chapter  6
Cognitive rehabilitation in mild cognitive impairment and prodromal Alzheimer’s disease
WithMartial van der Linden, Anne-Claude Juillerat, Xavier Delbeuck
Pages 16

An increasing number of studies have demonstrated the efficacy and effectiveness of various cognitive interventions in persons with mild to moderate Alzheimer’s disease (AD).1,2 Because AD is characterized by a progression of neuropathologic damage, the cognitive interventions have to be continually adapted to changes in the patient’s condition, and directly focused on daily-life situations, with the purpose of short-term effectiveness.3,4 In addition, due to a reduction of processing resources as well as planning and comprehension difficulties frequently associated with AD, cognitive improvement (that is, the use of a facilitation strategy each time it is necessary; for example, using a face-name imagery mnemonic technique each time the patient has to learn a new name) will be very difficult for most AD patients. Indeed, the continual adoption of a facilitating technique by the patient is very demanding: it requires extensive practice to automate the use of a facilitating strategy, the acquisition of an appropriate belief system (which supports the strategy and corrects deleterious cognitive attitudes), and, finally, the ability to identify the specific daily-life situations in which the strategy is useful, to remember to use the strategy, and to maintain it in memory while it is applied.5 Consequently, intervention in mild or moderate AD patients will mainly consist of temporarily facilitating cognitive processing on a particular occasion (for example, helping a patient to learn the neuropsychologist’s name by indicating a mnemonic strategy), or teaching AD patients specific knowledge (skills or facts; for example, a particular name or route) to make them more autonomous in everyday life, by using techniques (such as spaced-retrieval, vanishing-cues, or errorless methods) that tap intact memory systems. Another option in AD patients’ rehabilitation is to provide them with physical support or external aids (such as a memory book, diaries, and alarms) or to structure their (physical or human) environment to reduce the impact that cognitive deficits may have on everyday activities. Furthermore, the management of cognitive and behavioral problems in AD patients also implies the active participation of a caregiver.