Cognitive Rehabilitation in Early Dementia and Mild Cognitive Impairment: Is It helpful?

Submission note: A thesis submitted by published work in total fulfilment of the requirements of the degree of Doctor of Philosophy to the Lincoln Centre for Research on Ageing, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

Thesis with publications.

With the numbers of people living with dementia growing dramatically, ways to assist these individuals to live well and to stay independent for as long as possible are urgently needed. This research aimed to investigate the potential for individualised cognitive rehabilitation interventions to assist people with Mild Cognitive Impairment (MCI) or early dementia to function better in day-to-day life. In Study 1, the usefulness of information handouts outlining strategies to manage cognitive impairment was investigated (n equals 40). The study found that the handouts were largely ineffective for people with MCI/early dementia. Hence, a new goal directed, four-session, face-to-face intervention was designed to assist people with MCI/early dementia to learn and apply cognitive management strategies in day-today life. The intervention was implemented and evaluated in a randomised control trial (n equals 40), using a real-world clinical team with counsellors co-opted from the Alzheimer’s Association. The study demonstrated that people who received the intervention were more likely than the control group to report increases in goal performance and goal satisfaction. Two further qualitative studies were able to demonstrate improvements in psychological wellbeing and quality of life as well, for at least a subgroup of participants. Limitations of the second study included small sample size, no active control group, no informant- or clinician-rated goal attainment, and the potential for compromised treatment fidelity. Despite these limitations, it was concluded that a relatively short, individualised cognitive rehabilitation intervention can be clinically effective in enabling people with MCI/early dementia to improve their function in everyday tasks targeted in therapy. Further research is required to compare group and individually tailored formats for cognitive rehabilitation.