J Clin Neurol.  2012 Sep;8(3):190-197. 10.3988/jcn.2012.8.3.190.

The Effect of Cognitive Training in Patients with Mild Cognitive Impairment and Early Alzheimer's Disease: A Preliminary Study

• Hwang HR
• Choi SH
• Yoon DH
• Yoon BN
• Suh YJ
• Lee D
• Han IT
• Hong CG

• KMID: 2287590
• DOI: http://doi.org/10.3988/jcn.2012.8.3.190

Abstract

BACKGROUND AND PURPOSE
The objective of this study was to determine the benefits of cognitive training in patients with amnestic mild cognitive impairment (aMCI) and those with early Alzheimer's disease (AD).
METHODS
Eleven patients with aMCI and nine with early AD (stage 4 on the Global Deterioration Scale) participated in this study. Six participants with aMCI and six with AD were allocated to the cognitive training group, while five participants with aMCI and three with AD were allocated to a wait-list control group. Multicomponent cognitive training was administered in 18 weekly, individual sessions. Outcome measures were undertaken at baseline, and at 2 weeks and 3 months of follow-up.
RESULTS
In the trained MCI group, there were significant improvements in the delayed-recall scores on the Seoul Verbal Learning Test at both the 2-week and 3-month follow-ups compared with baseline (baseline, 1.6+/-1.5; 2 weeks, 4.4+/-1.5, p=0.04; 3 months, 4.6+/-2.3, p=0.04). The phonemic fluency scores (1.0+/-0.8 vs. 5.0+/-1.8, p=0.07) and Korean Mini-Mental State Examination scores (18.8+/-0.5 vs. 23.8+/-2.2, p=0.07) also showed a tendency toward improvement at the 2-week follow-up compared to baseline in the trained AD group.
CONCLUSIONS
This study provides evidence of the effectiveness of cognitive training in aMCI and early AD. The efficacy of cognitive training programs remains to be verified in studies with larger samples and a randomized design.

Keyword

Alzheimer's disease; cognitive therapy; memory; mild cognitive impairment; training

MeSH Terms

Alzheimer Disease
Cognitive Therapy
Follow-Up Studies
Humans
Memory
Mild Cognitive Impairment
Outcome Assessment (Health Care)
Verbal Learning

Figure

• 

  Fig. 1 Changes in the delayed recall scores on the Seoul Verbal Learning Test (SVLT) (A) and Korean Mini-Mental State Examination (K-MMSE) (B). A: In the trained mild cognitive impairment (MCI) group (♦), the delayed recall scores on the SVLT showed a significant improvement at both the 2-week and 3-month follow-ups compared to the baseline score (1.6±1.5 vs. 4.4±1.5, p=0.04; 1.6±1.5 vs. 4.6±2.3, p=0.04). B: The K-MMSE score showed a tendency to improve at the 2-week follow-up compared to baseline in the trained Alzheimer's disease (AD) group (○; 18.8±0.5 vs. 23.8±2.2, p=0.07).

Reference

1. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, et al. Current concepts in mild cognitive impairment. Arch Neurol. 2001. 58:1985–1992.

2. Busse A, Hensel A, Gühne U, Angermeyer MC, Riedel-Heller SG. Mild cognitive impairment: long-term course of four clinical subtypes. Neurology. 2006. 67:2176–2185.

3. Petersen RC, Thomas RG, Grundman M, Bennett D, Doody R, Ferris S, et al. Vitamin E and donepezil for the treatment of mild cognitive impairment. N Engl J Med. 2005. 352:2379–2388.

4. Zhang D, Wang Y, Zhou L, Yuan H, Shen D. Alzheimer's Disease Neuroimaging Initiative. Multimodal classification of Alzheimer's disease and mild cognitive impairment. Neuroimage. 2011. 55:856–867.

5. Doody RS, Ferris SH, Salloway S, Sun Y, Goldman R, Watkins WE, et al. Donepezil treatment of patients with MCI: a 48-week randomized, placebo-controlled trial. Neurology. 2009. 72:1555–1561.

6. Kalbe E, Salmon E, Perani D, Holthoff V, Sorbi S, Elsner A, et al. Anosognosia in very mild Alzheimer's disease but not in mild cognitive impairment. Dement Geriatr Cogn Disord. 2005. 19:349–356.

7. Akhtar S, Moulin CJ, Bowie PC. Are people with mild cognitive impairment aware of the benefits of errorless learning? Neuropsychol Rehabil. 2006. 16:329–346.

8. Jean L, Bergeron ME, Thivierge S, Simard M. Cognitive intervention programs for individuals with mild cognitive impairment: systematic review of the literature. Am J Geriatr Psychiatry. 2010. 18:281–296.

