Goal management training and psychoeducation / mindfulness for treatment of executive dysfunction in Parkinson's disease: A feasibility pilot trial.

INTRODUCTION: As there is currently no pharmacological treatment for Parkinson's Disease Mild Cognitive Impairment (PD-MCI) with executive dysfunctions, specific cognitive interventions must be investigated. Most previous studies have tested bottom-up cognitive training programs but have not shown very good results. OBJECTIVES: The aim of this study was to test ease of implementation, differential safety and preliminary efficacy of two top-down (strategy-learning) home-based, individualized, cognitive interventions: Goal Management Training (GMT), adapted for PD-MCI (Adapted-GMT), and a psychoeducation program combined with mindfulness exercises (PSYCH-Mind). METHODS: This was a single-blind block-randomized between-group comparative study. Twelve PD-MCI with mild executive dysfunctions were divided in four blocks and randomly assigned to any of the two interventions. The participants were included if they had PD-MCI diagnosis (no dementia), with stabilized medication. Both groups (Adapted-GMT and PSYCH-mind) received five intervention sessions each lasting 60-90 minutes for five weeks. Measures were collected at baseline, mid-point, one-week, four-week and 12-week follow-ups. Executive functions were assessed with the Dysexecutive questionnaire (DEX) and the Zoo Map Test (ZMT). Quality of life (QoL) and psychiatric symptoms were also evaluated. Repeated measures ANCOVAs (mixed linear analysis) were applied to all outcomes. RESULTS: There was one drop out, and both interventions were feasible and acceptable. Despite the small sample size limiting statistical power, patients of both groups significantly improved executive functions per the DEX-patient (Time: F(4,36) = 2.96, p = 0.033, CI95%: 10.75-15.23) and DEX-caregiver scores (Time: F(4,36) = 6.02, p = 0.017, CI95%: 9.63-17.23). Both groups significantly made fewer errors between measurement times on the ZMT (Time: F(3,36) = 16.66, p = 0.001, CI95%: 1.07-2.93). However, QoL significantly increased only in PSYCH-Mind patients at four-week follow-up (interaction Time*Group: F(4,36) = 5.31, p = 0.002, CI95%: 15.33-25.61). CONCLUSION: Both interventions were easily implemented and proved to be safe. Because both interventions are arguably cost-effective, these pilot findings, although promising, need to be replicated in large samples. CLINICALTRIALS.GOV IDENTIFIER: NCT04636541.

Methodological considerations when establishing reliable and valid normative data: Canadian Longitudinal Study on Aging (CLSA) neuropsychological battery.

Objective: Creation of normative data with regression corrections for demographic covariates reduces risk of small cell sizes compared with traditional normative approaches. We explored whether methods of correcting for demographic covariates (e.g., full regression models versus hybrid models with stratification and regression) and choice of covariates (i.e., correcting for age with or without sex and/or education correction) impacted reliability and validity of normative data. Method: Measurement invariance for sex and education was explored in a brief telephone-administered cognitive battery from the Canadian Longitudinal Study on Aging (CLSA; after excluding persons with neurological conditions N = 12,350 responded in English and N = 1,760 in French). Results: Measurement invariance was supported in hybrid normative models where different age-based regression models were created for groups based on sex and education level. Measurement invariance was not supported in full regression models where age, sex, and education were simultaneous predictors. Evidence for reliability was demonstrated by precision defined as the 95% inter-percentile range of the 5th percentile. Precision was higher for full regression models than for hybrid models but with negligible differences in precision for the larger English sample. Conclusions: We present normative data for a remotely administered brief neuropsychological battery that best mitigates measurement bias and are precise. In the smaller French speaking sample, only one model reduced measurement bias, but its estimates were less precise, underscoring the need for large sample sizes when creating normative data. The resulting normative data are appended in a syntax file.

Altered Theory of Mind in Parkinson's Disease and Impact on Caregivers: A Pilot Study.

