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 Table of Contents  
REVIEW ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 57-65

Cognitive remediation therapy for older adults


1 Department of Psychiatry, Institute of Mental Health and Hospital, Agra, India
2 Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
3 Department of Psychiatry, SN Medical College, Agra, Uttar Pradesh, India
4 Department of Obstetrics and Gynaecology, Mata Chanan Devi Hospital, New Delhi, India

Date of Web Publication6-May-2016

Correspondence Address:
Indira Sharma
"SHRISHTI", N8/180-118, Rajendra Vihar, Newada, Sunderpur, Varanasi - 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-9995.181919

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  Abstract 

There is a large body of research on cognitive interventions for older adults the review which suggests the following: (1) Cognition remediation therapy is indicated for healthy elderly, and in mild cognitive impairment (MCI), early dementia, brain disease and injury, and severe mental illness (SMI). (2) Studies on healthy elderly demonstrate that with cognitive training (CT), cognitive stimulation (CS), and/or cognitive rehabilitation (CR) age-related cognitive decline can be reversed, at least partially if not fully, even in advanced age, with improved social functioning and quality of life. Better results are obtained if cognitive remediation therapy (CRT) is combined with vocational/psychosocial rehabilitation. Generalization of training to activities of daily living (ADL) and to secondary outcome measures such as quality of life and self-esteem are issues that need to be addressed in older adults. (3) Research in MCI has indicated that CRT, especially memory training, has some role. Future studies should place focus on the assessment of dose-response relationship, training generalization, and ecologically relevant approaches. (4) Findings of earlier work in early-stage dementia were frustrating, more recent work, especially randomized controlled trials of high quality, has provided a ray of rope with respect to effectiveness of CT and CR. Further well-designed studies are required to provide more definitive evidence. (5) Significant therapeutic effects of CR have been observed on cognitive function and ADL in the elderly patients with stroke. Routine screening for stroke patients and those with brain injury for cognitive impairment is recommended. (6) Available research provides evidence that cognitive remediation benefits people with SMI, and when combined with psychiatric rehabilitation this benefit generalizes to functioning. Elderly with SMI need special focus. Further needs to be carried out on older people with SMI.

Keywords: Cognitive, cognitive decline, elderly, mild cognitive impairment, older adults, rehabilitation, remediation, therapy, training


How to cite this article:
Sharma I, Srivastava J, Kumar A, Sharma R. Cognitive remediation therapy for older adults. J Geriatr Ment Health 2016;3:57-65

How to cite this URL:
Sharma I, Srivastava J, Kumar A, Sharma R. Cognitive remediation therapy for older adults. J Geriatr Ment Health [serial online] 2016 [cited 2019 Mar 21];3:57-65. Available from: http://www.jgmh.org/text.asp?2016/3/1/57/181919


  Introduction Top


As the population ages, risk for cognitive decline threatens independence and quality of life for older adults and presents challenges to the health care system. Research on determinants and covariates of cognitive status in older people suggest that cognitive decline, to some extent may be reversible. [1] Sustained engagement in cognitively stimulating activities has been found to impact neural structure in both older humans and rodents. [2],[3] Both human and animal studies indicate that neural plasticity endures across the life span and that cognitive stimulation (CS) in the environment is an important predictor of enhancement and maintenance of cognitive functioning even in old age. [4] The available agents for Alzheimer's disease (AD) are only symptomatic treatments for AD; there is no cure for AD. Besides, compliance to such treatments is limited by possible adverse effects. Thus, the most promising avenues of intervention now lie in prevention.

Furthermore, a growing body of research supports the protective effects of late-life intellectual stimulation on incident dementia. [5],[6] Cognitive reserve is generally known to delay the cognitive and functional expression of neurodegenerative diseases. In this sense, CS/training programs might have an impact on cognitive reserve, by optimizing normal performances, in agreement with the already known effect of education level. [7],[8]

It is evident that maintenance of cognitive functions in old age has become increasing important to human society with an aging population. "Brain health" programs developed by aging interest groups such as the American Association of Retired Persons and the Alzheimer's Association provide directives on cognitive activities, in addition to other advice. [9] Assuming that "use it or loose it" principle applies to cognitive health, computer training memory tapes, and Nintendo games are marketed to the lay people with claims of enhancing cognition. [10],[11]

Over the past two decades, several studies have documented the beneficial effects of cognition enhancement techniques in different populations of older adults with cognitive impairment. This paper shall examine and present the current status with respect to the same.


