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Alzheimer Hastalığında Bilişsel Temelli Terapiler
Cognitive-Based Therapies in Alzheimer Disease
Received Date : 11 Jun 2020
Accepted Date : 10 Jul 2020
Available Online : 28 Sep 2020
Doi: 10.31609/jpmrs.2020-77305 - Makale Dili: TR
J PMR Sci. 2020;23(3):224-8
ÖZET
Alzheimer hastalığı (AH) tedavisinde kullanılan asetilkolinesteraz inhibitörleri ve memantinin etkileri sınırlı olduğundan, son zamanlarda farmakolojik tedaviye ek olarak bilişsel temelli terapiler gibi tamamlayıcı yöntemler üzerinde durulmaktadır. Bilişsel temelli terapiler, bilişsel eğitim ve bilişsel rehabilitasyon şeklinde 2 grupta sınıflandırılmaktadır. Bilişsel eğitim; bellek, dikkat, problem çözme gibi bilişsel işlevleri yansıtan standart bir grup görevi yerine getirmek üzere hazırlanmıştır. Bilişsel rehabilitasyon ise kişinin ailesi ve sağlık görevlileri tarafından duruma özgü gerçekçi hedeflerin oluşturulmasını ve bu hedeflere ulaşmak için gerekli yolların belirlenmesini amaçlayan kişiye özel bir yaklaşımdır. Uygulama yöntemleri arasındaki farklılıklardan dolayı etkinlik konusunda bazı çelişkiler bulunsa da yapılan çalışmalarda bu tür uygulamaların bilişsel yıkımı azaltmada faydalı olabileceği belirtilmektedir. Ayrıca bu uygulamalarla hastalardaki nöropsikiyatrik belirtilerin ve bakım veren tükenmişliğinin azaldığı ve hem hasta hem de bakım verenin yaşam kalitesinin arttığı gözlenmektedir. Bilişsel uygulamaların hem nöronal iletişim ağı düzeyinde hem de moleküler ve sinaptik düzeyde beyin fonksiyonlarını değiştirebileceği gösterilmiştir. Terapilerin, kişiye özgü, hedef odaklı ve gerçekçi olması önemlidir. Bu uygulamalara, en erken evrede hatta mümkünse normal sağlıklı yaşlılarda başlanmalı, düzenli sosyal etkileşim ve fiziksel aktiviteyle desteklenmelidir. Gerektiği durumlarda farmakolojik tedaviye devam edilmelidir. Bu derlemede, normal yaşlanmadan AH’ye kadar olan süreçte uygulanan bilişsel rehabilitasyon başta olmak üzere bilişsel temelli tedavilerin, biliş, işlevsellik, davranışsal belirtiler ve bakım veren yükü üzerindeki etkinliğinin araştırılması amaçlanmaktadır.
ABSTRACT
Because of the effects of acetylcholinesterase inhibitors and memantine used in the treatment of Alzheimer's disease (AD) are limited, recently, complementary methods such as cognitive-based therapies in addition to pharmacological treatment are considered. Cognitive based therapies are classified into 2 groups: cognitive training and cognitive rehabilitation. Cognitive training is designed to perform a standard group task that reflects cognitive functions such as memory, attention, problem solving. On the other hand, cognitive rehabilitation is a personalized approach aimed at establishing realistic conditions specific to the situation and determining the necessary ways to achieve these goals by the family and health workers. Although there are some contradictions about effectiveness due to the differences between the methods of interventions, it is emphasized in studies that such cognitive-based reinforcement therapies can be beneficial in reducing cognitive decline. In addition, it is observed that the neuropsychiatric symptoms of the patients and caregivers’ burnout decrease and the quality of life of both the patients and caregivers increase by these interventions. It has been shown that cognitive interventions can alter brain functions both at the neuronal communication network level and at the molecular and synaptic levels. It is important that the therapies are individual, goal oriented and realistic. These therapies should be initiated at the earliest stages of the disease and even in normal healthy elderly, if possible, and should be supported by regular social interaction and physical activity. If necessary, pharmacological treatment should be continued. In this review, it is aimed to investigate the effectiveness of cognitive based therapies, particularly cognitive rehabilitation, on cognition, functionality, behavioral symptoms and caregiver burden in the process from normal aging to AD.