Mild cognitive impairment (MCI) in Parkinson's disease (PD) includes deficits in theory of mind (ToM). However, associations between ToM and caregiver burden and distress are still unclear. The objective of this pilot study was to preliminarily explore the relation between ToM and caregiver burden and distress in a sample of PD-MCI patients. Twelve PD-MCI patients were evaluated on a ToM task (Faux Pas), whereas their caregivers were assessed on caregiver burden (Zarit Burden Interview-12 items) and distress (Neuropsychiatric Inventory-Distress). Cognitive ToM was significantly associated with caregiver distress, but caregiver burden was associated with the severity of patient psychiatric symptoms.

The Canadian longitudinal study on aging as a platform for exploring cognition in an aging population.

Objective: We present descriptive information on the cognitive measures used in the Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort, relate this to information on these measures in the extant literature, and identify key considerations for their use in research and clinical practice.Method: The CLSA Comprehensive Cohort is composed of 30,097 participants aged 45-85 years at baseline who provided a broad range of sociodemographic, physical, social, and psychological health information via questionnaire and took part in detailed physical and cognitive assessments. Cognitive measures included: the Rey Auditory Verbal Learning Test - immediate and 5-min delayed recall, Animal Fluency, Mental Alternation Test (MAT), Controlled Oral Word Association Test (COWAT), Stroop Test - Victoria Version, Miami Prospective Memory Test (MPMT), and a Choice Reaction Time (CRT) task.Results: CLSA Comprehensive Cohort sample sizes were far larger than previous studies, and performances on the cognitive measures were similar to comparable groups. Within the CLSA Comprehensive Cohort, main effects of age were observed for all cognitive measures, and main effects of language were observed for all measures except the CRT. Interaction effects (language × age) were observed for the MAT, MPMT Event-based score, all time scores on the Stroop Test, and most COWAT scores. Main effects of education were observed for all measures except for the MPMT Time score in the French sample, and interaction effects (age × education) were observed for the RAVLT (immediate and delayed) for the English sample and the Stroop Dot time for the French sample.Conclusion: This examination of the cognitive measures used in the CLSA Comprehensive Cohort lends support to their use in large studies of health and aging. We propose further exploration of the cognitive measures within the CLSA to make this information relevant to and available for clinical practice.

Normative comparison standards for measures of cognition in the Canadian Longitudinal Study on Aging (CLSA): Does applying sample weights make a difference?

Large-scale studies present the opportunity to create normative comparison standards relevant to populations. Sampling weights applied to the sample data facilitate extrapolation to the population of origin, but normative scores are often developed without the use of these sampling weights because the values derived from large samples are presumed to be precise estimates of the population parameter. The present article examines whether applying sample weights in the context of deriving normative comparison standards for measures of cognition would affect the distributions of regression-based normative data when using data from a large population-based study. To address these questions, we examined 3 cognitive measures from the Canadian Longitudinal Study on Aging tracking cohort (N = 14,110, Age 45-84 years at recruitment): Rey Auditory Verbal Learning Test - Immediate Recall, Animal Fluency, and the Mental Alternation Test. The use of sampling weights resulted in similar model parameter estimates to unweighted regression analyses and similar cumulative frequency distributions to the unweighted analyses. We randomly sampled progressively smaller subsets from the full database to test the hypothesis that sampling weights would help maintain the estimates from the full sample, but discovered that the weighted and unweighted estimates were similar and were less precise with smaller samples. These findings suggest that although use of sampling weights can help mitigate biases in data from sampling procedures, the application of weights to adjust for sampling biases do not appreciably impact the normative data, which lends support to the current practice in creation of normative data. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Miami Prospective Memory Test in the Canadian Longitudinal Study on Aging.

