Cognitive training in older adults with Mild Cognitive Impairment: Impact on cognitive and functional performance

Brum, Paula Schimidt; Forlenza, Orestes Vicente; Yassuda, Mônica Sanches

doi:10.1590/S1980-57642009DN30200010

Abstract

Aging is associated with cognitive decline, yet this does not prevent older adults from finding ways to compensate for age-related deficits. Earlier studies have shown that cognitively unimpaired older adults can benefit from training programs. The efficacy of cognitive interventions among older adults without dementia but with cognitive decline (mild cognitive impairment, MCI) has not yet been widely tested.

Objectives:

To evaluate the impact of 8-session cognitive training on the cognitive and functional performance of older adults with MCI.

Methods:

16 older adults diagnosed with MCI received cognitive training (18 participated as controls). All participants were assessed pre and post intervention using the Short Cognitive Test (SKT), Direct Assessment of Functional Scale Revised (DAFS-R), Geriatric Depression Scale (GDS), and Clock Drawing Test (CDT).

Results:

A significant improvement was observed in the study group between pre and post-test in attention (SKT), time orientation, shopping skills and dealing with finances (DAFS-R) along with reduced depressive symptoms (GDS).

Conclusion:

These results indicate the importance of non-pharmacological interventions for older adults with MCI to help compensate for cognitive decline.

Key words:
Mild Cognitive Impairment; cognitive training; aging; cognition; functionality.

Resumo

O envelhecimento está associado ao declínio de algumas funções cognitivas, entretanto, este fato não impede que a pessoa idosa encontre formas de compensar déficits. Estudos anteriores documentaram que a pessoa idosa sem declínio cognitivo pode beneficiar-se de programas de treino. A eficácia de intervenções cognitivas junto à população idosa sem demência mas com alterações cognitivas (comprometimento cognitivo leve, CCL) ainda não foi testada amplamente.

Objetivos:

Avaliar o impacto de treino cognitivo de 8 sessões na funcionalidade e desempenho cognitivo em idosos com CCL.

Métodos:

16 idosos com CCL receberam treino cognitivo e 18 participaram como grupo controle; pacientes e controles foram avaliados antes e depois da intervenção com o Short Cognitive Test (SKT), Direct Assessment of Funcional Scale Revised (DAFS-R), Escala de Depressão Geriátrica (GDS) e o Teste do Desenho do Relógio (TDR).

Resultados:

Foi observada melhora significante no grupo experimental do pré para o pós-teste no desempenho em atenção (SKT), orientação temporal, habilidade para fazer compras e lidar com dinheiro (DAFS-R) e diminuição nos sintomas depressivos (GDS).

Conclusões:

Estes resultados destacam a importância da intervenção não-farmacológica em idosos com CCL para compensar déficits cognitivos.

Palavras-chave:
Comprometimento Cognitivo Leve; treino cognitivo; envelhecimento; cognição; funcionalidade

