Clare L, Kudlicka A, Oyebode J R, et al. (2019). Goal-oriented cognitive rehabilitation for early-stage Alzheimer’s and related dementias: the GREAT RCT. Health Technology Assessment 23(10), 1-242.
Dementia continues to be a public health epidemic and, as of now, there exists no “cure” to arrest or reverse this problem, although many preventative approaches exist. For many individuals with cognitive impairment, cognitive rehabilitation has proven effective, yet it has rarely been employed in demented individuals. Recognizing that cognitive rehabilitation will not stop the progression of cognitive decline, it may be that a problem-solving approach to dementia care – using cognitive rehabilitation – has the potential to improve daily functioning in impaired individuals to a substantial degree. In a recent study, Clare and colleagues sought to explore the impact of cognitive rehabilitation on people with dementia by randomizing nearly 500 people to cognitive rehabilitation or “usual care”, with a focus on identifying one to 3 simple goals (e.g. learning to use new technology, increasing socialization, etc) to pursue over 10 sessions. Individuals receiving rehabilitation were assigned a therapist who helped them both identify goals and identify problem solving strategies, while also taking part in 4 maintenance sessions that occurred well past their last intervention session was over.
Individuals receiving cognitive rehabilitation appeared to experience significant improvement compared to their counterparts. They reported that their ability to achieve the goals in question had improved by 2.6 points on a 10-point scale, while reporting that their progress was still present at the end of 9 months, compared to those in the usual care group who reported very little improvement and no sustained change. Caregivers also noted meaningful improvement after the rehabilitation intervention. While potentially effective, the intervention was rather costly (over $2,000 per participant), raising inevitable questions about cost versus benefit. In general, the GREAT Randomized Controlled Trial supported the various recommendations that suggest that cognitive training and rehabilitation may be beneficial and worthy of consideration in individuals with milder expressions of dementia, though it highlighted potential “tradeoffs” with respect to cost that may dampen enthusiasm for the widespread implementation of such interventions. Individual therapists may want to consider using problem solving rehabilitation-based approaches in the treatment of patients with dementia, while healthcare systems may continue to be reluctant. Nevertheless, this research study is a useful reminder that rehabilitation psychologists should recognize the potential value of their “tools of the trade” in improving outcomes, even in patients with progressive degenerative conditions.
THIS REHABILITATION SCIENCE SPOTLIGHT was chosen by Jim Jackson PsyD, Vanderbilt Medical Center, Nashville, TN