Cognitive rehabilitation: Literature review based on levels of evidence

Manzine, Patricia Regina; Pavarini, Sofia Cristina Iost

doi:10.1590/S1980-57642009DN30300012

Abstract

The aim of this study was to review the scientific publications on cognitive rehabilitation in Alzheimer's disease by year published and methodology employed. The principles of systematic review by the Brazilian Cochrane Center were used. Reviews conducted by this Center were identified together with those held on the LILACS and Medline scientific databases. Nine levels of evidence were considered for analysis and a total of 37 articles were found. The results showed a growing number of publications from 2001 onwards, with majority being published early this decade. Few studies have been published on cognitive rehabilitation, with an average of three articles published per year during the study period (1985-2008). The highest levels of evidence were observed in the more recently published studies. Cognitive rehabilitation can yield greater benefits in rehabilitating patients when associated with other forms of intervention. The latest studies demonstrating greater scientific evidence concluded that results remain limited and that further studies on the topic are needed.

Key words:
elderly; dementia; Alzheimer's disease; rehabilitation.

Resumo

O objetivo foi revisar publicações científicas sobre reabilitação cognitiva na doença de Alzheimer segundo ano de publicação e rigor metodológico. Foram utilizados pressupostos da revisão sistemática do Centro Cochrane do Brasil. Foram identificados estudos de revisão já realizados por este Centro e incluídos estudos das bases LILACS e Medline. Nove níveis de evidência foram considerados para análise. Foram encontrados 37 artigos. Os resultados mostram uma crescente incidência de publicação a partir de 2001, com maior concentração no início desta década. São poucas ainda as publicações sobre reabilitação cognitiva, sendo uma média inferior a três artigos por ano no período estudado (1985-2008). Os maiores níveis de evidência foram observados nas publicações mais recentes. A reabilitação cognitiva quando em associação com outras intervenções pode apresentar maiores benefícios na reabilitação dos pacientes. Os estudos mais atuais e de maior evidência cientifica apontam que os resultados ainda são limitados e novas investigações são necessárias.

Palavras-chave:
idoso; demência; doença de Alzheimer; reabilitação.

