Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-28T20:13:48.228Z Has data issue: false hasContentIssue false
  • English
  • Français

Group and individual cognitive therapies in Alzheimer's disease: the ETNA3 randomized trial

Published online by Cambridge University Press:  17 November 2015

Hélène Amieva ,
Philippe H. Robert ,
Anne-Sophie Grandoulier ,
Céline Meillon ,
Jocelyne De Rotrou ,
Sandrine Andrieu ,
Claudine Berr ,
Béatrice Desgranges ,
Bruno Dubois  and
Chantal Girtanner
...Show all authors
Hélène Amieva*
Affiliation:
INSERM, U897-Epidemiology-Biostatistics, University of Bordeaux, F-33076, Bordeaux, France CHU Bordeaux, Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), France
Philippe H. Robert
Affiliation:
CHU Nice, Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), France
Anne-Sophie Grandoulier
Affiliation:
CHU Bordeaux, Pôle de Santé Publique, USMR and CIC-EC 7, F-33000, Bordeaux, France
Céline Meillon
Affiliation:
CHU Bordeaux, Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), France
Jocelyne De Rotrou
Affiliation:
AP-HP, Hôpital Broca, Service de Gérontologie, F-75013, Paris, France
Sandrine Andrieu
Affiliation:
INSERM, UMR1027, University of Toulouse III, F-31000, Toulouse, France CHU Toulouse, Department of epidemiology and public health, F-31000, Toulouse, France
Claudine Berr
Affiliation:
INSERM, UMR 1061, University of Montpellier, F-33400 Montpellier, France CHU Montpellier, Memory Center of Montpellier (Centre Mémoire de Ressources et de Recherche), Department of Neurology, F-33400 Montpellier, France
Béatrice Desgranges
Affiliation:
INSERM, U1077, Université de Caen Basse-Normandie, Ecole Pratique des Hautes Etudes, CHU de Caen, France
Bruno Dubois
Affiliation:
INSERM UMR S975, Hôpital de la Salpêtrière, F-75651 Paris cedex 13, France
Chantal Girtanner
Affiliation:
CHU de Saint-Étienne, Hôpital Charité, Service de gérontologie clinique, France
Marie-Eve Joël
Affiliation:
University of Paris-Dauphine, Laboratoire d’Economie et de Gestion des Organisations de Santé (LEDa-LEGOS), Paris, France
Benoit Lavallart
Affiliation:
Direction Générale de la Santé, Paris, France
Fati Nourhashemi
Affiliation:
INSERM, UMR1027, University of Toulouse III, F-31000, Toulouse, France CHU Toulouse, Department of epidemiology and public health, F-31000, Toulouse, France
Florence Pasquier
Affiliation:
CHU Lille, Memory Center of Lille (Centre Mémoire de Ressources et de Recherche), France
Muriel Rainfray
Affiliation:
CHU Bordeaux, Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), France
Jacques Touchon
Affiliation:
INSERM, UMR 1061, University of Montpellier, F-33400 Montpellier, France CHU Montpellier, Memory Center of Montpellier (Centre Mémoire de Ressources et de Recherche), Department of Neurology, F-33400 Montpellier, France
Geneviève Chêne
Affiliation:
INSERM, U897-Epidemiology-Biostatistics, University of Bordeaux, F-33076, Bordeaux, France CHU Bordeaux, Pôle de Santé Publique, USMR and CIC-EC 7, F-33000, Bordeaux, France
Jean-François Dartigues
Affiliation:
INSERM, U897-Epidemiology-Biostatistics, University of Bordeaux, F-33076, Bordeaux, France CHU Bordeaux, Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), France
*
Correspondence should be addressed to: Prof Hélène Amieva INSERM U897 Epidemiology and Biostatistics, Université Bordeaux Segalen, 146 Rue Léo Saignat, 33076 Bordeaux cedex, France. Phone: +33 5 57 57 15 10. Email: Helene.Amieva@isped.u-bordeaux2.fr.
Get access

Abstract

Background:

Although non-drug interventions are widely used in patients with Alzheimer's disease, few large scale randomized trials involving a long-term intervention and several cognitive-oriented approaches have been carried out. ETNA3 trial compares the effect of cognitive training, reminiscence therapy, and an individualized cognitive rehabilitation program in Alzheimer's disease to usual care.