OBJECTIVE: The aim of this study was to verify the effect of age, education and sex on Miami Prospective Memory Test (MPMT) performance obtained at baseline of the Canadian Longitudinal Study on Aging (CLSA) by neurologically healthy French- and English-speaking subsamples of participants (N = 18,511). METHOD: The CLSA is a nation-wide large epidemiological study with participants aged 45-85 years old at baseline. The MPMT is an event- and time-based measure of prospective memory, with scores of intention, accuracy and need for reminders, administered as part of the Comprehensive data collection. Participants who did not self-report any conditions that could impact cognition were selected, which resulted in 15,103 English- and 3408 French-speaking participants. The samples are stratified according to four levels of education and four age groups (45-54; 55-64; 65-74; 75+). RESULTS: There is a significant age effect for English- and French-speaking participants on the Event-based, Time-based, and Event- + Time-based scores of the MPMT. The effect of the education level was also demonstrated on the three MPMT scores in the English-speaking group. The score 'Intention to perform' was the most sensitive to the effect of age in both the English and French samples. Sex had no impact on performance on the MPMT. CONCLUSIONS: This study confirms the impact of age and level of education on this new prospective memory task. It informs future research with this measure including the development of normative data in French- and English-speaking Canadians on the Event-based and Time-based MPMT.

The impact of cognitive interventions on cognitive symptoms in idiopathic Parkinson's disease: a systematic review.

This systematic review addressed efficacy of cognitive stimulation (CS), cognitive training (CT), and cognitive rehabilitation (CR) to improve cognitive functions in Parkinson's disease (PD) with (PD-MCI) and without mild cognitive impairment (PD-H). Five databases were searched. Twelve CT, four CS, and a combination of CT with CR were found. PD-H benefited from CT or CS compared to active or passive controls in 42.1% of cognitive tests, and in 33.3% of psychological and functional measures. PD-MCI alone, compared with controls, only improved in 6.9% of cognitive measures after CT. PD-H and PD-MCI, alone or together, somehow improved information processing speed, attention, working memory, executive functions, and visual episodic memory. PD-MCI improved better than PD-H in global cognition and planning abilities. The outcomes suggest some efficacy of cognitive interventions in PD. However, small samples, lack of information regarding standardization of interventions, and poor methodological quality limit results validity and prevent firm conclusions.

Effects of Antiparkinson Medication on Cognition in Parkinson's Disease: A Systematic Review.

OBJECTIVE: This study aimed to systematically review the effects of currently prescribed antiparkinson medication on cognition in patients with mild-to-moderate Parkinson's disease (PD) who were either cognitively intact or mildly impaired. METHODS: English- and French-language studies published between 1969 and 2017 were accessed via MedLine, PsychNET, EMBASE and EBSCO databases. Methodological quality (MQ) was evaluated with the quality assessment instrument of the Cochrane Collaboration Depression, Anxiety and Neurosis Review (scores from 0% to 44% indicate very low quality; scores from 45% to 64% indicate low quality; scores from 65% to 84% indicate medium quality; and scores from 85% to 100% indicate high quality). Hedges' g and Student's t-test were performed on all cognitive outcome measures reported. RESULTS: In total, 14 studies assessed the cognitive effects of levodopa (L-D), pramipexole (PRX), selegiline (SEL) and rasagiline (RAS) in mild-to-moderate non-demented PD patients. The MQ was overall low, with an average score of 49.1%. Results for L-D showed deleterious effects on a test of cognitive inhibition, as well as benefits on tests of attention/processing speed/working memory, executive functions and episodic memory. Pramipexole was associated with a worsening of episodic memory and impulse control. Results on SEL indicated a deterioration of global cognition over time and of concept formation. Rasagiline had some benefits on working memory and verbal fluency. CONCLUSION: Antiparkinson medications can have deleterious (L-D; PRX; SEL) and beneficial (L-D; RAS) effects on cognition. However, randomized double-blind placebo-controlled trials with larger sample sizes are required to better elucidate this issue.

The influence of vascular risk factors on cognitive function in early Parkinson's disease.