REFERENCES
  1. Alzheimer's Association. Alzheimer's disease facts and figures. Alzheimers Dement. 2011;7(2):208-44. [Crossref]  [PubMed] 
  2. Fiest KM, Roberts JI, Maxwell CJ, Hogan DB, Smith EE, Frolkis A, et al. The prevalence and ıncidence of dementia due to Alzheimer's disease: a systematic review and meta-analysis. Can J Neurol Sci. 2016;43 Suppl 1:S51-82. [Crossref]  [PubMed] 
  3. Gurvit H, Emre M, Tinaz S, Bilgic B, Hanagasi H, Sahin H, et al. The prevalence of dementia in an urban Turkish population. Am J Alzheimers Dis Other Demen. 2008;23(1):67-76. [Crossref]  [PubMed] 
  4. Sperling RA, Aisen PS, Beckett LA, Bennett DA, Craft S, Fagan AM, et al. Toward defining the preclinical stages of Alzheimer's disease: recommendations from the national iğnstitute on aging-Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):280-92. [Crossref]  [PubMed]  [PMC] 
  5. Rebok GW, Ball K, Guey LT, Jones RN, Kim HY, King JW, et al. Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc. 2014;62(1):16-24. [Crossref]  [PubMed]  [PMC] 
  6. Olazarán J, Mu-iz R, Reisberg B, Pe-a-Casanova J, del Ser T, Cruz-Jentoft AJ, et al. Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease. Neurology. 2004;28;63(12):2348-53. [Crossref]  [PubMed] 
  7. Choi J, Twamley EW. Cognitive rehabilitation therapies for Alzheimer's disease: a review of methods to improve treatment engagement and self-efficacy. Neuropsychol Rev. 2013;23(1):48-62. [Crossref]  [PubMed]  [PMC] 
  8. Kallio EL, Öhman H, Kautiainen H, Hietanen M, Pitkälä K. cognitive training interventions for patients with Alzheimer's disease: a systematic review. J Alzheimers Dis. 2017;56(4):1349-72. [Crossref]  [PubMed] 
  9. Clare L, Woods RT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: a review. Neuropsychological Rehabilitation. 2004;14(4):385-401. [Crossref] 
  10. Wilson BA, Evans JJ, Keohane C. Cognitive rehabilitation: a goal-planning approach. J Head Trauma Rehabil. 2002;17(6):542-55. [Crossref]  [PubMed] 
  11. Clare L, Woods RT, Moniz Cook ED, Orrell M, Spector A. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev. 2003;(4):CD003260. [Crossref] 
  12. Kasper E, Thöne-Otto A, Bürger K, Schröder SG, Hoffmann W, Schneider W, et al. [Cognitive rehabilitation in early stage Alzheimer's disease]. Nervenarzt. 2016;87(7):708-18. [Crossref]  [PubMed] 
  13. Belleville S, Clément F, Mellah S, Gilbert B, Fontaine F, Gauthier S, et al. Training-related brain plasticity in subjects at risk of developing Alzheimer's disease. Brain. 2011;134(Pt 6):1623-34. [Crossref]  [PubMed] 
  14. Heiss WD, Kessler J, Mielke R, Szelies B, Herhols K. Long-term effects of phosphatidylserine, pyritinol, and cognitive training in Alzheimer's disease: a neuropsychological EEG, and PET investigation. Dementia. 1994;5(2):88-98. [Crossref]  [PubMed] 
  15. Pariente J, Cole S, Henson R, Clare L, Kennedy A, Rossor M, et al. Alzheimer patients engage an alternative cortical network during a memory task. Ann Neurol. 2005;58(6):870-9. [Crossref]  [PubMed] 
  16. Clare L, Linden DE, Woods RT, Whitaker R, Evans SJ, Parkinson CH, et al. Goal-oriented cognitive rehabilitation for people with early-stage Alzheimer disease: a single-blind randomized controlled trial of clinical efficacy. Am J Geriatr Psychiatry. 2010;18(10):928-39. [Crossref]  [PubMed] 
  17. Hertzog C, Kramer AF, Wilson RS, Lindenberger U. Enrichment effects on adult cognitive development: can the functional capacity of older adults be preserved and enhanced? Psychol Sci Public Interest. 2008;9(1):1-65. [Crossref]  [PubMed] 
  18. Foresight Mental Capital and Wellbeing Project (2008). Final Project Report. London: The Government Office for Science; 2008. p.317.
