A randomized cross-over controlled study on cognitive rehabilitation of instrumental activities of daily living in Alzheimer disease

Am J Geriatr Psychiatry. 2014 Nov;22(11):1188-99. doi: 10.1016/j.jagp.2013.03.008. Epub 2013 Jul 17.


Objective: The goal of the study was to investigate the effectiveness of a memory rehabilitation program to re-learn instrumental activities of daily living (IADLs) in patients with Alzheimer disease (AD).

Design: This was a 6-month block-randomized cross-over controlled study.

Setting: All evaluation and training sessions were performed at each patient's home.

Participants: Twenty participants with mild to moderate AD.

Intervention: The trained IADL was chosen by the patient and his/her caregiver in order to target the patient's needs and interests. Participants were trained twice a week for 4 weeks with the errorless learning (ELL) and spaced retrieval (SR) cognitive techniques. After training, there were several follow-ups over a period of at least 3 months.

Measurements: Performance on the trained IADL was assessed by a Direct Measure of Training (DMT), an observational instrument adapted from a well-validated scale. General cognitive function, everyday memory functioning, quality of life, neuropsychiatric symptoms and ADL/IADL of patients, as well as the caregiver's burden were assessed as secondary outcomes.

Results: A statistical significant difference was found between the trained and untrained groups on the DMT immediately following the intervention. Improvements were maintained for a 3-month period. The training did not have effects on any other measures.

Conclusions: The present study showed that it is possible for AD patients to relearn significant IADLs with the ELL and SR techniques and to maintain these gains during at least 3 months. The findings of this study emphasize the importance to design robust but individualized intervention tailored on patients' particular needs.

Keywords: Alzheimer disease; cognitive rehabilitation; errorless learning; instrumental activities of daily living; spaced retrieval.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living / psychology*
  • Aged, 80 and over
  • Alzheimer Disease / psychology
  • Alzheimer Disease / rehabilitation*
  • Cognition
  • Cross-Over Studies
  • Female
  • Humans
  • Male
  • Memory
  • Neuropsychological Tests
  • Quality of Life / psychology
  • Treatment Outcome