  Types of cognitive interventions Top


Cognitive interventions are based on two major approaches. The restorative approach (direct intervention/process specific) is based on the theory that repetitive exercise promotes recovery of damaged processes and restores lost function. The compensatory approach (functional approach) focuses on teaching patients to employ various strategies to cope with underlying cognitive impairments and accompanying social deficits. Among the different types of cognitive interventions, cognitive training (CT), cognitive rehabilitation (CR), and CS are most common. [12] CT typically involves guided practice of standard tasks to increase or maintain particular cognitive functions such as attention or problem solving. [13],[14] Recently, the definition of CT has been broadened to include strategy training, which involves the instruction and practice of strategies to minimize cognitive impairment and enhance performance (for example, method of loci and visual imagery) and cognitive exercise. [15] Tasks may be presented in paper and pencil [16],[17],[18] or computerized [19] form or may involve analogs of activities of daily living (ADL). [20],[21] CT may be offered through individual [17],[21] or group [22],[23] sessions or facilitated by family members [21],[24] or with therapist support. In accordance with the suggestion that CT may enhance the effects of pharmacological therapy, [25] some workers have evaluated the efficacy of CT in combination with acetylcholinesterase-inhibitors [23] or other [26] medications. In addition, CT for persons with dementia has sometimes been included as a component of supportive interventions for caregivers. [27]

Cognition-focused interventions are interventions that directly or indirectly target cognitive functioning as opposed to interventions that focus primarily on behavioral (for example, wandering), emotional (for example, anxiety), or physical (for example, sedentary lifestyle) function. [28]

CR also involves the practice of some tasks, but generally prioritizes personal goals as targets in order to improve, one at a time, specific impairments in everyday life. [12],[13],[29] CR offers retraining in the ability to think, use judgment, and make decisions [30] and helps brain-injured or otherwise cognitively impaired individuals to restore normal functioning or to compensate for cognitive deficits. CS promotes the involvement in activities that are aimed at general enhancement of cognitive and social functioning, without specific objectives. [12],[13],[29]

Cognitive remediation therapy (CRT), also called cognitive enhancement therapy, is designed to improve neurocognitive abilities such as attention, working memory, and executive functions, including cognitive flexibility and planning, which leads to improved social functioning. [31] Metacognitive training provides awareness and knowledge and focuses on strategies for problem solving. [32]

Other types of cognitive interventions include: "Training in specific tasks" such as systematic training of routines, [31] interventions with help of "virtual reality" - for training specific abilities such as memory, attention or of functional tasks (such as crossing the street, [33] and "Training in social abilities" such as parent-child relationships or relations with peers. [9]

Tailoring of task difficulty on the basis of the individual performance level is becoming increasingly available through computerized packages. Brain Function therapy for cognitive remediation has been developed at the National Institute of Mental Health and Neurosciences, Bengaluru, India, by Mukundan. [34] It may be noted that these approaches are complementary, and the choice of a particular approach depends on the objectives of cognitive enhancement or maintenance and on the cognitive profile of the population targeted. [29]


  Indications for cognitive interventions Top


Cognitive intervention for the enhancement of cognitive function is indicated in older adults, with age-related cognitive decline (ARCD), mild cognitive impairment (MCI), early stages dementia, (AD and vascular dementia [VaD]), brain damage or disease (stroke, brain tumors, traumatic brain injury, etc.), and severe mental illness (SMI).

Older adults

Interest in cognitive remediation techniques in elderly have increased with a growing understanding of the impact of cognitive impairment on loss of independence in day to day function. In recent years, several studies have assessed the efficacy of different cognitive interventions in the elderly and reported beneficial effects, [35],[36],[37],[38],[39],[40],[41],[42],[43] even in advanced age, [41],[44] which could be maintained for a considerable period of time beyond training. [4],[39],[40] The focus of interventions in these studies was memory and related functions.

The effect of mnemonic (organizational strategies) training on recall has been explored extensively. About 3 mnemonic strategies the method of loci, the use of imagery and techniques for processing new information more accurately, have been especially influential. [1] However, the effects of teaching mnemonics are task specific and limited to the immediate posttraining period. [1]

Multifaceted training that combines three relatively diverse strands of therapy: A form of counseling/behavior therapy to target psychosocial variables (self-efficacy beliefs, feelings of control, and optimism), CT to target cognitive functions and complimentary physical activity, appears to have some benefit in maintaining a higher level of cognitive function over time. [1]

The value of CT for specific cognitive abilities that normally decline in aging is provided by the Seattle Longitudinal Study. [45] Older adults with existing declines in either inductive reasoning or spatial orientation performance were provided with a brief (5 h) training program. Two-third of the participants demonstrated improvement with 40% returning to a baseline level obtained 14 years earlier. Ongoing effects continued up to 7 years after training.