OBJECTIVES: Hypertension, dyslipidemia, diabetes, and obesity are well-established risk factors for cognitive impairment and dementia in older adults. In contrast, previous studies that have assessed the impact of vascular risk factors (VRFs) on cognition in Parkinson's disease (PD) have had methodological limitations and reported conflicting findings. We address this question in a large well-characterized cohort of de novo PD patients. METHODS: A total of 367 untreated and non-demented patients aged 50 years and older with early PD (H&Y = 1.0-2.0) underwent a comprehensive clinical and neuropsychological assessment at baseline and 24 months later. A series of linear mixed models were used to determine the effects of VRFs on cognition while controlling for patient and disease characteristics. The outcomes included norm-referenced Z-scores of global cognition, visuospatial skills, verbal episodic memory, semantic verbal fluency, attention, and working memory tests. RESULTS: A longer history of hypertension and a higher pulse pressure were significant predictors of lower Z-scores on immediate and delayed free recall, recognition, and verbal fluency tests. On average, every 10 mmHg increase in pulse pressure was associated with a 0.08 reduction on the cognitive Z-scores. The effects were independent of age, education, disease duration, motor impairment, medication, and depressive symptoms. Other VRFs were not associated with cognitive outcomes. CONCLUSIONS: Our results are consistent with previous studies suggesting that hypertension exerts a detrimental effect on memory and verbal fluency in early PD. Management of blood pressure and cardiovascular health may be important to reduce risk of cognitive decline in PD. Copyright © 2017 John Wiley & Sons, Ltd.

Goal management training ® home-based approach for mild cognitive impairment in Parkinson's disease: a multiple baseline case report.

Approximately 30% of patients with Parkinson's disease experience mild cognitive impairment (PD-MCI), often affecting executive functions. Our objective was to assess tolerability, safety and preliminarily efficacy of Goal Management Training® (GMT) for PD-MCI. GMT was administered at home, for five weeks. Dysexecutive Questionnaire (DEX), Parkinson Disease Questionnaire (PDQ-39), Zoo Map Test and Dementia Rating Scale-II were administered before, one and four weeks after Adapted-GMT. Reliable Change Index (RCI) was calculated. One participant completed GMT with caregiver. Executive complaints decreased (DEX RCIs between -2.10 and -1.68), PDQ-39 was maintained (RCI = -0.18). Adapted-GMT seems safe for PD-MCI, but efficacy remains doubtful.

A SEMantic and EPisodic Memory Test (SEMEP) Developed within the Embodied Cognition Framework: Application to Normal Aging, Alzheimer's Disease and Semantic Dementia.

Embodiment has highlighted the importance of sensory-motor components in cognition. Perception and memory are thus very tightly bound together, and episodic and semantic memories should rely on the same grounded memory traces. Reduced perception should then directly reduce the ability to encode and retrieve an episodic memory, as in normal aging. Multimodal integration deficits, as in Alzheimer's disease, should lead to more severe episodic memory impairment. The present study introduces a new memory test developed to take into account these assumptions. The SEMEP (SEMantic-Episodic) memory test proposes to assess conjointly semantic and episodic knowledge across multiple tasks: semantic matching, naming, free recall, and recognition. The performance of young adults is compared to healthy elderly adults (HE), patients with Alzheimer's disease (AD), and patients with semantic dementia (SD). The results show specific patterns of performance between the groups. HE commit memory errors only for presented but not to be remembered items. AD patients present the worst episodic memory performance associated with intrusion errors (recall or recognition of items never presented). They were the only group to not benefit from a visual isolation (addition of a yellow background), a method known to increase the distinctiveness of the memory traces. Finally, SD patients suffer from the most severe semantic impairment. To conclude, confusion errors are common across all the elderly groups, whereas AD was the only group to exhibit regular intrusion errors and SD patients to show severe semantic impairment.

An evidence-based approach to the creation of normative data: base rates of impaired scores within a brief neuropsychological battery argue for age corrections, but against corrections for medical conditions.

