Poster Presentations: P2 P495
Conclusions: As most people with advanced dementia in India die in their
own homes or hospitals, there are training needs to be addressed as well.
P2-370 COGNITIVE BEHAVIORALTHERAPY TO
ENHANCE COGNITIVE REHABILITATION
EFFICACY IN ALZHEIMER’S DISEASE
Megan Fane1, Paul Lysaker2, Joanna Fiszdon3, Elizabeth Twamley4,
Amanda Gooding5, Casey Baginski1, Jimmy Choi1, 1Columbia University
Medical Center, New York, New York, United States; 2Indiana University
School of Medicine, Indianapolis, Indiana, United States; 3Yale University
School of Medicine, West Haven, Connecticut, United States; 4University of
California San Diego, San Diego, California, United States; 5Fordham
University, Bronx, New York, United States. Contact e-mail: fanemeg@
nyspi.columbia.edu
Background: While cognitive rehabilitation (CR) programs for individuals
with dementing pathology have been shown to be moderately efficacious, as
a stand-alone treatment, they can be difficult for this group of patients, as
they serve as a constant reminder of cognitive deficits, which can lead to
low self-esteem and a sense of hopelessness. Because of these limitations of
standard CR programs, add-on therapies directly targeting hopelessness and
self-esteem may enhance the efficacy of CR. Methods: 47outpatients diag-
nosed with early to moderate Alzheimer’s disease(AD) were randomly as-
signed to 4 months of (1) computer-based memory training (MT), or (2)
a newly designed cognitive behavioral therapy (CBT) regimen in conjunction
with the same MT(CBT-MT) designed to target automatic distorted schemes
of hopelessness and perceptions of poor self-competency for the training ex-
ercises. Assessments of cognitive function, quality of life, neuropsychiatric
symptoms, treatment adherence, depression, hopelessness, treatment motiva-
tion, and perceptions of self-efficacy were conducted at intake and immedi-
ately following treatment conclusion. Results: Patients in CBT-MT
reported less overall depressive symptoms at post treatment and reported
greater willingness and efficacy to tackle the challenging exercises in the
CR program. Subsequently, the CBT-MT group had less treatment attrition
in CR compared to theMT group. Of note, greater perceptions of self-efficacy
for the training at baseline significantly predicted memory outcome and ac-
counted for 49% of the variance (R2¼.49, F [3,43]¼5.14; p¼.001) followed
by baseline mental flexibility, which explained another 20% (R2¼.20,
F [3,43]¼4.74; p¼.01).Depression severity and neuropsychiatric symptoms
did not contribute to memory outcome beyond what was found in the model.
Conclusions: Findings suggest that enhancing CR treatments with add-on in-
terventions directly targeting self-efficacy may increase their effectiveness.
Specifically, these add-on treatments may be effective by directly increasing
elements of control, self-efficacy, and intrinsic motivation for treatment, lead-
ing to both psychological and neuropsychological benefits. The potential use
of these types of add-on treatments in individuals in prodromal stages of de-
mentia (mild cognitive impairment) will also be discussed.