Targeted cognitive interventions, especially memory training interventions, have been widely used. Memory training including stress management, health promotion, and memory self-efficacy support has been tested in older adults in retirement residences. [9] Memory training for healthy older adults typically includes mnemonic strategies, concentration and attention, relaxation, personal insight, self-monitoring, motivation, feedback, and problem-solving, succeeded in improving memory performance. [9] Improved memory performance and efficacy beliefs were reported postintervention. However, improved memory performance was not associated with improved ADL performance.

With memory training classes, elders improve their performance on cognitive tasks including perceptual discrimination, visual search, recognition, recall, and spatial perception. [33]

The Advanced CT for Independent and Vital Elderly (ACTIVE) randomized controlled clinical trial provided strong evidence of effectiveness CT. The participants of the trial were 2000 healthy, community-dwelling older adults. Ten training sessions were provided for verbal episodic memory, inductive reasoning, or processing speed. Immediate post-training improvements occurred in the specifically targeted skills, and with booster sessions 11 months after initial training, improvement continued for 2 years. [4] The 5-year follow-up for the ACTIVE study found that four booster treatments resulted in both better performance on the specific domains and in less functional decline in instrumental ADLs (IADLs) for the inductive reasoning group. [46] Besides, experimental (versus control) group participants were less likely to suffer significant declines in health-related quality of life. [47] These findings are intriguing provide a lead for ongoing research to test the impact of cognitive interventions on daily lives of older adults.

The review of research evaluating the effect of cognitively stimulating lifestyles on cognitive function of older adults suggests that overall research findings support positive effects of cognitive and physical activity, social engagement, and therapeutic nutrition in optimizing cognitive aging. However, the strength of the research evidence is limited by research designs.

Stuss et al. [48] adopted scientifically based principles of strategic processing for developing a program to improve general strategic abilities in older adults who had experienced normal ARCD. It focused on the development of basic and practically oriented strategies for learning, remembering, and problem-solving, combined with an explicit emphasis on enhancing psychosocial well-being. It consisted of three distinct 4-week modules, administered over 12 weeks; a group format was adopted in which individuals as a group met weekly in relatively short (3 h), highly interactive sessions and assessed performance in the domains of memory, goal management, and psychosocial stress. The authors concluded that changes in strategic processing can be trained in the elderly and that any changes observed were the direct result of rehabilitation.

The results of the cognitive intervention programs administered to healthy elderly in the past 10 years, until March 2011, were reviewed. [49] The efficacy of 14 cognitive intervention programs administered to healthy elderly participants was examined. Nine out of 14 studies targeted memory as the principal cognitive function to train or stimulate. Face-name associations, mental imagery, paired associations, and the method of loci were the main techniques taught to participants. Improvements were observed on at least one outcome measure in each study included in this paper. Important suggestions for future work were the utilization of more robust experimental designs, the inclusion of measures of generalization of training in daily life, and the assessment of IADL, quality of life, and self-esteem.

CR in elderly has been studies in relation static balance. During balancing, there is interaction of sensory processes among the somatic senses, including proprioception, visual sense, and stereotactic input from the vestibular system. [50] Reduction of balance ability due to aging has been reported to be associated with cognitive function [51] and slowing of central information processing speed. [52] Lee et al. [53] in a randomized controlled study investigated the effects of a 6-week-long computer-assisted CR training program on the improvement of cognition and balance abilities of the elderly. Computer-assisted CR training was found to an effective intervention method for the improvement of the cognition and balance abilities of the elderly.

In summary, the available data suggest that cognitive remediation therapies have great promise for improving cognition and quality of life of elderly.

Mild cognitive impairment

The rate of AD is expected to increase 2-3-fold in the coming decades. [54] In response to this challenge, two important developments have taken place. First, attempts to identify at-risk patients before the onset of AD. Thus, MCI that captures cognitively symptomatic individuals who are likely to convert to AD was accepted as a diagnosis by the National Institute on Aging's and the Alzheimer's Association's [55] and the American Psychiatric Association's. [56] Second, attempts are being made to identify pharmacologic and nonpharmacologic interventions that can enhance, maximize, or otherwise prolong functioning in at-risk patients. This is especially important since there is often a multi-year period of cognitive stability between conversion from "healthy" to MCI and subsequent progression to AD. [57],[58],[59]

Debate continues on the extent to which pharmacological agents impact cognition and conversion rates. Explicit learning and memory represent the characteristic areas of impairment in MCI and also the focus of techniques of CR. This paper will focus on nonpharmacologic approaches to MCI.

