![]() In this paper, we discuss cognitive enhancement methods that have been studied in AD as well as the obstacles related to the successful delivery of these treatments, and offer therapeutic approaches that have been used successfully in other populations to promote engagement and adherence, which may also improve efficacy and outcome for AD.Ĭognitive enhancement in Alzheimer’s disease However, the unique circumstances surrounding dementia present distinctive challenges for the effective administration of cognitive enhancement therapies. To date, cognitive training has been successfully used to target cognitive impairments in other disorders such as schizophrenia ( Fiszdon et al., 2005, Twamley et al., 2012, Wexler and Bell, 2005, Wykes et al., 2011), head injury ( Cicerone et al., 2005, Cicerone et al., 2011), stroke ( Lincoln et al., 2000, Rohling et al., 2009), and substance abuse ( Vocci, 2008). These methods entail either learning strategies that minimize cognitive demands (compensation) or repeatedly practicing cognitive skills until premorbid performance levels are reached. ![]() Cognitive enhancement is a behavioral treatment for cognitive impairment that targets cognitive skills and fosters improvement through the practice of compensatory and/or restorative strategies ( Kurtz, 2003, Twamley et al., 2008, Wykes and Spaulding, 2011). Cognitive enhancement therapies for early and moderate AD are becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance ( Cipriani et al., 2006, Farina et al., 2002, Talassi et al., 2007). Medications such as cholinesterase inhibitors and memantine provide limited benefits, but recent evidence suggests that concurrent pharmacologic and behavioral methods may maximize functional benefits for patients suffering from dementia ( Buschert et al., 2010, van Dyck, 2004). Indeed, preventing a 2-point decline on the Mini Mental Status Examination (MMSE) could save a family thousands of dollars annually, while a 2-point increase in MMSE score would save even more ( Ernst Rl, 1997). Even if the delay is only temporary, doing so may have a significant positive impact on the high treatment costs associated with AD. As health systems prepare to accommodate an influx of dementing older adults across the US, it is particularly important to develop effective, targeted treatments to halt or delay the onset of cognitive decline associated with AD. AD is the leading cause of dementia in the general US population ( Cummings Jl, 2002, van Dyck et al., 2007) and is often associated with a high risk of comorbid medical and psychiatric disorders, which further strain medical center and family resources due to their high direct and indirect costs ( Fillit and Hill, 2004). A whole generation of baby boomers are aging and reaching a vulnerable stage where they are susceptible to neurodegenerative disorders. The overall prevalence of Alzheimer’s disease (AD) is rapidly increasing, with an estimated 16 million diagnosed cases projected by the year 2050 ( NIH Alzheimer’s disease Fact Sheet, 2005). ![]() The goal is to stimulate discussion among researchers and clinicians alike on how treatment effects may be mediated by engagement in treatment, and what can be done to enhance patient adherence for cognitive rehabilitation therapies in order to obtain greater cognitive and functional benefits from the treatment itself. We review approaches to cognitive rehabilitation in AD, neuropsychological as well as psychological obstacles to effective treatment in this population, and methods that target adherence to treatment and may therefore be applicable to cognitive rehabilitation therapies for AD. In order for cognitive rehabilitation methods to be effective, patients must be adequately engaged and motivated to not only begin a rehabilitation program but also to remain involved in the intervention until a therapeutic dosage can be attained. Cognitive rehabilitation training exercises are also labor intensive and, unfortunately, serve as a repeated reminder about the memory impairments and attendant functional consequences. However, people with AD may have difficulty adhering to these cognitive treatments due to denial of memory deficits, compromised brain systems, cognitive incapacity for self-awareness, general difficulty following through on daily tasks, lack of motivation, hopelessness, and apathy, all of which may be either due to the illness or be secondary to depression. ![]() Cognitive rehabilitation therapies for Alzheimer’s disease (AD) are becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. ![]()
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