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References

¹
Camarano A. Envelhecimento da população brasileira: uma contribuição demográfica. In: Freitas EV, Py L, Cançado FAX, Gorzoni ML (Eds). Tratado de geriatria e gerontologia (Rio de Janeiro): Guanabara Koogan, 2 edição; 2006:88-102
²
Salthouse TA. Theoretical perspectives on cognitive aging. Hillsdale, NJ: Erlbaum; 1991
³
West RL. An application of prefrontal cortex function theory to cognitive aging. Psychol Bull 1996;120:272-292
⁴
Morris JC, Storandt M, Miller JP, Mckeel DW, Price JL, Rubin EH. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol 2001; 58:397-405
⁵
Hansson O, Zetterberg H, Buchhave P, Londos E, Blennow K, Minthon L. Association between CSF biomarkers and incipient Alzheimer's disease in patients with mild cognitive impairment: a follow-up study. Lancet Neurol 2006;5:228-234
⁶
Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV. Current concepts in mild cognitive impairment. Arch Neurol 2001;58:1985-1992
⁷
Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, Dekosky ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of. Neurology. Neurology 2001;56:1133-1142. Comment in: Neurology 2001;56:1131-1132
⁸
Raschetti R, Albanese E, Vanacore N, Maggini M. Cholinesterase inhibitors in mild cognitive impairment: a systematic review of randomised trials. PLoS Med. 2007; 27;4:e338
⁹
Diniz BS, Pinto JA, Gonzaga MLC, Guimarães FM, Gattaz WF, Forlenza OV. 'To treat or not to treat'? A meta-analysis of the use of cholinesterase inhibitors in mild cognitive impairment for delaying progression to Alzheimer's disease. European Eur Arch Psychiatry Clin Neurosci 2009 ;259:248-256.
¹⁰
Belleville S. Cognitive training for persons with mild cognitive impairment. Int psychogeriatr 2008;20:57-66.
¹¹
Miotto EC, Serrão VT, Guerra GB, Lúcia MCS, Scaff M. Reabilitação neuropsicológica de deficits cognitivos e transtorno cognitivo leve. Uma revisão da literatura. Dement Neuropsychol 2008;2:139-145
¹²
Olchik MR. Treino de memória: um novo aprender no envelhecimento. Tese. Universidade Federal do Rio Grande do Sul. Porto Alegre. 2008;14-130.
¹³
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment : clinical characterization and outcome. Arch Neurol 1999;56: 303-308.
¹⁴
Bottino CM, Almeida OP, Tamai S, Forlenza OV, Scalco MZ, Carvalho IAM. CAMDEX The Cambridge Examination for Mental Disorders of the Elderly: tradução e adaptação para o português. Projeto Terceira Idade (PROTER). 1999; São Paulo: Instituto e Departamento de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.
¹⁵
Jorn AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry 1988;152:209-213
¹⁶
Wilson BA, Baddeley AD, Cockburn JM. The Rivermead Behavioural Memory Test. 2.Ed. Tradução Oliveira RM, Schmidt SL. Suffolk: Thames Valley Company, 1991.
¹⁷
Fuld P. Guaranteed stimulus processing in the evaluation of memory and learning. Cortex 1980;16:255-271.
¹⁸
Flaks MK, Yassuda MS, Regina ACB, Cid CG, Camargo CHP, Gattaz WF, Forlenza OV. The Short Cognitive Performance Test (SKT): a preliminary study of its psychometric properties in Brazil. Int Psychogeriatr 2006;18:121-133.
¹⁹
Hartmut L, Hellmut, E. The SKT. A Short Cognitive Performance Test for Assessing Deficits of Memory and Attention. Int Psychogeriatr 1997;9:115-121.
²⁰
Zubicaray G, Ashton R. Nelson's Modified Cards Sorting Test: a review. Clin Neuropsychol 1996;10:245-254.
²¹
Army individual test battery. Manual of directions and scoring. Washington, DC: War Department, Adjunt General's Office;1944.
²²
Wechsler DI. Examiner's Manual: Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation;1981.
²³
Loewenstein AD, Amigo E, Duara R, et al. A new scale for the assessment of functional status in Alzheimer Disease and related disorders. J Gerontol 1989; 4:114-121.
²⁴