A Cochrane Review of randomized controlled trials (RCTs) in those with MCI found no benefit of cognitively based interventions relative to control conditions. [60] However, this conclusion was based on only three studies that used a wide variety of techniques. Subsequently, at least seven reviews [61],[62],[63],[64],[65],[66],[67] and one meta-analysis [68] over a period of 3 years studies have indicated that patients could benefit from CR of memory. Thereafter, a quasi-experimental randomized controlled study [69] with test-retest design from Iran evaluated the effectiveness of CR on selective attention in patients with MCI in older adults. CR comprised 12 sessions (2 h each section) of CR with the Neurocognitive Joyful Attentive Training Intervention. The results indicated that CR can impact on improving selective focus in people with MCI.

Hampstead et al. 2014 [70] carried out a methodological review of 36 studies of CR of memory for MCI and outlined the methodological pitfalls of the studies such as diagnostic variability, use of multitechnique approach, variability of outcome measures, and need for assessment of dose-response relationship and training generalization. They suggested that future studies should place greater emphasis on ecologically relevant approaches and suggested a hierarchical model that may aid in this pursuit.

In conclusion, although earlier studies were not encouraging, several later studies do indicate that many patients may benefit from CRT.

Alzheimer's disease and vascular dementia

Interventions to assist with aspects of cognitive functioning and associated functional limitations are important in the milder stages of AD or VaD as they may allow the person greater independence and can possibly minimize the risk of "excess disability." Interventions for people with mild dementia can be pharmacological, nonpharmacological, or both. There is considerable doubt that disease-modifying drugs can show a positive effect by the time dementia is fully developed. [71] On the other hand, nonpharmacological interventions and particularly cognition-based interventions are increasingly being recognized as an important adjunct (and, in some cases, alternative) to pharmacological treatments for individuals with dementia and those at risk of dementia.

Earlier studies suggested that cognition-based interventions are not appropriate as they are ineffective and result in frustration and depression for participants and caregivers. [72] However, with a growing emphasis on early detection and intervention in dementia care, there is a need for a clear evidence base for cognition-focused interventions.

CT and CR are specific forms of nonpharmacological intervention to address cognitive and noncognitive outcomes in persons with mild to moderate AD or VaD.

Some recent studies have reported positive results, for example, CR may help people with dementia to maintain residual memory ability by identifying the best way to obtain important information. [73],[74],[75] Besides, in patients with mild AD, several learning techniques and strategies such as spaced retrieval, dual cognitive support, and procedural memory training have been demonstrated as methods to enhance learning ability [76],[77],[78] and CT was demonstrated in people with early stage dementia to have an effect on memory, mood, and analogs of ADL. [17],[18],[22]

A recent Cochrane review that focused on interventions concluded that general CS and reality orientation approaches consistently produce improvements in general cognition and in some cases, in self-reported quality of life and well-being, primarily in people with mild to moderate dementia. [79]

Bahar-Fuchs et al. 2013 [28] systematically reviewed the evidence for interventions in people with mild AD or VaD. RCTs, comparing CR or CT interventions with control conditions and reporting relevant outcomes for the person with dementia or the family caregiver (or both), were considered for inclusion. Eleven RCTs were included in the review. CT was not associated with positive or negative effects in relation to any of the reported outcomes. The overall quality of the trials was low to moderate. The single RCT of CR found promising results in relation to some patient and caregiver outcomes and was generally of high quality. Further well-designed studies of CT and CR are required to provide more definitive evidence.

In a recent randomized controlled study, [31] it was found that CR rehabilitation including tasks of CT is an effective intervention for improving occupation performance and satisfaction with respect to ADL and specific cognitive functions (orientation subscale of Mini-Mental State Exam).

In conclusion, the findings of earlier work in early dementia (AD and VaD) were frustrating. However, recent data, especially from a high-quality RCT, has provided a ray of hope.

Traumatic brain injury or brain disease

According to the World Health Organization, about 15 million people have a stroke worldwide annually. Five million of survivors are left permanently disabled, [80] with complications including motor (50-83%), cognitive (50%), language impairments (23-36%), and psychological disturbances (20%). [81]

Cognitive impairment is a frequent consequence of stroke. CR following a stroke can make the difference in a full or partial recovery. Recent studies show that rehabilitation is responsible for more than 70% of the recovery process. [82] CR offers retraining in the ability to think, use judgment, and make decisions. The focus is on correcting deficits in memory, concentration and attention, perception, learning, planning, sequencing, and judgment. [83] Stroke survivors may greatly benefit from CR treatment to decrease their cognitive deficits. [84]

A quasi-experimental controlled study [82] at Assiut University Hospital Egypt evaluated the effect of CR of elderly patients with stroke on their cognitive function and ADL. Significant therapeutic effects of CR were observed on cognitive function and ADL in the elderly patients. Routine screening of stroke patients for cognitive impairment was recommended.