Methods:

This is a multicenter (40 French clinical sites) randomized, parallel-group trial, with a two-year follow-up comparing groups receiving standardized programs of cognitive training (group sessions), reminiscence therapy (group sessions), individualized cognitive rehabilitation program (individual sessions), and usual care (reference group). Six hundred fifty-three outpatients with Alzheimer's disease were recruited. The primary efficacy outcome was the rate of survival without moderately severe to severe dementia at two years. Secondary outcomes were cognitive impairment, functional disability, behavioral disturbance, apathy, quality of life, depression, caregiver's burden, and resource utilization.

Results:

No impact on the primary efficacy measure was evidenced. For the two group interventions (i.e. cognitive training and reminiscence), none of the secondary outcomes differed from usual care. The larger effect was seen with individualized cognitive rehabilitation in which significantly lower functional disability and a six-month delay in institutionalization at two years were evidenced.

Conclusions:

These findings challenge current management practices of Alzheimer's patients. While cognitive-oriented group therapies have gained popularity, this trial does not show improvement for the patients. The individualized cognitive rehabilitation intervention provided clinically significant results. Individual interventions should be considered to delay institutionalization in Alzheimer's disease.

Keywords

non-drug therapiesAlzheimerdementiacognitive trainingreminiscenceindividualized cognitive rehabilitation
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 5 , May 2016 , pp. 707 - 717
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, J., Arens, K., Johnson, R. and Coppens, P. (2001). Spaced retrieval vs memory tape therapy in memory rehabilitation for dementia of the Alzheimer's type. Clinical Gerontologist, 24, 123–139.CrossRefGoogle Scholar
Bahar-Fuchs, A., Clare, L. and Woods, R. T. (2013). Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev, 6, CD003260.Google Scholar
Breuil, V. et al. (1994). Cognitive stimulation of patients with dementia: preliminary results. International Journal of Geriatric Psychiatry, 9, 211–217.CrossRefGoogle Scholar
Butler, R. N. (1963). The life review: an interpretation of reminiscence in the aged. Psychiatry, 26, 65–76.CrossRefGoogle ScholarPubMed
Camp, C. J., Bird, M. J. and Cherry, K. E. (2000). Retrieval strategies as a rehabilitation aid for cognitive loss in pathological aging. In Hill, R. D., Bäckman, L. and Stigsdotter, N. A. (eds.), Cognitive Rehabilitation in Old Age. Oxford: Oxford University Press.Google Scholar
Clare, L., Wilson, B. A., Carter, G., Gosses, A., Breen, K. and Hodges, J. R. (2000). Intervening with everyday memory problems in dementia of Alzheimer type: an errorless learning approach. Journal of Clinical and Experimental Neuropsychology, 22, 132–146.CrossRefGoogle ScholarPubMed
Clare, L., Wilson, B. A., Carter, G., Hodges, J. R. and Adams, M. (2001). Long-term maintenance of treatment gains following a cognitive rehabilitation intervention in early dementia of Alzheimer type: a single case study. Neuropsychological Rehabilitation, 11, 477–494.CrossRefGoogle Scholar
Clare, L., Wilson, B. A., Carter, G., Roth, I. and Hodges, J. R. (2002). Relearning face-name associations in early Alzheimer's disease. Neuropsychology, 16, 538–47.CrossRefGoogle ScholarPubMed
Clare, L. and Woods, R. T. (2004). Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: a review. Neuropsychological Rehabilitation, 14, 385–401.CrossRefGoogle Scholar
Clare, L., Woods, R. T., Moniz Cook, E. D., Orrell, M. and Spector, A. (2003). Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Systematic Reviews, 4, CD003260.Google Scholar
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Gaugler, J. E., Kane, R. L., Kane, R. A., Clay, T. and Newcomer, R. (2003). Caregiving and institutionalization of cognitively impaired older people: utilizing dynamic predictors of change. The Gerontologist, 43, 219–229.CrossRefGoogle ScholarPubMed
