Dementia and occupational therapy.

In order to evaluate the efficacy of the occupational therapy in patients with dementia, we included in the occupational therapy (OT) program 34 patients with dementia and a moderate to severe cognitive impairment admitted at our RSA. Fourteen of them had vascular dementia (VD), twenty had Alzheimer dementia (AD). For a period of 40 days they followed a daily therapeutic program of OT for washing, personal hygiene (combing their hair, shaving), dressing, sanitary services and eating. Patients were tested with the Ronchi brief evaluation battery (RBEB) before and after therapy. After the treatment we observed a significant improvement in both groups in their mean scores obtained with the RBEB in many of their functional areas. These improvements in patients with vascular dementia were more consistent compared to those patients with AD, but in spite of these differences we saw that, independently from the etiology, it is possible to recuperate residual functional capacities utilizing OT programs in order to guarantee the highest level of autonomy possible for each patient.

The results for the psychomotor rehabilitation programs during stay in the subacute care nursing home.

The modifications of certain psychophysical parameters were evaluated in an elderly population admitted to our subacute care nursing home (abbreviated from the Italian name: "Residenza Sanitaria Assistenziale" as RSA) during the year 2002. These patients, admitted to undergo psychomotor rehabilitative interventions, were evaluated under a cognitive, affective and functional profile at the beginning and at the end of the treatment. Our study showed an increase in all of these performances by the end of the prescribed therapeutic program.

Evaluation of the nutritional status during stay in the subacute care nursing home.

Malnutrition represents an underestimated danger in the elderly population. It is found frequently and casually during admissions to our subacute care nursing homes (abbreviated from the Italian name: "Residenza Socio-Assistenziale" = RSA) when patients are treated for other types of disorders. During a period of 24 months, in our RSA, we found that 93% of patients were malnourished or at risk of malnourishment at admission. Specific interventions allowed us to substantially improve the nutritional status of these patients.

Occupational therapy and tools for monitoring the effectiveness of therapy.

We have constructed a battery of tests for assessment of some aspects of self-sufficiency (washing, dressing, eating) and called it the Ronchi brief evaluation battery (RBEB). The tests were designed to allow for more accurate monitoring of the effects of occupational therapy interventions with patients recovering in our subacute care nursing home (abbreviated from the Italian name: "Residenza Sanitaria Assistenziale" as RSA). The RBEB results showed great advantage, in maximizing levels of independence of patients, of occupational therapy input. Furthermore, when RBEB results are compared to those from the Barthel index, greater improvements are seen in each of the functions tested suggesting that the RBEB results are more detailed and therefore more appropriate. The RBEB tests are based on analysis of the activities of daily living (ADL) and have provided us with brief, clear, accurate, low-cost and practical baseline assessment and review tool.

Memory training and drug therapy act differently on memory and metamemory functioning: evidence from a pilot study.

The aim of this study was to assess the influence of drug therapy (DT) with pramiracetam and memory training (MT), each alone, and in combination (DTMT), on both the objective memory and metamemory performance. Thirty-five non-depressed, non-demented healthy elderly (mean age: 64.8 years) with objective (story recall) and/or subjective (cognitive difficulties scale) memory loss were randomly included in four open-label conditions: an MT condition (n = 10), a DT condition (n = 8), a DTMT condition (n = 10), and a control (CTR) condition (n = 7). MT and DTMT subjects participated in 12 real-life tutor-guided MT sessions, once weekly, each lasting 1.5 hrs. The subjects were tested for objective (Randt memory test) and subjective (Sehulster metamemory scale; memory functioning questionnaire) memory proficiency prior to (t(0)) and shortly after treatment (t(1)). Results showed that objective memory gains of the two groups receiving pramiracetam were significantly larger than that of the MT and CTR groups. The ranking order in terms of decreasing score improvements was DTMT - DT - MT - CTR. Metamemory, on the other hand, displayed only a trend to between-group differences with opposite patterns for the DT and DTMT groups. In the DT group, the level of depression, negatively interfered with metamemory but not with actual memory performance. The present findings stress, once again, the complex relationships between memory, metamemory and affective status, which may be differently modified by DT and MT.