Severe mental illness

Elderly persons may develop SMI in old age or the same may be carried into senescence. Recognition that cognitive deficit is a major determinant of outcome in people with severe, chronic mental illnesses has generated considerable interest in cognitive remediation. [85] Most of the research work on SMI has been done in young people and adults. People with severe SMI are disadvantaged in many ways; by old age, SMI, delirious effects of psychotropic medication, and by the negative attitude of the society. This group needs special attention. Thus, the research work CR in SMI is presented as the same can be applied as such in older adults or with suitable modifications. It may be noted that efforts to improve cognitive functions in SMI devolved from applications in the rehabilitation of people with brain injury.

Most people with SMI have cognitive impairments which tend to be stable over time and do not respond to currently available pharmacotherapy. Cognitive impairment has been reported in many areas including attention, psychomotor speed, working memory, verbal learning and memory, and executive function [86],[87],[88] and has been reported to be related to several parameters of poor outcome. [89],[90] Alternatively, better cognitive functioning predicts better work outcomes. [91]

Metacognitive training, which focuses on building knowledge and ability to use problem-solving strategies, is a useful approach for persons with SMI. [32] Some programs supplemented individualized cognitive exercises with group practice activities. [92],[93],[94],[95] Most cognitive remediation programs provide a minimum of 2 h per week of practice and require 3-6 months to complete. [96]

In current approaches to cognitive remediation, multiple domains are generally targeted by computerized tasks or paper and pencil exercises, designed to provide practice of cognitive skills in order to restore or improve them. [97] A laboratory facilitator, or cognitive specialist, generally monitors task performance, provides encouragement for effort, help with problem-solving tasks that are challenging or frustrating, and positive reinforcement by pointing out progress. The cognitive specialists may also provide instruction, or strategy coaching, for example, on methods for improving attention (e.g., talking out loud through a task) or learning (e.g., breaking up material into manageable chunks). [97] Recently, meta-analysis of work done in this area concluded that cognitive remediation was related to improved community functioning. [98]

More recent efforts have focused on combining cognitive remediation with vocational rehabilitation. [92],[99],[100] Researchers evaluated the effects of combining neurocognitive enhancement therapy, [92] Computer-Assisted Cognitive Strategy Training, [99] and the Thinking Skills for Work Program (CR program with supported employment) [91] with community-based vocational rehabilitation. [100] The results from these studies indicate improvements in both cognitive and work functioning. However, in these studies, characteristics of participants, the vocational rehabilitation models, and the methods of combining cognitive and vocational therapies varied considerably. There are other approaches to cognitive and vocational rehabilitation such as errorless learning and CT to compensate for cognitive impairment, etc. [98] A meta-analysis [101] including 2104 participants concluded that cognitive remediation benefits people with schizophrenia, and when combined with psychiatric rehabilitation, this benefit generalizes to functioning. A recent overview of CRT for people with SMI has found it be effective, especially if combined with vocational rehabilitation. [85]


  Conclusion Top


There is a large body of research on cognitive interventions for older adults.

  1. Studies on healthy elderly demonstrate that with CT, CS, and/or CR ARCD can be reversed, at least partially if not fully, even in advanced age, with improved social functioning and quality of life. Better results are obtained if CRT is combined with vocational/psychosocial rehabilitation. Generalization of training to ADL and to secondary outcome measures such as quality of life and self-esteem are issues that need to be addressed in older adults
  2. Research in MCI has indicated that CRT, especially memory training, has some role. Future studies should place focus on the assessment of dose-response relationship, training generalization, and ecologically relevant approaches
  3. Findings of earlier work in early-stage dementia were frustrating, but more recent work, especially an RCT of high quality, has provided a ray of rope with respect to effectiveness of CT and CR. Further well-designed studies are required to provide more definitive evidence
  4. Significant therapeutic effects of CR have been observed on cognitive function and ADL in the elderly patients with stroke. Routine screening for stroke patients and those with brain injury for cognitive impairment is recommended
  5. Available research provides evidence that cognitive remediation benefits people with SMI, and when combined with psychiatric rehabilitation this benefit generalizes to functioning. Elderly with SMI need special focus. Further needs to be carried out on older people with SMI.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Dawson D, Winokur G, Moscovitch M. The psychosocial environment and cognitive rehabilitation in the elderly. In: Stuss DT, Winocur G, Robertson IH, editors. Cognitive Neurorehabilitation. Cambridge, UK: Cambridge University Press; 1999. p. 94-108.  Back to cited text no. 1
    