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References

¹
Brandt J, Rich JB. Memory disorders in the dementias. In: Baddeley AD, Wilson BA, Watts FN, Editors. Handbbok of Memory Disorders. Chichester: John Wiley & Sons Ltd; 1995.
²
Prigatano GP. Learning from our Successes and Failures: Reflections and Comments on "Cognitive Rehabilitation: How it is and How it Might Be". J Int Neuropsychol Soc 1997;3:497-499.
³
Ávila R, Miotto E. Reabilitação neuropsicológica de déficits de memória em pacientes com demência de Alzheimer. Rev Psiq Clín 2002;29:190-196.
⁴
Wilson BA. Reabilitação das deficiências cognitivas. In: Nitrini R, Caramelli P, Mansur LL, Editores. Neuropsicologia das bases anatômicas à reabilitação. Clínica Neurológica 1996; 314-343.
⁵
Caliman GT, Oliveira RMW. Novas perspectivas no tratamento da doença de Alzheimer. Iniciação Científica CESUMAR 2005:141-162.
⁶
Clare L, Woods B. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia (Cochrane Review). The Cochrane Library 2008;4. Oxford: Update Software.
⁷
Engelhardt E, Brucki SM, Cavalcanti JL, Forlenza OV, Laks J, Vale FA. Departamento de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. [Treatment of Alzheimer's disease: recommendations and suggestions of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Arq Neuropsiquiatr 2005;63:1104-112
⁸
Bottino C, Carvalho I, Alvarez, et al. Reabilitação cognitiva em pacientes com doença de Alzheimer: relato de trabalho em equipe multidisciplinar. Arq Neuropsiquiatr 2002;60:70-79.
⁹
Galvão CM, Sawada NO, Rossi LA. A prática baseada em evidências: considerações teóricas para sua implementação na enfermagem perioperatória. Rev Latino-Am Enfermagem 2002;10:690-695.
¹⁰
Galvão CM, Sawada NO, Mendes IAC. A busca das melhores evidências. Rev Esc Enferm USP 2003;37:43-50.
¹¹
Driever MJ. Are evidence-based practice and best practice the same? West J Nurs Res 2002;24:591-597.
¹²
Humpris D. Types of evidence. In: Hamer S, Collinson G, Editors. Achieving evidence-based practice: a handbook for practitioners. Baillière Tindall; 1999:13-40.
¹³
Higgins JPT, Green S. (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org
» www.cochrane-handbook.org
¹⁴
Pagano M, Gauvreau K. Princípios de Bioestatística, 2ª ed. São Paulo: Pioneira Thomson Learning; 2004.
¹⁵
Opie J, Rosewarne R, O'Connor DW. The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review. Aust N Z J Psychiatry 1999;33:789-799.
¹⁶
Clare L, Wilson BA, Carter G, Hodges JR, Adams M. Long-term maintenance of treatment gains following a cognitive rehabilitation intervention in early dementia of Alzheimer type: a single case study. Neuropsychol Rehabil 2001;11:477-494.
¹⁷
Koltai DC, Bohmer KAW, Schmechel DE. Influence of anosognosia on treatment outcome among dementia patients. Neuropsychol Rehabil 2001;11:455-475.
¹⁸
Farina E, Fioravanti R, Chiavari L, et al. Comparing two programs of cognitive training in Alzheimer's disease: a pilot study. Acta Neurol Scand 2002;105:365-371.
¹⁹
Spector A, Thorgrimsen L, Woods B, et al. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. Brit J Psychiatry 2003;183:248-254.
²⁰
Bird M. Behavioural difficulties and cued recall of adaptive behaviour in dementia: Experimental and clinical evidence. Neuropsychol Rehabil 2001;11:357-375.
²¹
Wilson BA. Towards a comprehensive model of cognitive rehabilitation. Neuropsychol rehabil 2002;12:97-110.
²²
Burns A. Meaningful treatment outcomes in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2002;73:471-472.
²³
Sitzer DI, Twamley EW, Jeste DV. Cognitive training in Alzheimer's disease: a meta-analysis of the literature. Acta Psychiatr Scand 2006;114:75-90.
²⁴
Hogan DB, Bailey P, Black S, et al. Diagnosis and treatment of dementia: Approach to management of mild to moderate dementia. CMAJ 2008;179:787-793.
²⁵
Corbeil RR, Quayhagen MP, Quayhagen M. Interventions effects on dementia caregiving interaction: a stress-adaptation modeling approach. J Aging Health 1999;11:79-95.
²⁶
Quayhagen MP, Quayhagen M, Corbeil RR, et al. Coping with Dementia: Evaluation of Four Nonpharmacologic Interventions. Int Psychogeriatr 2000;12:249-265.
²⁷
Davis RN, Massman PJ, Doody RS. Cognitive Intervention in Alzheimer Disease: A Randomized Placebo-Controlled Study. Alzheimer Dis Assoc Disord 2001;15:1-9.
²⁸
Chapman SB, Weiner MF, Rackley A, Hynan L, Zientz J. Effects of Cognitive-Communication Stimulation for Alzheimer's Disease Patients Treated With Donepezil. J Speech Lang Hear Res 2004;47:1149-1163.
²⁹
Olazarán J, Muniz R, Reisberg B, et al. Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology 2004;63:2348-2353.
³⁰
Onder G, Zanetti O, Giacobini E, et al. Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: randomized controlled trial. Br J Psychiatry 2005; 187:450-455.
³¹
Bottino C, Carvalho I, Alvarez AM, et al. Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study. Clin Rehabil 2005;19:861-869.
³²
Meguro M, Kasai M, Akanuma K, Ishii H, Yamaguchi S, Meguro K. Comprehensive approach of donepezil and psychosocial interventions on cognitive function and quality of life for Alzheimer's disease: the Osaki-Tajiri Project. Age Ageing 2008;37:469-473.
³³
Gil P, Ayuso JLD, Marey JM, Antón M, Quilo CG. Variability in the diagnosis and management of patients with Alzheimer's disease and cerebrovascular disease. Clin Drug Invest 2008; 28:429-437.
³⁴
Panza F, Solfrizzi V, Mastroiani F, Nardó GA, Cigliola F, Capurso A. A rehabilitation program for mild memory impairments. Arch Gerontol Geriatr 1996;22(suppl 1):51-55.
³⁵
Zanetti O, Zanieri G, Giovanni GD, et al. Effectiveness of procedural memory stimulation in mild Alzheimer's disease patients: A controlled study. Neuropsychol Rehabil 2001;11:263-272.
³⁶
Moore S, Sandman CA, McGrady K, Kesslak JP. Memory training improves cognitive ability in patients with dementia. Neuropsychol Rehabil 2001;11:245-261.
³⁷
Kixmiller JS. Evaluation of prospective memory training for individuals with mild Alzheimer's disease. Brain Cogn 2002; 49:237-241.
³⁸
Knapp M, Thorgrimsen L, Patel A, et al. Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. Br J Psychiatry 2006;188:574-580.
³⁹
Matsuda O. Cognitive stimulation therapy for Alzheimer's disease: the effect of cognitive stimulation therapy on the progression of mild Alzheimer's disease in patients treated with donepezil. Int Psychogeriatr 2007;19:241-252.
⁴⁰
Backman L, Josephsson S, Herlitz A, Stigsdotter A. The generalizability of training gains in dementia: effects of an imagery-based mnemonic on face-name retention duration. Psychol Aging 1991;6:489-492.
⁴¹
Hofmann M, Hock C, Kuhler A, Muller-Spahn F. Interactive computer-based cognitive training in patients with Alzheimer's disease. J Psychiat Res 1996;30:493-501.
⁴²
Zanetti O, Binetti G, Magni E, Rozzini L, Bianchetti A, Trabucchi M. Procedural memory stimulation in Alzheimer's disease: impact of a training programme. Acta Neurol Scand 1997;95:152-157.
⁴³
Clare L, Wilson BA, Carter G, Roth I, Hodges JR. Relearning face-name associations in early Alzheimer's Disease. Neuropsychology 2002;16:538-547.
⁴⁴
Mahendra N, Arkin S. Effects of four years of exercise, language, and social interventions on Alzheimer discourse. J Commun Disord 2003;36:395-422.
⁴⁵
Baldelli MV, Pradelli JM, Zucchi P, Martini B, Orsi F, Fabbo A. Occupational therapy and dementia: the experience of an Alzheimer special care unit. Arch Gerontol Geriatr 2007;(Suppl 1):49-54.
⁴⁶
Hill RD, Evankovich KD, Sheikh JI, Yesavage JA. Imagery mnemonic training in a patient with primary degenerative dementia. Psychol Aging 1987;2:204-205.
⁴⁷
Ávila R. Resultados da reabilitação neuropsicológica em pacientes com doença de Alzheimer leve. Rev Psiq Clín 2003; 30:139-146.
⁴⁸
Clare L, Wilson BA, Carter G, Hodges JR. Cognitive rehabilitation as a component of early intervention in Alzheimer's disease: a single case study. Aging Ment Health 2003;7:15-21.
⁴⁹
Burns A, O'Brien J. Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology. J Psychopharmacol 2006;20:732-755.

