Alzheimer Disease: Spector A

Spector A, Woods B, Orrell M. · Sub-Department of Clinical Health Psychology, University College London, Gower Street, London WC1E 6BT, UK. · Expert Rev Neurother. · Pubmed #18457532 No free full text.

Abstract: In recent years, there has been an increase in the recognition and use of psychosocial interventions for dementia. This has coincided with an increase in high-quality research in the area, and restrictions in the use of drug therapies for Alzheimer's disease in the UK. Cognitive stimulation therapy (CST) is a brief group treatment for people with mild-to-moderate dementia, based on the theoretical concepts of reality orientation and cognitive stimulation. It involves 14 sessions of themed activities which typically run twice a week over a 7-week period. A multicenter, randomized controlled trial showed significant benefits in cognition and participant-rated quality of life when comparing CST versus no treatment. These benefits in cognition were comparable to those gained through medication, and CST also proved to be cost-effective. Influenced by this research, the latest guidelines released by NICE recommended cognitive stimulation only as an intervention for treating the cognitive symptoms of dementia. This perspective describes how CST was developed and evaluated, its use in clinical settings and issues for future investigation, such as individualized CST.

Clare L, Woods RT, Moniz Cook ED, Orrell M, Spector A. · Sub-department of Clinical Health Psychology, University College London, Gower Street, London, UK, WC1E 6BT. · Cochrane Database Syst Rev. · Pubmed #14583963 No free full text.

Abstract: BACKGROUND: Memory problems are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific approaches designed to address everyday memory difficulties. OBJECTIVES: The main aim was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed at improving memory functioning for people in the early stages of Alzheimer's disease or vascular dementia. The two types of intervention were considered separately. SEARCH STRATEGY: The CDCIG Specialized Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO and many other databases, was searched on 9 April 2003. SELECTION CRITERIA: RCTs comparing cognitive rehabilitation or cognitive training interventions with comparison conditions, and reporting outcomes for the person with dementia and/or the family caregiver, were considered for inclusion. DATA COLLECTION AND ANALYSIS: Six studies reporting cognitive training interventions were included. Statistical analyses were conducted to provide an indication of intervention effect sizes. Data from ordinal scales was treated as continuous, and a fixed effects model was applied in calculating weighted mean differences and 95% confidence intervals. No studies were found that reported a fully individualised cognitive rehabilitation approach. MAIN RESULTS: None of the six studies reporting cognitive training interventions demonstrated any statistically significant effects in any domain, although there were indications of some modest, non-significant effects in various domains of cognitive functioning. REVIEWER'S CONCLUSIONS: The present findings do not provide strong support for the use of cognitive training interventions for people with early-stage AD or vascular dementia, although these findings must be viewed with caution due to the limited number of RCTs available and to the methodological limitations identified, and further well-designed trials would help to provide more definitive evidence. Due to a complete absence of RCTs evaluating an individualised cognitive rehabilitation approach, It is not possible at present to draw conclusions about the efficacy of individualised cognitive rehabilitation interventions for people with early-stage dementia, and further research is required in this area.

Spector A, Davies S, Woods B, Orrell M. · Department of Psychiatry and Behavioural Sciences, University College London, England. · Gerontologist. · Pubmed #10820923 No free full text.

Abstract: The effectiveness of classroom reality orientation (RO) in dementia was evaluated by conducting a systematic literature review. This yielded 43 studies, of which 6 were randomized controlled trials meeting the inclusion criteria (containing 125 subjects.) Results were subjected to meta-analysis. Effects on cognition and behavior were significant in favor of treatment (cognition standardized mean difference [SMD] = -0.59; 95% confidence interval [CI] -0.95(-)-0.22; behavior SMD = -0.64, 95% CI = -1.20(-)-0.08). The evidence indicates that RO has benefits on both cognition and behavior for dementia sufferers. However, a continued program may be needed to sustain potential benefits. Future research should evaluate RO in well-designed multicenter trials.

Spector A, Orrell M. · Department of Mental Health Sciences, University College London, London, UK. · Alzheimer Dis Assoc Disord. · Pubmed #16917186 No free full text.

Abstract: Evaluating quality of life (QoL) in people with dementia has become increasingly valued, for example in assessing the effectiveness of interventions or making treatment decisions. This study compared the QoL of people with dementia as assessed by the individuals and their care staff, and possible factors associated with the discrepancy between ratings. Seventy-six dyads of people with dementia and care staff in 9 residential homes were recruited. People with dementia were interviewed, using the "quality of life-Alzheimer disease" (QoL-AD) and assessed for severity of cognitive impairment. Staff completed the QoL-AD with respect to the person with dementia, and measures assessing their job satisfaction, level of hope, and person-centeredness. Results showed that people with dementia and care staff rated QoL differently. Some items on the QoL-AD ("physical health," "family," and "friends") were rated similarly between the 2 groups and others differently ("ability to do chores," "marriage/closest relationship," "memory," and "life as a whole"). Neither staff factors (hope, person-centeredness, or job satisfaction) nor the severity of cognitive impairment in the people with dementia explained the discrepancy between ratings. However, when data were aggregated within residential settings, a correlation between increased hope in staff and better resident assessed QoL emerged. Care homes should be aware that low staff hope may be linked to lower resident QoL. Effective training and support for care staff may impact on residents' QoL.

Thorgrimsen L, Selwood A, Spector A, Royan L, de Madariaga Lopez M, Woods RT, Orrell M. · Department of Psychiatry and Behavioural Sciences, University College London, London, UK. · Alzheimer Dis Assoc Disord. · Pubmed #14657783 No free full text.

Abstract: Quality of life (QoL) is becoming an increasingly used outcome measure in both clinical practice and research. There are now more than 1000 scales available to measure QoL, and it is important that they are assessed for reliability and validity. This study aims to assess the reliability and validity of the Quality of Life-Alzheimer's Disease (QoL-AD) scale, which is dementia specific and brief and uses the patient's own responses. Two separate samples of people with dementia (sample 1, n = 60; sample 2, n = 201) were assessed. Five focus groups were conducted involving both people with dementia and their caregivers; the focus groups showed that people with dementia had higher hopes for their QoL than their caregivers did for them. Questionnaires about the scale were completed by 71 health care professionals working with people with dementia. The scale was found to have good content validity with no additional items required and all items necessary. It also correlated well with the Dementia Quality of Life scale (0.69) and with the Euroqol-5D scale (0.54), indicating good criterion concurrent validity. Construct validity was also good with the principal components analysis showing all 13 items of the QoL-AD loaded on component 1. Interrater reliability was excellent with all Cohen's kappa values >0.70. Internal consistency was excellent with a Cronbach's alpha coefficient of 0.82. Some people with severe dementia and a Mini-Mental State Examination score as low as 3 were able to satisfactorily complete the QoL-AD. The QoL-AD has very good psychometric properties and can be completed with people with a wide range of severity of dementia.

Spector A, Orrell M, Davies S, Woods B. · No affiliation provided · Nurs Times. · Pubmed #11954530 No free full text.

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