OBJECTIVE: We detail a new approach to the creation of normative data for neuropsychological tests. The traditional approach to normative data creation is to make demographic adjustments based on observations of correlations between single neuropsychological tests and selected demographic variables. We argue, however, that this does not describe the implications for clinical practice, such as increased likelihood of misclassification of cognitive impairment, nor does it elucidate the impact on decision-making with a neuropsychological battery. METHOD: We propose base rate analyses; specifically, differential base rates of impaired scores between theoretical and actual base rates as the basis for decisions to create demographic adjustments within normative data. Differential base rates empirically describe the potential clinical implications of failing to create an appropriate normative group. We demonstrate this approach with data from a short telephone-administered neuropsychological battery given to a large, neurologically healthy sample aged 45-85 years old. We explored whether adjustments for age and medical conditions were warranted based on differential base rates of spuriously impaired scores. CONCLUSIONS: Theoretical base rates underestimated the frequency of impaired scores in older adults and overestimated the frequency of impaired scores in younger adults, providing an evidence base for the creation of age-corrected normative data. In contrast, the number of medical conditions (numerous cardiovascular, hormonal, and metabolic conditions) was not related to differential base rates of impaired scores. Despite a small correlation between number of medical conditions and each neuropsychological variable, normative adjustments for number of medical conditions does not appear warranted. Implications for creation of normative data are discussed.

Smoking history is associated to cognitive impairment in Parkinson's disease.

INTRODUCTION: Patients with Parkinson's disease (PD) are more likely to suffer from cognitive impairment and dementia than healthy older adults. The aim of this study was to investigate smoking history as a risk factor for cognitive decline in PD. METHOD: One hundred thirty-nine PD patients aged 50 years and older (Hoehn and Yahr = 1-3) were recruited from a clinical database. Global cognitive function was assessed with the Mini-Mental State Examination (MMSE) and smoking history was investigated as part of a standard clinical interview. A multiple linear regression analysis was used to develop a model for predicting participants' MMSE scores from age, education, Hoehn and Yahr stage, disease duration, the number of vascular risk factors and the number of smoking pack-years. RESULTS: The regression model significantly accounted for 22.9% of the variance in MMSE scores. Significant predictors were education (ß = .312, p < .001), age (ß = -.215, p = .013) and total smoking pack-years (ß = -.180, p = .029). In former smokers, the number of years since quitting had no effect on global cognition and there were no significant difference between patients who had quit smoking more than 10 years ago and those who had quit less than 10 years ago, F(1, 63) = 1.72, p = .195. CONCLUSION: Smoking history was associated to global cognitive impairment in PD even in patients who had quit smoking. These results are in line with findings in healthy older adults that have linked smoking to cognitive impairment, global brain atrophy and functional changes. Future studies should consider a broader assessment of cognitive functions.

Cognitive measures in the Canadian Longitudinal Study on Aging.

OBJECTIVE: We describe the implementation of cognitive measures within the Canadian Longitudinal Study on Aging (CLSA), a nationwide, epidemiological study of aging, and relate CLSA Tracking cohort data (n over 20,000) to previous studies using these measures. METHOD: CLSA participants (aged 45-85, n over 50,000) provided demographic, social, physical/clinical, psychological, economic, and health service utilization information relevant to health and aging through telephone interviews (Tracking cohort, n over 20,000) or in-person (i.e. Comprehensive cohort, n over 30,000) in both official languages (i.e. English, French). Cognitive measures included: the Rey Auditory Verbal Learning Test (RAVLT) - Trial 1 and five-minute delayed recall; Animal Fluency (AF), the Mental Alternation Test (MAT) (both cohorts); Controlled Oral Word Association Test, Stroop Test, Prospective Memory Test, and Choice reaction times (Comprehensive Cohort). RESULTS: Performance on the RAVLT Trial 1 and AF were very similar to comparable groups studied previously; CLSA sample sizes were far larger. Within the CLSA Tracking cohort, main effects of age and language were observed for all cognitive measures except RAVLT delayed recall. Interaction effects (language × age) were observed for AF. CONCLUSION: This preliminary examination of the CLSA Tracking cognitive measures lends support to their use in large studies of aging. The CLSA has the potential to provide the 'best' comparison data for adult Canadians generated to date and may also be applicable more broadly. Future studies examining relations among the psychological, biological, health, lifestyle, and social measures within the CLSA will make unique contributions to understanding aging.

