Effects of cholinergic drugs and cognitive training on dementia
Requena C, Lopez Ibor MI, Maestu F, Campo P, Lopez Ibor JJ and Ortiz T;
Commented by , 24 May 2004
Aim of the study
Evaluate the efficacy of a combined treatment (donepezil plus cognitive training) on cognitive processes and affective states associated with Alzheimer’s disease (AD)
Method
Eighty-six with mild to moderate stage AD diagnosed using DSM-IIIR and NINCDS-ADRDA criteria attending a day program in the city of León were divided in four groups: donepezil and cognitive training, donepezil only, cognitive stimulation only, neither treatment. Donepezil was given once a day at10mg.
The cognitive training comprised seven areas of stimulation: orientation, bodily awareness, family and society, caring for oneself, reminiscing, household activities, animals, people and things; the program was carried out in groups of five, five days a week. All subjects were followed over one year. Outcomes at baseline and end of study included MMSE, ADAS-cog, Geriatric Depression Scale (GDS) and FAST.
Results
The untreated group did the worst in terms of decline on MMSE (6.8 points decline) whereas the combined treatment did the best (1.5 points better), although the untreated group was a little more severe to start with (baseline MMSE 19.39 vs 22.95).
ADAS-cog and FAST were also better in the combined group. Even the cognitive stimulation only group did better than the untreated group on MMSE and FAST. The GDS improved in all groups.
Discussion
This type of study is long overdue, since there are good reasons to believe that the combination of a cholinesterase inhibitor such as donepezil with a well structured cognitive training should have additive benefit. Furthermore the combined therapy is felt by the authors as increasing the attentional processes necessary for handling activities of daily living (ADL).
This could be verified in future studies using appropriate ADL scales such as the Disability Assessment in Dementia which is sensitive to initiation, planning and execution of both instrumental and self-care tasks.
Similar results have been described by Silveri et al. using reality orientation therapy added to cholinesterase inhibitors in mild as well as more severe AD (Ref 1). Pilot work in the amnestic type of mild cognitive impairment without drug treatment is under way in Montreal at the Institut Universitaire de Gériatrie,
There is thus a genuine effort at evaluating the impact of cognitive training in different stages of AD.
References
Silveri et al, Neurobiology of Aging 2004; 25 (Suppl. 1), S2 (Abstracts of the 8th International Montreal/Springfield Symposium on Advances in Alzheimer Therapy)