Gélinas, I., Gauthier, L., McIntyre, M. and Gauthier, S. (1999). Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. American Journal of Occupational Therapy, 53, 471–81.CrossRefGoogle ScholarPubMed
Graff, M. J., Vernooj-Dassen, M. J., Thijssen, M., Dekker, J., Hoefnagels, W. H. and Rikert, M. G. (2006). Community based occupational therapy for patients with dementia and their care givers: randomised controlled trial. BMJ, 333, 1196.CrossRefGoogle ScholarPubMed
Hebert, R., Dubois, M. F., Wolfson, C., Chambers, L. and Cohen, C. (2001). Factors associated with long-term institutionalization of older people with dementia: data from the Canadian study of health and aging. Journal of Gerontology: Medical Sciences, 56, 693–699.Google ScholarPubMed
Heyman, A., Peterson, B., Fillenbaum, G. and Pieper, C. (1997). Predictors of time to institutionalization of patients with Alzheimer's disease: the CERAD experience, part XVII. Neurology, 48, 1304–1309.CrossRefGoogle ScholarPubMed
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–32.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA working group under the auspices of department of health and human services task force on Alzheimer’ disease. Neurology, 34, 939–944.CrossRefGoogle Scholar
Montgomery, S. A. and Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.CrossRefGoogle ScholarPubMed
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1988). The global deterioration scale (GDS). Psychopharmacology Bulletin, 24, 661–663.Google ScholarPubMed
Robert, P. H. et al. (2002). The apathy inventory: assessment of apathy and awareness in Alzheimer's disease, Parkinson's disease and mild cognitive impairment. International Journal of Geriatric Psychiatry, 17, 1099–1105.CrossRefGoogle ScholarPubMed
Rosen, W. G., Mohs, R. C. and Davis, K. L. (1984). A new rating scale for Alzheimer's disease. American Journal of Psychiatry, 141, 1356–1364.Google ScholarPubMed
Spector, A., Orrell, M., Davies, S. and Woods, R. T. (2000). Reminiscence therapy for dementia. Cochrane Database Systematic Reviews, 4, CD001120.Google Scholar
Vellas, B. (2003). PHRC REAL.FR: french network on Alzheimer's disease. Revue de Médecine Interne, 24, Suppl. 3, 275s–277s.CrossRefGoogle ScholarPubMed
Vellas, B. et al. (2005). French Society of Gerontology and Geriatrics. [Consensus statement on severe dementia]. Revue de Neurologie, 161, 868–77.CrossRefGoogle Scholar
Wattmo, C., Wallin, A. K., Londos, E. and Minthon, L. (2011). Risk factors for nursing home placement in Alzheimer's disease: a longitudinal study of cognition, ADL, service utilization, and cholinesterase inhibitor treatment. Gerontologist, 51, 17–27.CrossRefGoogle ScholarPubMed
Wimo, A. and Winblad, B. (2003). Resource utilization in dementia: RUD lite. Brain Aging, 3, 48–59.Google Scholar
Woods, B., Aguirre, E., Spector, A. E. and Orrell, M. (2012a). Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Systematic Reviews, 2, CD005562.Google Scholar
Woods, B., Spector, A., Jones, C., Orrell, M. and Davies, S. (2005). Reminiscence therapy for dementia. Cochrane Database Systematic Reviews, 2, CD001120.Google Scholar
Woods, R. T. et al. (2012b). REMCARE: reminiscence groups for people with dementia and their family caregivers - effectiveness and cost-effectiveness pragmatic multicentre randomised trial. Health Technology Assessment, 16, V–XV, 1–116.CrossRefGoogle ScholarPubMed
Yaffe, K. et al. (2002). Patient and caregiver characteristics and nursing home placement in patients with dementia. JAMA, 287, 2090–2097.CrossRefGoogle ScholarPubMed
Zarit, S. H., Todd, P. A. and Zarit, J. M. (1986). Subjective burden of husbands and wives as caregivers: a longitudinal study. Gerontologist, 26, 260–266.CrossRefGoogle ScholarPubMed
Supplementary material: File

Amieva supplementary material S1

Consort 2010 Checklist

Download Amieva supplementary material S1(File)
File 222.2 KB