RESUMO
In the present study we tested the cognitive effects of transcranial direct current stimulation (tDCS) in a case of probable Alzheimer disease (AD). The patient (male, 60â years, mild AD) underwent two cycles of treatments, separated by 2â months. In the first cycle, active stimulation (10 sessions, 2â mA for 20â min; anode over the left dorsolateral prefrontal cortex) was followed by computerised tasks (CTs) specifically chosen to engage the most impaired cognitive processes in the patient (tDCS+CT condition). In the second cycle, which was structured as the first, CTs were administered after placebo stimulation (sham+CT condition). Effects on cognitive performance were evaluated not only by the CTs, but also by neuropsychological tests assessing global cognitive functioning. Statistical analyses revealed that whereas the tDCS+CT condition had few effects on the CTs, it induced a stability of the patient's global cognitive functioning lasting approximately 3â months, which was not achieved when the patient underwent sham+CT condition. Therefore, the synergetic use of tDCS and CTs appeared to slow down the cognitive decline of our patient. This preliminary result, although in need of further confirmation, suggests the potentiality of tDCS as an adjuvant tool for cognitive rehabilitation in AD.
Assuntos
Doença de Alzheimer/psicologia , Doença de Alzheimer/reabilitação , Cognição/fisiologia , Córtex Pré-Frontal/fisiopatologia , Estimulação Transcraniana por Corrente Contínua , Doença de Alzheimer/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Método Simples-Cego , Resultado do TratamentoRESUMO
BACKGROUND: Recent research suggests that a combination of both pharmacological and psychosocial treatments targeting cognitive functions improves cognition in patients with Alzheimer's disease (AD). The present study evaluated the effectiveness of a 1-year cognitive training (CT) by comparing the cognitive performance of 16 patients with AD treated with CT and cholinesterase inhibitors (ChEIs) (experimental group) with the performance of 16 patients treated with a non-specific cognitive treatment and ChEIs (control group). METHODS: This study was a single-blind randomized controlled trial. The patients in the experimental group received pharmacological treatment and repeated cycles of CT for 1 year, whereas the control group received pharmacological treatment and repeated cycles of non-specific cognitive exercises. The patients in the two groups were administered a variety of neuropsychological tests measuring several cognitive functions (i.e. memory, language, reasoning, executive function, working memory and apraxia), activities of daily living, and depression. RESULTS: After 1 year of training, the experimental group scored significantly higher on the Mini Mental State Examination, the Milan Overall Dementia Assessment battery and in other five neuropsychological tests, compared to the control group. CONCLUSIONS: Present results suggest that repeated cycles of CT in patients with AD treated with ChEIs are associated with benefits in several areas of cognitive function.
Assuntos
Doença de Alzheimer/terapia , Terapia Cognitivo-Comportamental/métodos , Atividades Cotidianas , Idoso , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/reabilitação , Inibidores da Colinesterase/uso terapêutico , Terapia Combinada , Humanos , Testes Neuropsicológicos , Método Simples-Cego , Ensino/métodosRESUMO
Background: The focus-based integrated model (FBIM) is a form of psychotherapy that integrates psychodynamic and cognitive psychotherapy and Erikson's life cycle model. Although there are many studies on the effectiveness of integrated models of psychotherapy, few have examined the efficacy of FBIM. Objective: This pilot study explores clinical outcome measures concerning individual wellbeing, the presence/absence of symptoms, life functioning, and risk in a cohort of subjects after they received FBIM therapy. Methods: A total of 71 participants were enrolled at the CRF Zapparoli Center in Milan, 66.2% of whom were women (N = 47). The mean age of the total sample was 35.2 years (SD = 12.8). We used the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) to test treatment efficacy. Results: The results revealed that participants improved in all four dimensions of CORE-OM (i.e., wellbeing, symptoms, life functioning, and risk), women improved more than men, and in most cases (64%), the change was clinically reliable. Conclusion: The FBIM model seems to be effective for treating several patients. Most of the participants saw significant changes in symptoms, life functioning, and general wellbeing.
RESUMO
Starting from the observation of a reduced gray matter in the inferior temporal regions of Alzheimer's disease (AD) patients, the present study hypothesized an altered language-related functional activity in left occipito-temporal areas in AD, and the possibility of a plastic change of these regions induced by an intensive cognitive training. To this aim, eleven mild/moderate AD underwent to a 5-week cognitive training (40 h). Before and after the training, evoked potentials were recorded from 26 scalp electrodes during a lexical decision task which required word/no-word discrimination. Stimuli included high- and low-frequency words and non-words, and the recognition potential (RP) together with the N400 have been analyzed and compared with those collected from a matched healthy control group. Results comparing controls and patients before training showed a normal RP in AD patients with a clear peak over left occipito-temporal sites. In addition, controls exhibited a left anterior lateralization of N400 component to words and an inverted pattern for non-words, whereas an altered N400 with bilateral distribution at both word and non-word conditions was found in AD patients. After the cognitive training, AD patients did not show changes in the N400, but revealed a significant enhanced amplitude of RP to high-frequency words. Behavioral responses to the lexical decision task and scores from neuropsychological tests did not evidence improvements nor worsening after training. These data point to an intact functionality of left posterior linguistic networks in mild/moderate AD, and the possibility to increase plastically their activity after a cognitive training.
Assuntos
Doença de Alzheimer/complicações , Encéfalo/fisiopatologia , Terapia Cognitivo-Comportamental/métodos , Potenciais Evocados/fisiologia , Transtornos da Linguagem , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/patologia , Análise de Variância , Mapeamento Encefálico , Eletroencefalografia , Feminino , Lateralidade Funcional , Humanos , Transtornos da Linguagem/etiologia , Transtornos da Linguagem/patologia , Transtornos da Linguagem/reabilitação , Masculino , Entrevista Psiquiátrica Padronizada , Testes Neuropsicológicos , Estimulação Luminosa , Tempo de Reação/fisiologia , VocabulárioRESUMO
Healthy older adults and Alzheimer's disease (AD) patients are reported in the literature to be impaired in memory and executive functions. This research investigates the extent of these two abilities in determining pathological aging. Groups of young-old and old-old healthy people (Experiment 1) and individuals with amnestic mild cognitive impairment (a-MCI) and AD (Experiment 2) were administered verbal and visuo-spatial tests graded for memory and/or executive requirements. Results indicate a decline in visuo-spatial tasks requiring memory and executive functions in healthy aging. The a-MCI showed memory deficits similar to those shown by AD, but preserved executive functions. Executive function decline could be the critical feature of dementia.