Pereira FS, Yassuda MS, Oliveira AM, Forlenza OV. Disfunção Executiva correlacionada com insuficiência do status funcional em idosos com diferentes graus de comprometimento cognitivo. Int Psychogeriatr 2008;20:1104-1115.
²⁵
Almeida OP, Almeida SA. Confiabilidade da versão brasileira da escala de depressão em geriatria (GDS) versão reduzida, Arq Neuropsiquiatr 1999;57:421-426.
²⁶
Aprahamian I, Martinelli JE, Yassuda MS. O teste do desenho do relógio: revisão critica de seu valor na triagem de demências iniciais em idosos. Rev Soc Bras Clín Méd 2008;6:130-134.
²⁷
Fuzikawa C, Lima-Costa MF, Uchoa E, Barreto SM, Shulman K. Bambuí Health and Ageing Study. A population based study on the intra and inter-rater reliability of the clock drawing test in Brazil: the Bambuí Health and Ageing Study. Int J Geriatr Psychiatry. 2003;18:450-456.
²⁸
Sunderland T, Hill JL, Mellow AM, et al. Clock Drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.
²⁹
Rapp S, Brenes G, Marsh AP. Memory enhancement training for older adults with mild cognitive impairment: a preliminary study. Aging Ment Health 2002;6:5-11.
³⁰
Belleville S, Chetrkow H, Gauthier S. Working memory and control of attention in person with Alzheimer's disease and mild cognitive impairment. Neuropsychology 2007;21:456-469.
³¹
Winocur G, Craik FIM, Levine B, et al. Cognitive rehabilitation in the elderly: Overview and future directions. J Int Neuropsychol Society 2007;13:166-171.
³²
Talassi E, Guerrecshi M, Feriani M, Fedi V, Bianchetti A, Trabucci M. Effectiveness of a cognitive rehabilitation program in mild dementia (MD) and mild cognitive impairment (MCI): a case control study. Arch Gerontol Geriatr 2007; 44 (Suppl 1):391-399.
³³
Cipriani G, Bianchetti A, Trabucchi M. Outcomes of a computer-based cognitive rehabilitation program on Alzheimer's disease patients compared with those on patients affected by mild cognitive impairment. Arch Gerontol Geriatr 2006; 43:327-335.
³⁴
Akhtar S, Moulin CJA, Bowie PCW. Are people with mild cognitive impairment aware of the benefits of errorless learning? Neuropsychol Rehabil 2006;16:329-346.
³⁵
Levine B, Stuss DT, Winocur W, et al. Cognitive rehabilitation in the elderly: Effects on strategic behavior in relation to goal management. J Int Neuropsychol Society. 2007; 13:143-152
³⁶
Rozzini L, Costardi D, Vicini CB, Franzoni, S, Trabucchi M, Padovani A. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. Int J Geriatr psychiatry 2007;22:356-360.
³⁷
Belleville S, Gilbert B, Fontaine F, Gagnon L, Menard E, Gauthier S. Improvement of episodic memory in persons with mild cognitive impairment and healthy older adults: evidence from a cognitive intervention program. Dement Geriatr Cogn Disord 2006;22:486-499.
³⁸
Troyer AK, Graves RE, Cullum CM. Executive functioning as a mediator of the relationship between age and episodic memory in healthy aging. Aging Neuropsychol Cog 1994;1:45- 53.
³⁹
Willis SL, Tennstedt SL, Marsiske M, et al. Long term effects of cognitive training on everyday functional outcomes in older adults. JAMA 2006;296):2805-2814.
⁴⁰
Yassuda MS. Memória e envelhecimento saudável. In: Freitas EV, Py L, Cançado FAX, Gorzoni ML (Eds). Tratado de geriatria e gerontologia (Rio de Janeiro): Guanabara Koogan, 2 edição; 2006:1245-1251.
⁴¹
Yassuda MS, Abreu, VPS. Avaliação cognitiva. In: Freitas EV, Py L, Cançado FAX, Gorzoni ML (Eds). Tratado de geriatria e gerontologia (Rio de Janeiro): Guanabara Koogan, 2 edição; 2006:1252-1259.
⁴²
Hampstead BM, Sathian K, Moore AB, Nalisnick C, Stringer AY. Explicit memory training leads to improved memory for face-name pairs in patients with mild cognitive impairment: results of a pilot investigation. J Int Neuropsychol Soc 2008; 14:883-889.
⁴³
Kurz A, Pohl C, Ramsenthaler M, Sorg C. Cognitive rehabilitation in patients with mild cognitive impairment. Int J Geriatr Psychiatry 2009; 24:163-168.
⁴⁴
Ramos, LR. Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano: Projeto Epidoso, São Paulo. Cad Saúde Pública 2003;19:793-797.