Publication Dates

Publication in this collection
Jul-Sep 2009

History

Received
01 July 2009
Accepted
17 Aug 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Brandt J, Rich JB. Memory disorders in the dementias. In: Baddeley AD, Wilson BA, Watts FN, Editors. Handbbok of Memory Disorders. Chichester: John Wiley & Sons Ltd; 1995.

[2] ²
Prigatano GP. Learning from our Successes and Failures: Reflections and Comments on "Cognitive Rehabilitation: How it is and How it Might Be". J Int Neuropsychol Soc 1997;3:497-499.

[3] ³
Ávila R, Miotto E. Reabilitação neuropsicológica de déficits de memória em pacientes com demência de Alzheimer. Rev Psiq Clín 2002;29:190-196.

[4] ⁴
Wilson BA. Reabilitação das deficiências cognitivas. In: Nitrini R, Caramelli P, Mansur LL, Editores. Neuropsicologia das bases anatômicas à reabilitação. Clínica Neurológica 1996; 314-343.

[5] ⁵
Caliman GT, Oliveira RMW. Novas perspectivas no tratamento da doença de Alzheimer. Iniciação Científica CESUMAR 2005:141-162.

[6] ⁶
Clare L, Woods B. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia (Cochrane Review). The Cochrane Library 2008;4. Oxford: Update Software.

