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

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Linda Clare, Aleksandra Kudlicka, Jan R. Oyebode, Roy W. Jones, Antony Bayer, Iracema Leroi, Michael Kopelman, Ian A. James, Alison Culverwell, Jackie Pool, Andrew Brand, Catherine Henderson, Zoe Hoare, Martin Knapp, Bob Woods

Original languageEnglish
Pages (from-to)709-721
Number of pages13
JournalInternational Journal of Geriatric Psychiatry
Issue number5
Early online date6 Feb 2019
Publication statusE-pub ahead of print - 6 Feb 2019

King's Authors


© 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.

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