RESUMO
OBJECTIVE: The purpose of this study was to analyze the effect of a neuropsychological rehabilitation (NR) program on patients with Alzheimer's disease (AD). METHODS: The sample was composed of 16 elderly outpatients who participated in an open trial with rivastigmine (6 to 12 mg/day) for 4 months and were randomized to 3 different groups: 1. group NR (N=5), 2. individualized NR (N=6) and 3. NR at home under supervision of a relative or caregiver (N=5). All 3 groups fulfilled the same NR protocol consisting of a once a week session. Just before and after the 22 week period of rehabilitation, all patients were evaluated using psychiatric and functional scales, and neuropsychological tests by interviewers that did not participate in the cognitive training. RESULTS: The intervention did not produce any statistically significant change, but small gains were observed on some cognition tests, activities of daily living (ADL), and psychiatric symptoms in groups 1 and 2. CONCLUSION: Group NR is recommended for reducing psychiatric symptoms, and individualized NR for improving ADL. NR at home either has no associated benefits, or the training sessions were not appropriately conducted by the caregiver. However, additional research with larger samples is necessary to confirm these observations.
Assuntos
Atividades Cotidianas , Doença de Alzheimer/reabilitação , Terapia Cognitivo-Comportamental/métodos , Transtornos da Memória/terapia , Fármacos Neuroprotetores/uso terapêutico , Fenilcarbamatos/uso terapêutico , Idoso , Doença de Alzheimer/psicologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Rivastigmina , Índice de Gravidade de Doença , Resultado do Tratamento , Aprendizagem VerbalRESUMO
OBJECTIVE: This study aims to show preliminary results of the 'combined treatment' (acetylcholinesterase inhibitor + cognitive training) on a group of mild Alzheimer's disease (AD) patients, followed-up for 7 months. METHODS: Six mild AD patients, diagnosed according to ICD-10 and NINCDS-ADRDA criteria, were included on a open trial with Rivastigmine, 6-12 mg/day, for 2 months, followed by a weekly cognitive rehabilitation group, for 5 months. Caregivers were submitted to a weekly group of counseling and support for 5 months. RESULTS: Stabilization or mild improvement of patients' cognitive and activities of daily living deficits were found, besides reduction of patients and caregivers' depressive and anxiety levels. CONCLUSION: The 'combined treatment' can help on the stabilization or result on a mild improvement of AD patients' cognitive and functional deficits. Support and counseling interventions can reduce the levels of caregivers' psychiatric symptoms.
Assuntos
Doença de Alzheimer/terapia , Carbamatos/uso terapêutico , Inibidores da Colinesterase/uso terapêutico , Transtornos Cognitivos/reabilitação , Fenilcarbamatos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/tratamento farmacológico , Cuidadores/psicologia , Transtornos Cognitivos/tratamento farmacológico , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Equipe de Assistência ao Paciente , RivastigminaRESUMO
OBJECTIVE: To study the efficacy of cognitive rehabilitation combined with acetylcholinesterase inhibitor (AChE-I) treatment in patients with mild Alzheimer's disease and their relatives. METHOD: Thirteen patients with mild Alzheimer's disease treated with rivastigmine 6-12 mg/day for more than two months started cognitive rehabilitation training. Before and after the cognitive rehabilitation training patients were assessed through cognitive tests, activities of daily living scale, neuropsychological battery and scales to evaluate caregivers' depressive and anxiety symptoms. Six patients were randomized to a combined treatment group (AChE-I plus cognitive rehabilitation and caregiver support) and seven patients to a control group (AChE-I only) and followed up for five months. RESULTS: Mini-Mental State Examination (MMSE) scores (p = 0.047) and backward digit span scores (p = 0.018) were significantly different between the groups on follow-up. The combined treatment group showed a better positive treatment effect on cognitive and neuropsychological tests applied to patients and reduction of psychiatric symptoms was observed in their caregivers (nonsignificant). CONCLUSION: Cognitive rehabilitation associated with AChE-I treatment can potentially be useful to stabilize or improve cognitive and functional performance of patients with mild Alzheimer's disease and can reduce caregivers' psychiatric symptoms.
Assuntos
Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/reabilitação , Inibidores da Colinesterase/uso terapêutico , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental , Fenilcarbamatos/uso terapêutico , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Ansiedade , Cuidadores/psicologia , Transtornos Cognitivos/etiologia , Depressão , Feminino , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Projetos Piloto , Rivastigmina , Resultado do TratamentoRESUMO
OBJETIVO: Apresentar resultados preliminares do 'tratamento combinado' (inibidor da acetilcolinesterase + treinamento cognitivo), em um grupo de pacientes com doença de Alzheimer (DA) leve, acompanhados por 7 meses. MÉTODO: Seis pacientes com diagnóstico de DA leve, de acordo com critérios diagnósticos da CID-10 e NINCDS-ADRDA, foram submetidos a ensaio clínico aberto com Rivastigmina, 6-12 mg/dia, por 2 meses, seguido por grupo de reabilitaçäo cognitiva semanal, por 5 meses. Os familiares/cuidadores foram atendidos em grupo semanal de suporte e aconselhamento, por 5 meses. RESULTADOS: Ao final do acompanhamento, houve: estabilizaçäo ou discreta melhora dos déficits cognitivos e das atividades de vida diária dos pacientes; estabilizaçäo ou reduçäo dos níveis de depressäo e ansiedade nos pacientes e familiares. CONCLUSÄO: O 'tratamento combinado' pode auxiliar na estabilizaçäo ou resultar em leve melhora dos déficits cognitivos e funcionais de pacientes com DA leve. As intervençöes de suporte e aconselhamento podem reduzir o nível de sintomas psiquiátricos de seus familiares. PALAVRAS-CHAVE: demência, doença de Alzheimer, inibidor da acetilcolinesterase, reabilitaçäo cognitiva, atividades de vida diária, cuidadores