2.
Krampe RT, Ericsson KA. Maintaining excellence: Deliberate practice and elite performance in young and older pianists. J Exp Psychol Gen 1996;125:331-59.  Back to cited text no. 2
    
3.
Recanzone GH. Cerebral cortical plasticity: Perception and skill acquisition. In: Gazzaniga S, editor. The New Cognitive Neurosciences. Cambridge, Mass: The MIT Press; 2000. p. 237-47.  Back to cited text no. 3
    
4.
Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, Marsiske M, et al. Effects of cognitive training interventions with older adults: A randomized controlled trial. JAMA 2002;288:2271-81.  Back to cited text no. 4
    
5.
Wilson RS, Mendes De Leon CF, Barnes LL, Schneider JA, Bienias JL, Evans DA, et al. Participation in cognitively stimulating activities and risk of incident Alzheimer disease. JAMA 2002;287:742-8.  Back to cited text no. 5
    
6.
Scarmeas N, Levy G, Tang MX, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer′s disease. Neurology 2001;57:2236-42.  Back to cited text no. 6
    
7.
Le Carret N, Lafont S, Letenneur L, Dartigues JF, Mayo W, Fabrigoule C. The effect of education on cognitive performances and its implication for the constitution of the cognitive reserve. Dev Neuropsychol 2003;23:317-37.  Back to cited text no. 7
    
8.
Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 2002;8:448-60.  Back to cited text no. 8
    
9.
Williams KN, Kemper S. Interventions to reduce cognitive decline in aging. J Psychosoc Nurs Ment Health Serv 2010;48:42-51.  Back to cited text no. 9
    
10.
Cassel CK. Use it or lose it: Activity may be the best treatment for aging. JAMA 2002;288:2333-5.  Back to cited text no. 10
    
11.
Salthouse TA. Mental exercise and mental aging: Evaluating the validity of the "use it or lose it" hypothesis. Perspect Psychol Sci 2006;1:68-87.  Back to cited text no. 11
    
12.
Clare L, Woods RT, Moniz Cook ED, Orrell M, Spector A. Cognitive rehabilitation and cognitive training for early-stage Alzheimer′s disease and vascular dementia. Cochrane Database Syst Rev 2003:CD003260.  Back to cited text no. 12
    
13.
Clare L, Woods RT. Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer′s disease: A review. Neuropsychol Rehabil 2004;14:385-401.  Back to cited text no. 13
    
14.
Clare L. Cognitive training and cognitive rehabilitation for people with early-stage dementia. Rev Clin Gerontol 2003;13:75-83.  Back to cited text no. 14
    
15.
Gates NJ, Sachdev PS, Fiatarone Singh MA, Valenzuela M. Cognitive and memory training in adults at risk of dementia: A systematic review. BMC Geriatr 2011;11:55.  Back to cited text no. 15
    
16.
Quayhagen MP, Quayhagen M, Corbeil RR, Roth PA, Rodgers JA. A dyadic remediation program for care recipients with dementia. Nurs Res 1995;44:153-9.  Back to cited text no. 16
    
17.
Davis RN, Massman PJ, Doody RS. Cognitive intervention in Alzheimer disease: A randomized placebo-controlled study. Alzheimer Dis Assoc Disord 2001;15:1-9.  Back to cited text no. 17
    
18.
De Vreese LP, Neri M, Fioravanti M, Belloi L, Zanetti O. Memory rehabilitation in Alzheimer′s disease: A review of progress. Int J Geriatr Psychiatry 2001;16:794-809.  Back to cited text no. 18
    
19.
Schreiber M, Schweizer A, Lutz K, Kalveram KT, Jäncke L. Potential of an interactive computer-based training in the rehabilitation of dementia: An initial study. Neuropsychol Rehabil 1999;9:155-67.  Back to cited text no. 19
    
20.
Loewenstein DA, Acevedo A, Czaja SJ, Duara R. Cognitive rehabilitation of mildly impaired Alzheimer disease patients on cholinesterase inhibitors. Am J Geriatr Psychiatry 2004;12:395.  Back to cited text no. 20
    
21.
Neely AS, Vikstrom S, Josephsson S. Collaborative memory intervention in dementia: Caregiver participation matters. Neuropsychol Rehabil 2009;19:696-715.  Back to cited text no. 21
    
22.
Koltai DC, Welsh-Bohmer KA, Smechel DE. Influence of anosognosia on treatment outcome among dementia patients. Neuropsychol Rehabil 2001;11:455-75.  Back to cited text no. 22
    
23.
Cahn-Weiner DA, Malloy PF, Rebok GW, Ott BR. Results of a randomized placebo-controlled study of memory training for mildly impaired Alzheimer′s disease patients. Appl Neuropsychol 2003;10:215-23.  Back to cited text no. 23
    