Normative data for phonemic and semantic verbal fluency test in the adult French-Quebec population and validation study in Alzheimer's disease and depression.

OBJECTIVE: Verbal fluency tasks are principally used to assess lexical access and have shown usefulness for differential diagnosis. The purpose of Study 1 was to provide normative data in the adult French-Quebec population (Canada) for semantic verbal fluency (animals), for two sets of phonemic verbal fluency (TNP and PFL), and for letter P alone (60 seconds per category/letter). The objectives of Study 2 were to establish the diagnostic and predictive validity of the present tasks and normative data in Alzheimer's disease (AD) and major depressive episode (MDE). METHOD: The normative sample consisted of 932 participants aged 19-91 years. Based on multiple linear regressions, equations to calculate Z-scores were provided. To assess validity, performance of 62 healthy participants was compared to 62 participants with AD and 41 with MDE aged over 50. RESULTS: Age and education, but not gender, predicted performance on each verbal fluency task. Healthy adults aged 50 and younger had a better performance on semantic than phonemic verbal fluency. In comparison to MDE, AD participants had lower performance on animals and TNP, but not on letter P. Ninety percent of people with a Z-score ≤ -1.50 on semantic verbal fluency had AD and the global accuracy was 76.6%. Test-retest reliability over one year was high for both animals (r = .711) and TNP (r = .790) in healthy older participants, but dropped for animals in people with AD (r = .493). CONCLUSIONS: These data will strengthen accurate detection of verbal fluency deficits in French-Quebec adults.

Impact of Depressive Symptoms on Memory for Emotional Words in Mild Cognitive Impairment and Late-Life Depression.

BACKGROUND: Amnestic mild cognitive impairment (aMCI) and late-life depression (LLD) are associated with increased risk of Alzheimer's disease (AD). This is also true for aMCI with concomitant depressive symptoms (aMCI/D+), but few studies have investigated this syndrome. OBJECTIVES: We aimed to clarify the association between cognitive and depressive symptoms in individuals at risk for AD by examining episodic memory for emotional stimuli in aMCI, aMCI/D+, and LLD. METHODS: Participants were 34 patients with aMCI, 20 patients with aMCI/D+, 19 patients with LLD, and 28 healthy elderly adults. In an implicit encoding task, participants rated the emotional valence of 12 positive, 12 negative, and 12 neutral words. Immediately and 20 minutes later, participants recalled as many words as possible. They were also asked to identify previously presented words during a yes/no recognition trial. RESULTS: At immediate recall, aMCI participants displayed better recall of emotional words, particularly positive words. aMCI/D+ and control participants displayed better recall of positive and negative words compared to neutral words. LLD participants recalled more negative than neutral words. At delayed recall, emotional words were generally better-remembered than neutral words by all groups. At recognition, all subjects responded more liberally to emotional than to neutral words. CONCLUSION: We find that the type of emotional information remembered by aMCI patients at immediate recall depends on the presence or absence of depressive symptoms. These findings contribute to identifying sources of heterogeneity in individuals at risk for AD, and suggest that the cognitive profile of aMCI/D+ is different from that of aMCI and LLD. Future studies should systematically consider the presence of depressive symptoms in elderly at-risk individuals.

Impact of a cognitive rehabilitation intervention on neuropsychiatric symptoms in mild to moderate Alzheimer's disease.

