately severe to severe dementia at two years. Secondary outcomes were cognitive impairment, functional disability, behavioral disturbance, apathy, quality of life, depression, caregiver's burden, and resource utilization.
  
  
  RESULTS
  No impact on the primary efficacy measure was evidenced. For the two group interventions (i.e. cognitive training and reminiscence), none of the secondary outcomes differed from usual care. The larger effect was seen with individualized cognitive rehabilitation in which significantly lower functional disability and a six-month delay in institutionalization at two years were evidenced.
  
  
  CONCLUSIONS
  These findings challenge current management practices of Alzheimer's patients. While cognitive-oriented group therapies have gained popularity, this trial does not show improvement for the patients. The individualized cognitive rehabilitation intervention provided clinically significant results. Individual interventions should be considered to delay institutionalization in Alzheimer's disease.
authors.affiliation: INSERM,U897-Epidemiology-Biostatistics,University of Bordeaux,F-33076,Bordeaux,France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Amieva
authors.affiliation: CHU Nice,Memory Center of Nice (Centre Mémoire de Ressources et de Recherche),France.
authors.forename: Philippe H
authors.initials: PH
authors.lastname: Robert
authors.affiliation: CHU Bordeaux,Pôle de Santé Publique,USMR and CIC-EC 7,F-33000,Bordeaux,France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Grandoulier
authors.affiliation: CHU Bordeaux,Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche),France.
authors.forename: Céline
authors.initials: C
authors.lastname: Meillon
authors.affiliation: AP-HP,Hôpital Broca,Service de Gérontologie,F-75013,Paris,France.
authors.forename: Jocelyne
authors.initials: J
authors.lastname: De Rotrou
authors.affiliation: INSERM,UMR1027,University of Toulouse III,F-31000,Toulouse,France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Andrieu
authors.affiliation: INSERM,UMR 1061,University of Montpellier,F-33400 Montpellier,France.
authors.forename: Claudine
authors.initials: C
authors.lastname: Berr
authors.affiliation: INSERM,U1077,Université de Caen Basse-Normandie,Ecole Pratique des Hautes Etudes,CHU de Caen,France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Desgranges
authors.affiliation: INSERM UMR S975,Hôpital de la Salpêtrière,F-75651 Paris cedex 13,France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Dubois
authors.affiliation: CHU de Saint-Étienne,Hôpital Charité,Service de gérontologie clinique,France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Girtanner
authors.affiliation: University of Paris-Dauphine,Laboratoire d'Economie et de Gestion des Organisations de Santé (LEDa-LEGOS),Paris,France.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Joël
authors.affiliation: Direction Générale de la Santé,Paris,France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lavallart
authors.affiliation: INSERM,UMR1027,University of Toulouse III,F-31000,Toulouse,France.
authors.forename: Fati
authors.initials: F
authors.lastname: Nourhashemi
authors.affiliation: CHU Lille,Memory Center of Lille (Centre Mémoire de Ressources et de Recherche),France.
authors.forename: Florence
authors.initials: F
authors.lastname: Pasquier
authors.affiliation: CHU Bordeaux,Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche),France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Rainfray
authors.affiliation: INSERM,UMR 1061,University of Montpellier,F-33400 Montpellier,France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Touchon
authors.affiliation: INSERM,U897-Epidemiology-Biostatistics,University of Bordeaux,F-33076,Bordeaux,France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Chêne
authors.affiliation: INSERM,U897-Epidemiology-Biostatistics,University of Bordeaux,F-33076,Bordeaux,France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dartigues
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000534:rehabilitation*; D017028:Caregivers / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D003863:Depression; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008568:Memory; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome
keywords: Alzheimer; cognitive training; dementia; individualized cognitive rehabilitation; non-drug therapies; reminiscence