24.
Quayhagen MP, Quayhagen M, Corbeil RR, Hendrix RC, Jackson JE, Snyder L, et al. Coping with dementia: Evaluation of four nonpharmacologic interventions. Int Psychogeriatr 2000;12:249-65.  Back to cited text no. 24
    
25.
Newhouse PA, Potter A, Levin ED. Nicotinic system involvement in Alzheimer′s and Parkinson′s diseases. Implications for therapeutics. Drugs Aging 1997;11:206-28.  Back to cited text no. 25
    
26.
Yesavage JA, Westphal J, Rush L. Senile dementia: Combined pharmacologic and psychologic treatment. J Am Geriatr Soc 1981;29:164-71.  Back to cited text no. 26
    
27.
Brodaty H, Gresham M, Luscombe G. The Prince Henry hospital dementia caregivers′ training programme. Int J Geriatr Psychiatry 1997;12:183-92.  Back to cited text no. 27
    
28.
Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer′s or vascular type: A review. Alzheimers Res Ther 2013;5:35-48.  Back to cited text no. 28
    
29.
Buschert V, Bokde AL, Hampel H. Cognitive intervention in Alzheimer disease. Nat Rev Neurol 2010;6:508-17.  Back to cited text no. 29
    
30.
Abd-Elaziz SA, Khedr EM, Ahmed HA, Ibrahim HD. Effect of cognitive rehabilitation on improving cognitive function and activities of daily living among elderly patients with stroke at Assiut University hospital. J Educ Pract 2015;6:44-57.  Back to cited text no. 30
    
31.
Kim S. Cognitive rehabilitation for elderly people with early-stage Alzheimer′s disease. J Phys Ther Sci 2015;27:543-6.  Back to cited text no. 31
    
32.
Wykes T, Reeder C. Cognitive Remediation Therapy for Schizophrenia: Theory and Practice. London: Routledge; 2005.  Back to cited text no. 32
    
33.
Kramer AF, Bherer L, Colcombe SJ, Dong W, Greenough WT. Environmental influences on cognitive and brain plasticity during aging. J Gerontol A Biol Sci Med Sci 2004;59:M940-57.  Back to cited text no. 33
    
34.
Mukundan CR. Brain Function Therapy. Bengaluru: Axxonet; 2000.  Back to cited text no. 34
    
35.
Anschutz L, Camp CJ, Markley RP, Kramer JJ. Maintenance and generalization of mnemonics for grocery shopping by older adults. Exp Aging Res 1985;11:157-60.  Back to cited text no. 35
    
36.
Glisky EL, Glisky ML. Memory rehabilitation in the elderly. In: Stuss DT, Winocur G, Robertson HI, editors. Cognitive Neurorehabilitation. Cambridge: Cambridge University Press; 1999. p. 347-61.  Back to cited text no. 36
    
37.
Greenberg C, Powers SM. Memory improvement among adult learners. Educ Gerontol 1987;12:385-94.  Back to cited text no. 37
    
38.
Kliegl R, Smith J, Baltes PB. Testing-the-limits and the study of adult age differences in cognitive plasticity of a mnemonic skill. Dev Psychol 1989;25:247-56.  Back to cited text no. 38
    
39.
Stigsdotter Neely A, Bäckman L. Long-term maintenance of gains from memory training in older adults: Two 3½ year follow-up studies. J Gerontol Psychol Sci 1993a; 48:233-7.  Back to cited text no. 39
    
40.
Stigsdotter Neely A, Bäckman L. Maintenance of gains following multifactorial and unifactorial memory training in late adulthood. Educ Gerontol 1993b; 19:105-17.  Back to cited text no. 40
    
41.
Yesavage JA. Nonpharmacologic treatments for memory losses with normal aging. Am J Psychiatry 1985;142:600-5.  Back to cited text no. 41
    
42.
Yesavage JA, Rose TL. Concentration and mnemonic training in elderly subjects with memory complaints: A study of combined therapy and order effects. Psychiatry Res 1983;9:157-67.  Back to cited text no. 42
    
43.
Zarit SH, Cole KD, Guider RL. Memory training strategies and subjective complaints of memory in the aged. Gerontologist 1981;21:158-64.  Back to cited text no. 43
    
44.
Willis SL, Nesselroade CS. Long-term effects of fluid ability training in old-old age. Dev Psycbol 1990;26:905-10.  Back to cited text no. 44
    
45.
Schaie K, Willis S, Caskie G. The Seattle longitudinal study: Relationship between personality and cognition. Neuropsychol Cognit 2004;11:304-24.  Back to cited text no. 45
    
46.
Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 2006;296:2805-14.  Back to cited text no. 46
    