  19. Montoya-Murillo G, Ibarretxe-Bilbao N, Pe-a J, Ojeda N. Effects of cognitive rehabilitation on cognition, apathy, quality of life, and subjective complaints in the elderly: a randomized controlled trial. Am J Geriatr Psychiatry. 2020;28(5):518-29. [Crossref]  [PubMed] 
  20. Zhu X, Yin S, Lang M, He R, Li J. The more the better? A meta-analysis on effects of combined cognitive and physica lintervention on cognition in healthy older adults. Ageing Res Rev. 2016;31:67-79. [Crossref]  [PubMed] 
  21. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):270-9. [Crossref]  [PubMed]  [PMC] 
  22. Fabbri L, Mosca IE, Gerli F, Martini L, Pancani S, Lucidi G, et al. The games for older adults active life (GOAL) project for people with mild cognitive impairment and vascula cognitive impairment: a study protocol for a randomized controlled trial. Front Neurol. 2019;9:1040. [Crossref]  [PubMed]  [PMC] 
  23. Regan B, Wells Y, Farrow M, O'Halloran P, Workman B. MAXCOG-maximizing cognition: a randomized controlled trial of the efficacy of goal-oriented cognitive rehabilitationfor people with mild cognitive impairment and early Alzheimer disease. Am J Geriatr Psychiatry. 2017;25(3):258-69. [Crossref]  [PubMed] 
  24. Ge S, Zhu Z, Wu B, McConnell ES. Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review. BMC Geriatr. 2018;15;18(1):213. [Crossref]  [PubMed]  [PMC] 
  25. Germain S, Wojtasik V, Lekeu F, Quittre A, Olivier C, Godichard V, et al. Efficacy of cognitive rehabilitation in Alzheimer disease: a 1-year follow-up study. J Geriatr Psychiatry Neurol. 2019;32(1):16-23. [Crossref]  [PubMed] 
  26. Amieva H, Robert PH, Grandoulier AS, Meillon C, De Rotrou J, Andrieu S, et al. Group an individual cognitive therapies in Alzheimer's disease: the ETNA3 randomized trial. Int Psychogeriatr. 2016;28(5):707-17. [Crossref]  [PubMed] 
  27. Brueggen K, Kasper E, Ochmann S, Pfaff H, Webel S, Schneider W, et al. Cognitive rehabilitation in Alzheimer's disease: a controlled intervention trial. J Alzheimers Dis. 2017;57(4):1315-24. [Crossref]  [PubMed] 
  28. Draper B, Brodaty H, Finkel SI. Complete guide to behavioral and psychological symptoms of dementia. 3rd ed. Northfield, IL: International Psychogeriatric Association; 2010. p.222.The IPA Complete Guides to Behavioral and Psychological Symptoms of Dementia (BPSD)
  29. Tatsumi H, Nakaaki S, Torii K, Shinagawa Y, Watanabe N, Murata Y, et al. Neuropsychiatric symptoms predict change in quality of life of Alzheimer disease patients: a two-year follow-up study. Psychiatry Clin Neurosci. 2009;63(3):374-84. [Crossref]  [PubMed] 
  30. Craig D, Mirakhur A, Hart DJ, McIlroy SP, Passmore AP. A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease. Ame J Geriatr Psychiatry. 2005;13(6),460-8. [Crossref]  [PubMed] 
  31. Niu YX, Tan JP, Guan JQ, Zhang ZQ, Wang LN. Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer's disease: a randomized controlled trial. Clin Rehabil. 2010;24(12):1102-11. [Crossref]  [PubMed] 
  32. Brunelle-Hamann L, Thivierge S, Simard M. Impact of a cognitive rehabilitation intervention on neuropsychiatric symptoms in mild to moderate Alzheimer's disease. Neuropsychol Rehabil. 2015;25(5):677-707. [Crossref]  [PubMed]