Publication Dates

Publication in this collection
Apr-Jun 2009

History

Received
13 Feb 2009
Accepted
30 Apr 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Camarano A. Envelhecimento da população brasileira: uma contribuição demográfica. In: Freitas EV, Py L, Cançado FAX, Gorzoni ML (Eds). Tratado de geriatria e gerontologia (Rio de Janeiro): Guanabara Koogan, 2 edição; 2006:88-102

[2] ²
Salthouse TA. Theoretical perspectives on cognitive aging. Hillsdale, NJ: Erlbaum; 1991

[3] ³
West RL. An application of prefrontal cortex function theory to cognitive aging. Psychol Bull 1996;120:272-292

[4] ⁴
Morris JC, Storandt M, Miller JP, Mckeel DW, Price JL, Rubin EH. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol 2001; 58:397-405

[5] ⁵
Hansson O, Zetterberg H, Buchhave P, Londos E, Blennow K, Minthon L. Association between CSF biomarkers and incipient Alzheimer's disease in patients with mild cognitive impairment: a follow-up study. Lancet Neurol 2006;5:228-234

[6] ⁶
Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV. Current concepts in mild cognitive impairment. Arch Neurol 2001;58:1985-1992

[7] ⁷
Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, Dekosky ST. Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of. Neurology. Neurology 2001;56:1133-1142. Comment in: Neurology 2001;56:1131-1132

[8] ⁸
Raschetti R, Albanese E, Vanacore N, Maggini M. Cholinesterase inhibitors in mild cognitive impairment: a systematic review of randomised trials. PLoS Med. 2007; 27;4:e338

[9] ⁹
Diniz BS, Pinto JA, Gonzaga MLC, Guimarães FM, Gattaz WF, Forlenza OV. 'To treat or not to treat'? A meta-analysis of the use of cholinesterase inhibitors in mild cognitive impairment for delaying progression to Alzheimer's disease. European Eur Arch Psychiatry Clin Neurosci 2009 ;259:248-256.

[10] ¹⁰
Belleville S. Cognitive training for persons with mild cognitive impairment. Int psychogeriatr 2008;20:57-66.

[11] ¹¹
Miotto EC, Serrão VT, Guerra GB, Lúcia MCS, Scaff M. Reabilitação neuropsicológica de deficits cognitivos e transtorno cognitivo leve. Uma revisão da literatura. Dement Neuropsychol 2008;2:139-145

[12] ¹²
Olchik MR. Treino de memória: um novo aprender no envelhecimento. Tese. Universidade Federal do Rio Grande do Sul. Porto Alegre. 2008;14-130.

[13] ¹³
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment : clinical characterization and outcome. Arch Neurol 1999;56: 303-308.

[14] ¹⁴
Bottino CM, Almeida OP, Tamai S, Forlenza OV, Scalco MZ, Carvalho IAM. CAMDEX The Cambridge Examination for Mental Disorders of the Elderly: tradução e adaptação para o português. Projeto Terceira Idade (PROTER). 1999; São Paulo: Instituto e Departamento de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

[15] ¹⁵
Jorn AF, Korten AE. Assessment of cognitive decline in the elderly by informant interview. Br J Psychiatry 1988;152:209-213

[16] ¹⁶
Wilson BA, Baddeley AD, Cockburn JM. The Rivermead Behavioural Memory Test. 2.Ed. Tradução Oliveira RM, Schmidt SL. Suffolk: Thames Valley Company, 1991.

[17] ¹⁷
Fuld P. Guaranteed stimulus processing in the evaluation of memory and learning. Cortex 1980;16:255-271.

[18] ¹⁸
Flaks MK, Yassuda MS, Regina ACB, Cid CG, Camargo CHP, Gattaz WF, Forlenza OV. The Short Cognitive Performance Test (SKT): a preliminary study of its psychometric properties in Brazil. Int Psychogeriatr 2006;18:121-133.

[19] ¹⁹
Hartmut L, Hellmut, E. The SKT. A Short Cognitive Performance Test for Assessing Deficits of Memory and Attention. Int Psychogeriatr 1997;9:115-121.

[20] ²⁰
Zubicaray G, Ashton R. Nelson's Modified Cards Sorting Test: a review. Clin Neuropsychol 1996;10:245-254.

[21] ²¹
Army individual test battery. Manual of directions and scoring. Washington, DC: War Department, Adjunt General's Office;1944.

[22] ²²
Wechsler DI. Examiner's Manual: Wechsler Adult Intelligence Scale-Revised. New York: Psychological Corporation;1981.

[23] ²³
Loewenstein AD, Amigo E, Duara R, et al. A new scale for the assessment of functional status in Alzheimer Disease and related disorders. J Gerontol 1989; 4:114-121.

[24] ²⁴
Pereira FS, Yassuda MS, Oliveira AM, Forlenza OV. Disfunção Executiva correlacionada com insuficiência do status funcional em idosos com diferentes graus de comprometimento cognitivo. Int Psychogeriatr 2008;20:1104-1115.

[25] ²⁵
Almeida OP, Almeida SA. Confiabilidade da versão brasileira da escala de depressão em geriatria (GDS) versão reduzida, Arq Neuropsiquiatr 1999;57:421-426.

[26] ²⁶
Aprahamian I, Martinelli JE, Yassuda MS. O teste do desenho do relógio: revisão critica de seu valor na triagem de demências iniciais em idosos. Rev Soc Bras Clín Méd 2008;6:130-134.