9. Unverzagt FW, Kasten L, Johnson KE, Rebok GW, Marsiske M, Koepke KM, et al. Effect of memory impairment on training outcomes in ACTIVE. J Int Neuropsychol Soc. 2007. 13:953–960.

10. Rapp S, Brenes G, Marsh AP. Memory enhancement training for older adults with mild cognitive impairment: a preliminary study. Aging Ment Health. 2002. 6:5–11.

11. Rozzini L, Costardi D, Chilovi BV, Franzoni S, Trabucchi M, Padovani A. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. Int J Geriatr Psychiatry. 2007. 22:356–360.

12. Talassi E, Guerreschi M, Feriani M, Fedi V, Bianchetti A, Trabucchi M. Effectiveness of a cognitive rehabilitation program in mild dementia (MD) and mild cognitive impairment (MCI): a case control study. Arch Gerontol Geriatr. 2007. 44:Suppl 1. 391–399.

13. Troyer AK, Murphy KJ, Anderson ND, Moscovitch M, Craik FI. Changing everyday memory behaviour in amnestic mild cognitive impairment: a randomised controlled trial. Neuropsychol Rehabil. 2008. 18:65–88.

14. Kinsella GJ, Mullaly E, Rand E, Ong B, Burton C, Price S, et al. Early intervention for mild cognitive impairment: a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2009. 80:730–736.

15. Kurz A, Pohl C, Ramsenthaler M, Sorg C. Cognitive rehabilitation in patients with mild cognitive impairment. Int J Geriatr Psychiatry. 2009. 24:163–168.

16. Belleville S, Gilbert B, Fontaine F, Gagnon L, Ménard E, Gauthier S. Improvement of episodic memory in persons with mild cognitive impairment and healthy older adults: evidence from a cognitive intervention program. Dement Geriatr Cogn Disord. 2006. 22:486–499.

17. Wenisch E, Cantegreil-Kallen I, De Rotrou J, Garrigue P, Moulin F, Batouche F, et al. Cognitive stimulation intervention for elders with mild cognitive impairment compared with normal aged subjects: preliminary results. Aging Clin Exp Res. 2007. 19:316–322.

18. Stott J, Spector A. A review of the effectiveness of memory interventions in mild cognitive impairment (MCI). Int Psychogeriatr. 2011. 23:526–538.

19. Clare L, Woods RT, Moniz Cook ED, Orrell M, Spector A. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev. 2003. (4):CD003260.

20. 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.

21. Rami L, Molinuevo JL, Sanchez-Valle R, Bosch B, Villar A. Screening for amnestic mild cognitive impairment and early Alzheimer's disease with M@T (Memory Alteration Test) in the primary care population. Int J Geriatr Psychiatry. 2007. 22:294–304.

22. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 1994. 4th ed. Washington, DC: American Psychiatric Association.

23. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984. 34:939–944.

24. Choi SH, Na DL, Lee BH, Hahm DS, Jeong JH, Jeong Y, et al. The validity of the Korean version of Global Deterioration Scale. J Korean Neurol Assoc. 2002. 20:612–617.

25. Ahn HJ, Chin J, Park A, Lee BH, Suh MK, Seo SW, et al. Seoul Neuropsychological Screening Battery-dementia version (SNSB-D): a useful tool for assessing and monitoring cognitive impairments in dementia patients. J Korean Med Sci. 2010. 25:1071–1076.

26. Kang YW. A normative study of the Korean-Mini Mental State Examination (K-MMSE) in the elderly. Korean J Psychol Gen. 2006. 25:1–12.

27. Craik FI, Winocur G, Palmer H, Binns MA, Edwards M, Bridges K, et al. Cognitive rehabilitation in the elderly: effects on memory. J Int Neuropsychol Soc. 2007. 13:132–142.

28. Shin HY. A preliminary study on the Korean version of quality of life-Alzheimer's disease (QOL-AD) scale in community-dwelling elderly with dementia. J Prev Med Public Health. 2006. 39:243–248.

29. Bae JN, Cho MJ. Development of the Korean version of the Geriatric Depression Scale and its short form among elderly psychiatric patients. J Psychosom Res. 2004. 57:297–305.

30. Collie A, Maruff P. The neuropsychology of preclinical Alzheimer's disease and mild cognitive impairment. Neurosci Biobehav Rev. 2000. 24:365–374.

31. Jefferson AL, Byerly LK, Vanderhill S, Lambe S, Wong S, Ozonoff A, et al. Characterization of activities of daily living in individuals with mild cognitive impairment. Am J Geriatr Psychiatry. 2008. 16:375–383.

32. Olazarán J, Muñiz R, Reisberg B, Peña-Casanova J, del Ser T, Cruz-Jentoft AJ, et al. Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology. 2004. 63:2348–2353.