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Longitudinal Cognitive Training and Conversion Rate of Mild Cognitive Impairment to Dementia

This study examines the effects of cognitive training on the conversion rate from mild cognitive impairment to dementia. The aim is to improve cognitive and functional performance in MCI patients and delay the onset of dementia. The study involves two groups (experimental and control) and includes 64 sessions over a period of 2 years.

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Longitudinal Cognitive Training and Conversion Rate of Mild Cognitive Impairment to Dementia

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  1. Longitudinal cognitive training changes the conversion’s rate of Mild Cognitive Impairment to dementia Kounti, F.1, Poptsi, E.1, Agogiatou, C.1, Bakoglidou, E. 1, Soumpourou A. 1, Zafeiropoulos, S. 1, Batsila G. 1, Nikolaidou, E. 1, Vasiloglou, M. 1, Ouzouni, F. 1, Markou N. 1, Zafeiropoulou, M. 1, Tsolaki, M. 1, 2 Alzheimer Hellas 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, Greece

  2. Mild Cognitive Impairment • MCI represents a transitional state between the cognitive changes of aging and the earliest clinical features of dementia (Petersen, 2003; Petersen et al., 2001) • MCI patients are at increased risk for the development of dementia (Bruscoli & Lovestone, 2004; Petersen, 2004)

  3. MCI patients progress to dementia at very different rates • aMCImd patients appear to be at greatest risk for future dementia • (Di Carlo et al., 2007; Palmer et al., 2008; Tabert et al., 2006 Ravaglia et al., 2006) • Less than 20% of patients with aMCImd revert to normal aging • (Loewenstein, et al., 2009) • Others remain stable upon retest • (Bickel et al., 2006)

  4. Neurogenesis in aging (hippocampus)

  5. ChEIs and Mild Cognitive Impairment • ChEIs in patients with MCI are not associated with any delay in the onset of dementia • The risks associated with ChEIs are not negligible • (Raschetti et al., 2007) • It is important to study the possibility of cognitive training to improve cognitive and functional performance

  6. Aims of non pharmacological therapies Aim of cognitive therapy: • Cognitive improvement • Delay of conversion rate to dementia Expectedresults: • Reactivation of atrophic neurons in patients with MCI • (Swabb, 1994) • Maintenance of regenerated neurons after cognitive training for a long period of time

  7. The study • aMCImd patients • Non pharmacological therapy (cognitive training) • 64sessions(in a period of 2 years) • 2 groups (experimental and control)

  8. Study hypotheses Experimental group: • Improvement of targeted cognitive abilities (attention - parameters of executive function) • Generalization of cognitive benefit in other cognitive domains through the consolidation of new learning • Delay of conversion rate to dementia Control Group: • Stability of cognitive performance, a slight deterioration or a slight improvement, two years after the initial assessment

  9. Participants Inclusion criteria: • 60 years of age • Subjective cognitive complaints • aMCImd diagnosis (Petersen’s criteria 2001) • MMSE: 26-30 points • Spared language skills (speech comprehension or production)

  10. Participants Exclusion criteria: • Diagnosis of dementia (NINCDS-ADRDA criteria-McKahnn et al., 1984) • Severe psychotic traits (untreated depression, agitation or behavioral problems) • Other neurological disorders (stroke or ischemic lesions) • Antipsychotics • ChEIs • Difficulties in sensory abilities

  11. Participants • Outpatients of the memory and dementia clinic of “G.Papanikolaou” General Hospital and of the day care centers of Alzheimer Hellas • Area of Northern Hellas • Patients visited these sources voluntarily and signed an informed consent

  12. Participants

  13. Participants • No statistically significant differences between the two groups at baseline • In age, education, gender, cognitive and functional performance • Controls did not take part in any kind of cognitive therapy • They continued their regular daily activities

  14. Sample Characteristics

  15. Neuropsychological assessment • 1stassessment:at baseline • 2ndassessment: 2 yearslater, at the end of the therapy

  16. MEMORY RivermeadBehavioral Memory test (RBMT) Rey Auditory Verbal Learning Test (RAVLT) Rey – Osterrieth Complex figure Test(ROCFT) ATTENTION Test of Everyday Attention (TEA) WAIS-R (DIDIT SYMBOL) LANGUAGE Boston Naming Test (BNT) Verbal fluency test (ΧΣΑ) EXECUTIVE FUNCTION Wisconsin Card Sorting Test (WCST) Trail-making Test Part B (TRAIL B) Stroop Color Word test (SCWT) Functional Cognitive Assessment Scale (FUCAS-EXECUTIVE FUNCTION) GENERAL COGNITIVE FUNCTION Mini Mental State Examination (MMSE) Montreal Cognitive Assessment (MoCA) ADL Functional Rating Scale of Symptoms of Dementia (FRSSD) Functional Cognitive Assessment Scale (FUCAS-ADL) Neuropsychological battery

  17. Therapeutic techniques Cognitive Training techniques of Attention and Cognitive Parameters of Executive Function through: • Paper and pencil tasks • Kinetic instructions • Mental Imagery under Relaxation • Musical Stimuli • Reality Orientation in Currents Events • Computer software Each trainee took part in a specific therapeutic combination of techniques, related to his/her residual abilities and impaired functions

  18. Statistical analysis • SPSS 17.0 software program • Kolmogorov-Smirnov Z-test • Nonparametric tests • Mann–Whitney test for 2 independent samples (Monte Carlo method) between groups comparisons • Wilcoxon test for 2 related samples, within group comparisons Bonferonni correction was used in order to make our significance criterion more conservative

  19. Study Results

  20. Between groups comparison Experimental group in comparison to controls had better performance in: • attention (p= .009) • visual memory (p= .043) • executive function (p≤ .000) At the end of the intervention (2 years period)

  21. Within Group Comparisons between the 1st and the 2nd assessment • abilities of attention (p≤ .002) • executive function (p≤ .008) • verbal memory (p≤ .003) • visual memory (p= .000) • language (p= .000) • global cognitive performance (p= .028) Experimental group After two years’ participation in cognitive training Has shown improvement in:

  22. Within Group Comparisons between the 1st and the 2nd assessment Significant improvement in: • visual memory (p= .006) • attention (p= .007) Significant deterioration in: • executive function (p≤ .006) The rest of the cognitive abilities remained stable After two years control group has shown:

  23. Conversion to dementia • 6 patients (13.33%) out of the controls converted to dementia, as they fulfilled the dysfunction criteria for dementia (performance in FUCAS’ ADL ≥ 47) • NONE of the experimental group converted to dementia after two years of participation in cognitive training

  24. Conclusions

  25. Cognitive training helped experimental patientsto: • Improve abilities of attention and executive function • Generalize the cognitive benefit in visual memory, language & verbal memory • Stabilize ADL • Minimize the rate of conversion to dementia

  26. Further studies are needed in order to examine the longitudinal effectiveness of cognitive training in MCI

  27. for your attention Thank you Contact e-mail:elpida.alz@gmail.com e.poptsi@alzheimer-hellas.gr

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