[27] ²⁷
Fuzikawa C, Lima-Costa MF, Uchoa E, Barreto SM, Shulman K. Bambuí Health and Ageing Study. A population based study on the intra and inter-rater reliability of the clock drawing test in Brazil: the Bambuí Health and Ageing Study. Int J Geriatr Psychiatry. 2003;18:450-456.

[28] ²⁸
Sunderland T, Hill JL, Mellow AM, et al. Clock Drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.

[29] ²⁹
Rapp S, Brenes G, Marsh AP. Memory enhancement training for older adults with mild cognitive impairment: a preliminary study. Aging Ment Health 2002;6:5-11.

[30] ³⁰
Belleville S, Chetrkow H, Gauthier S. Working memory and control of attention in person with Alzheimer's disease and mild cognitive impairment. Neuropsychology 2007;21:456-469.

[31] ³¹
Winocur G, Craik FIM, Levine B, et al. Cognitive rehabilitation in the elderly: Overview and future directions. J Int Neuropsychol Society 2007;13:166-171.

[32] ³²
Talassi E, Guerrecshi M, Feriani M, Fedi V, Bianchetti A, Trabucci M. Effectiveness of a cognitive rehabilitation program in mild dementia (MD) and mild cognitive impairment (MCI): a case control study. Arch Gerontol Geriatr 2007; 44 (Suppl 1):391-399.

[33] ³³
Cipriani G, Bianchetti A, Trabucchi M. Outcomes of a computer-based cognitive rehabilitation program on Alzheimer's disease patients compared with those on patients affected by mild cognitive impairment. Arch Gerontol Geriatr 2006; 43:327-335.

[34] ³⁴
Akhtar S, Moulin CJA, Bowie PCW. Are people with mild cognitive impairment aware of the benefits of errorless learning? Neuropsychol Rehabil 2006;16:329-346.

[35] ³⁵
Levine B, Stuss DT, Winocur W, et al. Cognitive rehabilitation in the elderly: Effects on strategic behavior in relation to goal management. J Int Neuropsychol Society. 2007; 13:143-152

[36] ³⁶
Rozzini L, Costardi D, Vicini CB, Franzoni, S, Trabucchi M, Padovani A. Efficacy of cognitive rehabilitation in patients with mild cognitive impairment treated with cholinesterase inhibitors. Int J Geriatr psychiatry 2007;22:356-360.

[37] ³⁷
Belleville S, Gilbert B, Fontaine F, Gagnon L, Menard E, Gauthier S. Improvement of episodic memory in persons with mild cognitive impairment and healthy older adults: evidence from a cognitive intervention program. Dement Geriatr Cogn Disord 2006;22:486-499.

[38] ³⁸
Troyer AK, Graves RE, Cullum CM. Executive functioning as a mediator of the relationship between age and episodic memory in healthy aging. Aging Neuropsychol Cog 1994;1:45- 53.

[39] ³⁹
Willis SL, Tennstedt SL, Marsiske M, et al. Long term effects of cognitive training on everyday functional outcomes in older adults. JAMA 2006;296):2805-2814.

[40] ⁴⁰
Yassuda MS. Memória e envelhecimento saudável. In: Freitas EV, Py L, Cançado FAX, Gorzoni ML (Eds). Tratado de geriatria e gerontologia (Rio de Janeiro): Guanabara Koogan, 2 edição; 2006:1245-1251.

[41] ⁴¹
Yassuda MS, Abreu, VPS. Avaliação cognitiva. In: Freitas EV, Py L, Cançado FAX, Gorzoni ML (Eds). Tratado de geriatria e gerontologia (Rio de Janeiro): Guanabara Koogan, 2 edição; 2006:1252-1259.

[42] ⁴²
Hampstead BM, Sathian K, Moore AB, Nalisnick C, Stringer AY. Explicit memory training leads to improved memory for face-name pairs in patients with mild cognitive impairment: results of a pilot investigation. J Int Neuropsychol Soc 2008; 14:883-889.

[43] ⁴³
Kurz A, Pohl C, Ramsenthaler M, Sorg C. Cognitive rehabilitation in patients with mild cognitive impairment. Int J Geriatr Psychiatry 2009; 24:163-168.

[44] ⁴⁴
Ramos, LR. Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano: Projeto Epidoso, São Paulo. Cad Saúde Pública 2003;19:793-797.

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