Petra Bevilacqua Psychologist
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1 21 st Alzheimer Europe Conference Warsaw 6-8 October 2011 COGNITIVE STIMULATION THERAPY IN A GROUP OF PEOPLE WITH DEMENTIA Petra Bevilacqua Psychologist A.S.D.A.M. onlus Mirandola Italy petra.bevilacqua@hotmail.it asdam@libero.it
2 A.S.D.A.M. onlus ASDAM onlus (Association for caregivers and people with dementia) Psichogeriatric Consulting Centre in Mirandola (other 3 Consulting Rooms displaced on Modena s North territory).
3
4 Mirandola s district This is one of the 7 districts in Modena s province. Overall population: citizens Over 60 age population: 22,0 % (11,12% are over 70 age).
5 A.S.D.A.M. onlus projects and activities Cognitive Stimulation Therapy Territorial project Hours of relief Music Therapy Physical Exercise Memory Training Periodical Meetings: Caffè Alzheimer (Mirandola) Caffè Final-Mente (Finale Emilia)
6 Psychosocial Interventions: The Psychosocial Interventions are the cure for the psychological and behavioral problems that arise in the coping process and during the adaptation to the consequences of dementia (Dröes, 1991). They help to deal with the change by offering alternative opportunities for treatment without neglecting others aspects of life.
7 Psychosocial interventions Objectives: promote People with dementia s Quality of Life Caregivers Quality of Life People with dementia and theirs caregivers Well-Being Adaptation and coping with the disease Better used of the available Resources and residual ability
8 Cognitive StimulationTherapy: the Protocol Protocol used (Woods B et al.) Modified rispect our necessity and our culture
9 benefi Conclusion: Some Caregivers Intevention can reduce CG psychological soffering and help people with dementia stay at home longer. Programs that involve the people and their families and are intensive and modified to CGs needs are more successful. This first study found improvement in the outcomes measures in cognitive tests and that cognitive improvement are associated with benefits to quality of life
10 Treatment for people with mild to moderate dementia The effects of CST appear to be of a comparable size to those reported with the currently available anti-dementia drugs (Luijpen MW et al. 2003)
11 The ASDAM s protocol Cognitive stimulation therapy Theory background: CST (Spector, 2003) Scientific collaboration: Prof. R. Chattat and his staff (Bologna s University) Financial Support: Public Health Organization and Mirandola s Bank Foundation Collaboration with Psychogeriatric Teem: interested people recruitment
12 How was CST developed? Systematic review of the literature on the main nonpharmacological therapies (Spector 2003; Livingston 2005; Olazaràn 2010) Reality Orientation Therapy Reminiscence Therapy Cognitive Rehabilitation Validation Therapy Multisensory Stimulation
13 The ASDAM protocol of Cognitive Stimulation Therapy INTENSIVE TRAINING Patients: people with dementia (especially person with AD) Method: group sessions (5-7 participants) Number of sessions: 14, twice a week Duration: 1 hour Sessions planning: 3 cycles during the year Conductor: 1 psychologist Monitoring: neuropsychological evaluation pre and post training MANTEINANCE TRAINING Patients: people with dementia (especially person with AD) Method: group sessions (5-7 participants) Number of sessions: 10, once a week Duration: 1 hour Sessions planning: 2 cycles during the year Conductor: 1 psychologist Monitoring: neuropsychological evaluation pre and post training
14 SESSION STRUCTURE Introduction (15 minutes): welcome Reality Orientation Free interaction and conversation about news and events Core (30 minutes): Cognitive exercises (cognitive functions: language, praxis abilities, attention, residual memory, autobiographic memory) Reminescence and Multisensory stimulation Conclusion (10 minutes): Home exercices Next session remineder Greetings
15 NEUROPSYCHOLOGICAL PROTOCOL Mini Mental State Examination (MMSE) ADAS Cog Geriatric Depression Scale Short Form (15 items) Quality of Life Alzheimer s disease Scale Short Form-12 Health Survery (SF-12)
16 INTENSIVE TRAINING DATA Demographic features n Sex (M/F) Age (SD) Educ. (SD) 25 7/18 77,52 (6,71) 6,64 (3,58) Results of the Neuropsychological Assessment: pre and post Training confrontation Adjusted scores Pre-t Post-t p-value Cognitive functioning MMSE (SD) 24,63 (2,91) 25,58 (3,00) 0,032* ADAS - cog tot (SD) 12,06 (6,85) 12,19 (7,23) 0,89 ADAS- cog RIEVOCAZ (mean), (SD) 6,17 (1,40) 6,29 (1,19) 0,451 ADAS- COG DENOMIN 1,44 (9,61) 1 (0,95) 0,031* Psico-social Functioning GDS 15 items 4 (3,57) 3,52 (3,05) 0,27 SF-12 PCS 49,43 (9,29) 51,43 (6,22) 0,388 SF-12 MCS 48,45 (9,51) 47,59 (11,69) 0,717 QoL-AD (patient) 33,25 (5,39) 35,20 (5,30) 0,117 QoL-AD (ceregiver) 26,79 (5,62) 27,42 (4,76) 0,692
17 MAINTENANCE TRAINING DATA n sex (M/F) age (SD) educ. (SD) 30 8/22 81,20 (3,91) 6,23 (3,19) Results of the Neuropsychological Assessment: pre and post Training confrontation Adjusted scores pre post p-value Cognitive functioning MMSE (SD) 25,11 (3,17) 24,90 (3,55) 0,892 ADAS - cog tot (SD) 11,92 (6,86) 13,63 (7,48) 0,056 ADAS- cog RIEVOCAZ (mean), (SD) 6,43 (1,12) 6,42 (1,24) 0,97 ADAS- COG DENOMIN 1,21 (0,97) 1,24 (0,73) 0,813 ADAS- RECOGNITION(mean), (SD) 4,47 (2,49) 4,84 (2,27) 0,25 Psico-social Functioning GDS 15 items 5,23 (4,72) 4,97 (4,50) 0,363 SF-12 PCS 48,67 (8,55) 48,50 (10,14) 0,912 SF-12 MCS 45,46 (12,68) 45,08 (12,48) 0,829 QoL-AD (patient) 29,12 (7,50) 28,62 (7,34) 0,486 QoL-AD (ceregiver) 26,96 (6,56) 25,96 (5,79) 0,498
18 Comparison: Three cycling of CST (about months) 1 Intensive CST + 2 Mantenance CST 15 subjects
19 Comparison after Months MMSE- scores GDS 15 items scores p= 0,915 first exam last exam ADAS - cog scores p= 0,506 first exam last exam first exam first exam SF-12 scores last exam P=0,669 last exam SF-12 PCS SF-12 MCS
20 Discussion: The results don t show any chainging of measured cognitive parameters (cognitive and psichosocial functioning) The obtained results show that the psichosocial interventions seems efficacy to slow down the progression of the disease. This intervention is an important opportunity for people that can t receive the pharmacological therapy.
21 Il mantenimento della CST
22 Conclusions: The recent UK guidelines on dementia raccommend that all people with mild-moderate dementia should be given the opportunity to partecipate in structured group Cognitive Stimulation Program. NICE-SCIE guide of dementia management (2006)
23 Prospective Future
24 Prospective Activities Produce more scientific articles about Nonpharmacological Intervention. Future researches: Study of combined Psychosocial treatments.
25 THANK YOU FOR ATTENTION ASDAM onlus Staff
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