Cognitive Rehabilitation and Exposure/Sorting Therapy for Late-Life Hoarding: Effects on Neuropsychological Performance.

OBJECTIVES: Hoarding disorder (HD) is characterized by urges to save items, difficulty discarding possessions, and excessive clutter and has been associated with executive functioning deficits. A randomized controlled trial comparing Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) with a care management control condition demonstrated the efficacy of CREST in reducing hoarding symptoms in older adults. The purpose of the current study was to assess whether CREST may also lead to improved executive functioning. METHOD: All participants were administered a neurocognitive battery at baseline and posttreatment. Linear mixed models with random intercepts were used to evaluate change in global neuropsychological functioning as well as change in individual executive functioning variables. RESULTS: There was no significant group by time interaction for the Global Deficit score; however, there were significant group by time interactions on two of the executive functioning variables examined, such that participants in the CREST condition demonstrated significant improvement in cognitive flexibility and inhibition over time compared with the participants in the care management condition. DISCUSSION: Our initial findings support the notion that CREST may be able to improve task switching, an important component of executive functioning, in older adults with HD.

Supporting recovery from hoarding and squalor: insights from a community case study.

People with hoarding behaviours acquire a large number of possessions that are often of limited or no monetary value and which they are unable or unwilling to discard. Such behaviours can substantially impair a person's ability to attend to their normal daily activities, cause substantial distress and lead to squalid living conditions. Living in squalor can compromise a person's health and safety, be a public health issue and present substantial challenges to family, carers, social service agencies and clinical mental health services. Hoarding and squalor behaviours are more common among people with co-morbid organic and mental illness, such as developmental delay, schizophrenia, alcohol dependence and/or obsessive-compulsive disorder. This paper provides a narrative that explores the role of one Australian mental health nurse practitioner in the recovery of a person with hoarding behaviours.

Novel treatment for geriatric hoarding disorder: an open trial of cognitive rehabilitation paired with behavior therapy.

OBJECTIVES: To investigate the feasibility of an age-adapted, manualized behavioral treatment for geriatric hoarding. METHODS: Participants were 11 older adults (mean age: 66 years) with hoarding disorder. Treatment encompassed 24 individual sessions of psychotherapy that included both cognitive rehabilitation targeting executive functioning and exposure to discarding/not acquiring. Hoarding severity was assessed at baseline, mid-treatment, and posttreatment. RESULTS: Results demonstrated clinically and statistically significant changes in hoarding severity at posttreatment. No participants dropped out of treatment. Eight participants were classified as treatment responders, and three as partial responders. Partial responders reported severe/extreme hoarding and psychiatric comorbidities at baseline. CONCLUSIONS: The combination of cognitive rehabilitation and exposure therapy is a promising approach in the treatment of geriatric hoarding. Targeting neurocognitive deficits in behavioral therapy for these geriatric patients with hoarding disorder doubled response rates relative to our previous trial of cognitive behavior therapy alone.