The main goal of this study was to evaluate the impact of a cognitive rehabilitation programme on 12 behavioural and psychological symptoms of dementia (BPSD) in patients with mild to moderate Alzheimer's disease (AD). This six-month single-blind block-randomised cross-over controlled study was conducted with 15 mild to moderate AD participants and their caregivers. All participants received a four-week home-based cognitive rehabilitation programme to learn/re-learn an instrumental activity of daily living. They were assessed up until three months following the end of the intervention. The Neuropsychiatric Inventory (NPI-12) was employed to evaluate patients' BPSD at seven assessment points during the course of the study. A general linear mixed model analysis performed on the NPI data revealed that aberrant motor behaviours (AMB) increased significantly more in the treatment condition than in the control condition. In addition, both groups registered a significant reduction of delusional symptoms during the second half of the study. Employing a multi-symptom approach to assess participants' BPSD, this cross-over randomised controlled study showed that an individualised cognitive rehabilitation intervention was generally well-tolerated by mild to moderate AD patients. Future cognitive rehabilitation studies conducted with this population should pay attention to AMB symptom changes.

Normative data for the Rappel libre/Rappel indicé à 16 items (16-item Free and Cued Recall) in the elderly Quebec-French population.

Performance on verbal memory tests is generally associated with socio-demographic variables such as age, sex, and education level. Performance also varies between different cultural groups. The present study aimed to establish normative data for the Rappel libre/Rappel indicé à 16 items (16-item Free and Cued Recall; RL/RI-16), a French adaptation of the Free and Cued Selective Reminding Test (Buschke, 1984; Grober, Buschke, Crystal, Bang, & Dresner, 1988). The sample consisted of 566 healthy French-speaking older adults (50-88 years old) from the province of Quebec, Canada. Normative data for the RL/RI-16 were derived from 80% of the total sample (normative sample) and cross-validated using the remaining participants (20%; validation sample). The effects of participants' age, sex, and education level were assessed on different indices of memory performance. Results indicated that these variables were independently associated with performance. Normative data are presented as regression equations with standard deviations (symmetric distributions) and percentiles (asymmetric distributions).

A randomized cross-over controlled study on cognitive rehabilitation of instrumental activities of daily living in Alzheimer disease.

OBJECTIVE: The goal of the study was to investigate the effectiveness of a memory rehabilitation program to re-learn instrumental activities of daily living (IADLs) in patients with Alzheimer disease (AD). DESIGN: This was a 6-month block-randomized cross-over controlled study. SETTING: All evaluation and training sessions were performed at each patient's home. PARTICIPANTS: Twenty participants with mild to moderate AD. INTERVENTION: The trained IADL was chosen by the patient and his/her caregiver in order to target the patient's needs and interests. Participants were trained twice a week for 4 weeks with the errorless learning (ELL) and spaced retrieval (SR) cognitive techniques. After training, there were several follow-ups over a period of at least 3 months. MEASUREMENTS: Performance on the trained IADL was assessed by a Direct Measure of Training (DMT), an observational instrument adapted from a well-validated scale. General cognitive function, everyday memory functioning, quality of life, neuropsychiatric symptoms and ADL/IADL of patients, as well as the caregiver's burden were assessed as secondary outcomes. RESULTS: A statistical significant difference was found between the trained and untrained groups on the DMT immediately following the intervention. Improvements were maintained for a 3-month period. The training did not have effects on any other measures. CONCLUSIONS: The present study showed that it is possible for AD patients to relearn significant IADLs with the ELL and SR techniques and to maintain these gains during at least 3 months. The findings of this study emphasize the importance to design robust but individualized intervention tailored on patients' particular needs.

Normative data for the Dementia Rating Scale-2 in the French-Quebec population.

The Dementia Rating Scale-2 is used to measure cognitive status of adults with cognitive impairment, especially of the degenerative type, by assessing five cognitive functions, namely attention, initiation/perseveration, construction, conceptualization, and memory. The present study aimed to establish normative data for this test in the elderly French-Quebec population. A total of 432 French-speaking elders from the province of Quebec (Canada), aged 50 to 85 years, were administered the Dementia Rating Scale-2. Age and education were found to be associated with the total score on the test, while gender was not. Percentile ranks were then calculated for age- and education-stratified groups. Previous studies have shown that cultural background can affect performance on the DRS and the development of culture-specific norms for French-speaking Quebecers could be very useful to clinicians and researchers working with this population.