Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: A multicentre randomised controlled trial (the GREAT trial)

TY - JOUR

T1 - Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: A multicentre randomised controlled trial (the GREAT trial)

AU - Clare, Linda

AU - Kudlicka, Aleksandra

AU - Oyebode, Jan R.

AU - Jones, Roy W.

AU - Bayer, Antony

AU - Leroi, Iracema

AU - Kopelman, Michael

AU - James, Ian A.

AU - Culverwell, Alison

AU - Pool, Jackie

AU - Brand, Andrew

AU - Henderson, Catherine

AU - Hoare, Zoe

AU - Knapp, Martin

AU - Woods, Bob

PY - 2019/2/6

Y1 - 2019/2/6

N2 - © 2019 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd. Objectives: To determine whether individual goal-oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild-to-moderate dementia. Design and methods: Parallel group multicentre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer, vascular or mixed dementia, and mild-to-moderate cognitive impairment (Mini-Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self-reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition and study partner stress and quality of life. Results: We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant-rated goal attainment (d = 0.97; 95% CI, 0.75-1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89-1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71-1.17) and informant (d = 0.96; 95% CI, 0.73-1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. Conclusions: CR enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.

AB - © 2019 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons Ltd. Objectives: To determine whether individual goal-oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild-to-moderate dementia. Design and methods: Parallel group multicentre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer, vascular or mixed dementia, and mild-to-moderate cognitive impairment (Mini-Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self-reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition and study partner stress and quality of life. Results: We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant-rated goal attainment (d = 0.97; 95% CI, 0.75-1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89-1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71-1.17) and informant (d = 0.96; 95% CI, 0.73-1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. Conclusions: CR enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.

KW - activities of daily living

KW - Alzheimer disease

KW - disability

KW - goal-setting

KW - nonpharmacological intervention

KW - person-centred

KW - problem-solving

KW - reablement

KW - vascular dementia

UR - http://www.scopus.com/inward/record.url?scp=85062337909&partnerID=8YFLogxK

U2 - 10.1002/gps.5076

DO - 10.1002/gps.5076

M3 - Article

AN - SCOPUS:85062337909

SN - 0885-6230

VL - 34

SP - 709

EP - 721

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

IS - 5

ER -