[7] ⁷
Engelhardt E, Brucki SM, Cavalcanti JL, Forlenza OV, Laks J, Vale FA. Departamento de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. [Treatment of Alzheimer's disease: recommendations and suggestions of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Arq Neuropsiquiatr 2005;63:1104-112

[8] ⁸
Bottino C, Carvalho I, Alvarez, et al. Reabilitação cognitiva em pacientes com doença de Alzheimer: relato de trabalho em equipe multidisciplinar. Arq Neuropsiquiatr 2002;60:70-79.

[9] ⁹
Galvão CM, Sawada NO, Rossi LA. A prática baseada em evidências: considerações teóricas para sua implementação na enfermagem perioperatória. Rev Latino-Am Enfermagem 2002;10:690-695.

[10] ¹⁰
Galvão CM, Sawada NO, Mendes IAC. A busca das melhores evidências. Rev Esc Enferm USP 2003;37:43-50.

[11] ¹¹
Driever MJ. Are evidence-based practice and best practice the same? West J Nurs Res 2002;24:591-597.

[12] ¹²
Humpris D. Types of evidence. In: Hamer S, Collinson G, Editors. Achieving evidence-based practice: a handbook for practitioners. Baillière Tindall; 1999:13-40.

[13] ¹³
Higgins JPT, Green S. (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org
» www.cochrane-handbook.org

[14] ¹⁴
Pagano M, Gauvreau K. Princípios de Bioestatística, 2ª ed. São Paulo: Pioneira Thomson Learning; 2004.

[15] ¹⁵
Opie J, Rosewarne R, O'Connor DW. The efficacy of psychosocial approaches to behaviour disorders in dementia: a systematic literature review. Aust N Z J Psychiatry 1999;33:789-799.

[16] ¹⁶
Clare L, Wilson BA, Carter G, Hodges JR, Adams M. Long-term maintenance of treatment gains following a cognitive rehabilitation intervention in early dementia of Alzheimer type: a single case study. Neuropsychol Rehabil 2001;11:477-494.

[17] ¹⁷
Koltai DC, Bohmer KAW, Schmechel DE. Influence of anosognosia on treatment outcome among dementia patients. Neuropsychol Rehabil 2001;11:455-475.

[18] ¹⁸
Farina E, Fioravanti R, Chiavari L, et al. Comparing two programs of cognitive training in Alzheimer's disease: a pilot study. Acta Neurol Scand 2002;105:365-371.

[19] ¹⁹
Spector A, Thorgrimsen L, Woods B, et al. Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. Brit J Psychiatry 2003;183:248-254.

[20] ²⁰
Bird M. Behavioural difficulties and cued recall of adaptive behaviour in dementia: Experimental and clinical evidence. Neuropsychol Rehabil 2001;11:357-375.

[21] ²¹
Wilson BA. Towards a comprehensive model of cognitive rehabilitation. Neuropsychol rehabil 2002;12:97-110.

[22] ²²
Burns A. Meaningful treatment outcomes in Alzheimer's disease. J Neurol Neurosurg Psychiatry 2002;73:471-472.

[23] ²³
Sitzer DI, Twamley EW, Jeste DV. Cognitive training in Alzheimer's disease: a meta-analysis of the literature. Acta Psychiatr Scand 2006;114:75-90.

[24] ²⁴
Hogan DB, Bailey P, Black S, et al. Diagnosis and treatment of dementia: Approach to management of mild to moderate dementia. CMAJ 2008;179:787-793.

[25] ²⁵
Corbeil RR, Quayhagen MP, Quayhagen M. Interventions effects on dementia caregiving interaction: a stress-adaptation modeling approach. J Aging Health 1999;11:79-95.

[26] ²⁶
Quayhagen MP, Quayhagen M, Corbeil RR, et al. Coping with Dementia: Evaluation of Four Nonpharmacologic Interventions. Int Psychogeriatr 2000;12:249-265.

[27] ²⁷
Davis RN, Massman PJ, Doody RS. Cognitive Intervention in Alzheimer Disease: A Randomized Placebo-Controlled Study. Alzheimer Dis Assoc Disord 2001;15:1-9.

[28] ²⁸
Chapman SB, Weiner MF, Rackley A, Hynan L, Zientz J. Effects of Cognitive-Communication Stimulation for Alzheimer's Disease Patients Treated With Donepezil. J Speech Lang Hear Res 2004;47:1149-1163.

[29] ²⁹
Olazarán J, Muniz R, Reisberg B, et al. Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology 2004;63:2348-2353.