P2-371 A MULTICENTER, RANDOMIZED TRIALTO
ASSESS EFFICACYOFHOME-BASEDANDGROUP
COGNITIVE INTERVENTION PROGRAMS IN
AMNESTIC MILD COGNITIVE IMPAIRMENT
Hae Ri Na1, Seong Choi2, Jee H. Jeong3, Duk Na4, Sun Ah Park5, Eun-
Joo Kim6, Sang Won Seo7, Hyun Jeong Han8, Han Seol-Heui9, Jae-
Hong Lee10, So Moon11, Kyung Won Park12, 1Bobath Memorial Hospital,
Seongnam-Si, Kyungki-Do, South Korea; 2Inha University School of
Medicine, Incheon, South Korea; 3Ewha Womans University School of
Medicine, Seoul, South Korea; 4Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, South Korea; 5Soonchunhyang
University Bucheon Hospital, Bucheon, Gyeonggi-Do, South Korea; 6Pusan
University Hospital, Busan, South Korea; 7Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, South Korea;8Department of Neurology Myongji Hospital, Goyang, South Korea;9Konkuk University School of Medicine, Seoul, South Korea; 10Austin
Health, Heidelberg, VIC, Australia; 11Ajou University Hospital, Suwon,
South Korea; 12Dong-A University College of Medicine, Busan, South
Korea. Contact e-mail: [email protected]
Background:The efficacy of cognitive intervention programs remains to be
verified using a randomized trial with standardized intervention in mild cog-
nitive impairment (MCI). The effectiveness of home-based cognitive inter-
vention programs have never been studied in MCI. The objective of this
study was to investigate the efficacy of a group cognitive intervention and
a home-based cognitive intervention about cognitive function in amnestic
MCI (aMCI). Methods: Using a randomized control design, 297 partici-
pants with MCI were randomly assigned to a group cognitive intervention,
a home-based cognitive intervention, or waitlist control group. The inter-
vention was a multicomponent cognitive intervention which focused on
teaching prospective and episodic memory strategies and using them in their
daily life. Participants were assessed on primary measure of the modified
Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-Cog) at
baseline, post-intervention, and 12 weeks’ and 24 weeks’ follow-up. Sec-
ondary measures evaluated memory, cognition, behavior, quality of life,
and function. Results: Overall, 99 and 98 participants received group cog-
nitive intervention and home-based cognitive intervention, respectively, for
12weeks. Of these, about 70% of the participants completed the interven-
tion. We noted a significant decrease in modified ADAS-Cog (-2.766.1
vs. -0.8265.1, p ¼0.02) and Clinical Dementia Rating Sum of Boxes
(CDR-SB) scores (-0.2160.64 vs. 0.0460.56, p ¼0.01) in favor of home-
based cognitive intervention compared to the waitlist control group at the
post-intervention point. There was a significant group effect on modified
ADAS-cog through the all assessment points between home-based cognitive
intervention and controls (p ¼0.02). The interaction effect on modified
ADAS-cog was significant between the assessment phase effect and the
group (group cognitive intervention versus controls) (p ¼0.048). Conclu-
sions: Home-based cognitive intervention and group cognitive intervention
could be useful to improve cognition in aMCI.
P2-372 NON- PHARMACOLOGIC INTERVENTION IN
PEOPLE WITH DEMENTIA IN BRAZIL: AN
OVERVIEW
Jacqueline Abrisqueta-Gomez1, Karen Rosangela Silva De Souza
Saviotti2, Carmen Silvia Calandria Ponce3, Flavia Lorenzini Valenca
Locatelli4, Deolinda Lacerda F Batista4, 1Check up do Cerebro/Brain
Checkup - Consulting and Research in Cognitive Neurosciences, Sao Paulo
SP, Brazil; 2INTEGRARTE Centro de Atividades, Belo Horizonte/MG,
Brazil; 3Brain Checkup - Consulting and Research in Cognitive
Neurosciences, Sao Paulo, Brazil; 4Brain Checkup - Consulting and
Research in Cognitive Neurosciences., Sao Paulo/SP, Brazil.
Contact e-mail: [email protected]
Background: The challenges to governments to respond to the growing num-
bers of peoplewith dementia are substantial. A broad public health approach is
needed to improve the care andquality of life of peoplewith dementia and fam-
ily caregivers. Pharmacologic approaches, have modest benefits and some
risks. Some non-pharmacologic interventions (NPIs) have been shown to be
safe and can help to reduce the impact of cognitive, emotional and behavioral
symptoms. In Brazil there are few institutions and professionals working in
this field. Thus, our objective is to identify the national scientific production
on this matter. Methods: The search was conducted through Brazilian
Cochrane Center, together with the LILACS andMedline scientific databases.
We included all papers published up to 2012 by Brazilian groups. For the
search, the following key words were used: cognitive rehabilitation, neuro-
psychological rehabilitation, cognitive training, memory stimulation, prob-
lem solving, reality orientation, validation, reminiscence, ADL training,
external aid, memory aid, electronic aids, occupational therapy, music ther-
apy, transcranial stimulation, multisensory stimulation, physical exercise,
art therapy, massage and touch, recreation activities, social skills of commu-
nication, behavioral management, quality of life, well-being support group,
education, coping, training, day care, home care, comprehensive support.
Key words were crossed with the term [dementia OR cognitive impairment
OR Alzheimer OR caregivers]. Results: Eighteen articles were found, being
9 correspondent to cognitive intervention (cognitive or neuropsychological