[30] ³⁰
Onder G, Zanetti O, Giacobini E, et al. Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: randomized controlled trial. Br J Psychiatry 2005; 187:450-455.

[31] ³¹
Bottino C, Carvalho I, Alvarez AM, et al. Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study. Clin Rehabil 2005;19:861-869.

[32] ³²
Meguro M, Kasai M, Akanuma K, Ishii H, Yamaguchi S, Meguro K. Comprehensive approach of donepezil and psychosocial interventions on cognitive function and quality of life for Alzheimer's disease: the Osaki-Tajiri Project. Age Ageing 2008;37:469-473.

[33] ³³
Gil P, Ayuso JLD, Marey JM, Antón M, Quilo CG. Variability in the diagnosis and management of patients with Alzheimer's disease and cerebrovascular disease. Clin Drug Invest 2008; 28:429-437.

[34] ³⁴
Panza F, Solfrizzi V, Mastroiani F, Nardó GA, Cigliola F, Capurso A. A rehabilitation program for mild memory impairments. Arch Gerontol Geriatr 1996;22(suppl 1):51-55.

[35] ³⁵
Zanetti O, Zanieri G, Giovanni GD, et al. Effectiveness of procedural memory stimulation in mild Alzheimer's disease patients: A controlled study. Neuropsychol Rehabil 2001;11:263-272.

[36] ³⁶
Moore S, Sandman CA, McGrady K, Kesslak JP. Memory training improves cognitive ability in patients with dementia. Neuropsychol Rehabil 2001;11:245-261.

[37] ³⁷
Kixmiller JS. Evaluation of prospective memory training for individuals with mild Alzheimer's disease. Brain Cogn 2002; 49:237-241.

[38] ³⁸
Knapp M, Thorgrimsen L, Patel A, et al. Cognitive stimulation therapy for people with dementia: cost-effectiveness analysis. Br J Psychiatry 2006;188:574-580.

[39] ³⁹
Matsuda O. Cognitive stimulation therapy for Alzheimer's disease: the effect of cognitive stimulation therapy on the progression of mild Alzheimer's disease in patients treated with donepezil. Int Psychogeriatr 2007;19:241-252.

[40] ⁴⁰
Backman L, Josephsson S, Herlitz A, Stigsdotter A. The generalizability of training gains in dementia: effects of an imagery-based mnemonic on face-name retention duration. Psychol Aging 1991;6:489-492.

[41] ⁴¹
Hofmann M, Hock C, Kuhler A, Muller-Spahn F. Interactive computer-based cognitive training in patients with Alzheimer's disease. J Psychiat Res 1996;30:493-501.

[42] ⁴²
Zanetti O, Binetti G, Magni E, Rozzini L, Bianchetti A, Trabucchi M. Procedural memory stimulation in Alzheimer's disease: impact of a training programme. Acta Neurol Scand 1997;95:152-157.

[43] ⁴³
Clare L, Wilson BA, Carter G, Roth I, Hodges JR. Relearning face-name associations in early Alzheimer's Disease. Neuropsychology 2002;16:538-547.

[44] ⁴⁴
Mahendra N, Arkin S. Effects of four years of exercise, language, and social interventions on Alzheimer discourse. J Commun Disord 2003;36:395-422.

[45] ⁴⁵
Baldelli MV, Pradelli JM, Zucchi P, Martini B, Orsi F, Fabbo A. Occupational therapy and dementia: the experience of an Alzheimer special care unit. Arch Gerontol Geriatr 2007;(Suppl 1):49-54.

[46] ⁴⁶
Hill RD, Evankovich KD, Sheikh JI, Yesavage JA. Imagery mnemonic training in a patient with primary degenerative dementia. Psychol Aging 1987;2:204-205.

[47] ⁴⁷
Ávila R. Resultados da reabilitação neuropsicológica em pacientes com doença de Alzheimer leve. Rev Psiq Clín 2003; 30:139-146.

[48] ⁴⁸
Clare L, Wilson BA, Carter G, Hodges JR. Cognitive rehabilitation as a component of early intervention in Alzheimer's disease: a single case study. Aging Ment Health 2003;7:15-21.

[49] ⁴⁹
Burns A, O'Brien J. Clinical practice with anti-dementia drugs: a consensus statement from British Association for Psychopharmacology. J Psychopharmacol 2006;20:732-755.

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