47.
Wolinsky FD, Unverzagt FW, Smith DM, Jones R, Wright E, Tennstedt SL. The effects of the ACTIVE cognitive training trial on clinically relevant declines in health-related quality of life. J Gerontol B Psychol Sci Soc Sci 2006;61:S281-7.  Back to cited text no. 47
    
48.
Stuss DT, Robertson IH, Craik FI, Levine B, Alexander MP, Black S, et al. Cognitive rehabilitation in the elderly: A randomized trial to evaluate a new protocol. J Int Neuropsychol Soc 2007;13:120-31.  Back to cited text no. 48
    
49.
Tardif S, Simard M. Cognitive stimulation programs in healthy elderly: A review. Int J Alzheimers Dis 2011;2011:378934.  Back to cited text no. 49
    
50.
Di Fabio RP. Sensitivity and specificity of platform posturography for identifying patients with vestibular dysfunction. Phys Ther 1995;75:290-305.  Back to cited text no. 50
    
51.
Stelmach GE, Phillips J, DiFabio RP, Teasdale N. Age, functional postural reflexes, and voluntary sway. J Gerontol 1989;44:B100-6.  Back to cited text no. 51
    
52.
Colledge NR, Cantley P, Peaston I, Brash H, Lewis S, Wilson JA. Ageing and balance: The measurement of spontaneous sway by posturography. Gerontology 1994;40:273-8.  Back to cited text no. 52
    
53.
Lee YM, Jang C, Bak IH, Yoon JS. Effects of computer-assisted cognitive rehabilitation training on the cognition and static balance of the elderly. J Phys Ther Sci 2013;25:1475-7.  Back to cited text no. 53
    
54.
Brookmeyer R, Evans DA, Hebert L, Langa KM, Heeringa SG, Plassman BL, et al. National estimates of the prevalence of Alzheimer′s disease in the United States. Alzheimers Dement 2011;7:61-73.  Back to cited text no. 54
    
55.
Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer′s disease: Recommendations from the National Institute on Aging-Alzheimer′s Association workgroups on diagnostic guidelines for Alzheimer′s disease. Alzheimers Dement 2011;7:270-9.  Back to cited text no. 55
    
56.
APA. Diagnostic criteria from DSM-5. Washington, DC: APA; 2013.  Back to cited text no. 56
    
57.
Boyle PA, Wilson RS, Aggarwal NT, Tang Y, Bennett DA. Mild cognitive impairment: Risk of Alzheimer disease and rate of cognitive decline. Neurology 2006;67:441-5.  Back to cited text no. 57
    
58.
Manly JJ, Tang MX, Schupf N, Stern Y, Vonsattel JP, Mayeux R. Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol 2008;63:494-506.  Back to cited text no. 58
    
59.
Smith GE, Pankratz VS, Negash S, Machulda MM, Petersen RC, Boeve BF, et al. A plateau in pre-Alzheimer memory decline: Evidence for compensatory mechanisms? Neurology 2007;69:133-9.  Back to cited text no. 59
    
60.
Martin M, Clare L, Altgassen AM, Cameron MH, Zehnder F. Cognition-based interventions for healthy older people and people with mild cognitive impairment. Cochrane Database Syst Rev 2011:CD006220.  Back to cited text no. 60
    
61.
Belleville S. Cognitive training for persons with mild cognitive impairment. Int Psychogeriatr 2008;20:57-66.  Back to cited text no. 61
    
62.
Cotelli M, Manenti R, Zanetti O, Miniussi C. Non-pharmacological intervention for memory decline. Front Hum Neurosci 2012;6:46.  Back to cited text no. 62
    
63.
Huckans M, Hutson L, Twamley E, Jak A, Kaye J, Storzbach D. Efficacy of cognitive rehabilitation therapies for mild cognitive impairment (MCI) in older adults: Working toward a theoretical model and evidence-based interventions. Neuropsychol Rev 2013;23:63-80.  Back to cited text no. 63
    
64.
Jean L, Bergeron ME, Thivierge S, Simard M. Cognitive intervention programs for individuals with mild cognitive impairment: Systematic review of the literature. Am J Geriatr Psychiatry 2010;18:281-96.  Back to cited text no. 64
    
65.
Reijnders J, van Heugten C, van Boxtel M. Cognitive interventions in healthy older adults and people with mild cognitive impairment: A systematic review. Ageing Res Rev 2013;12:263-75.  Back to cited text no. 65
    
66.
Simon SS, Yokomizo JE, Bottino CM. Cognitive intervention in amnestic mild cognitive impairment: A systematic review. Neurosci Biobehav Rev 2012;36:1163-78.  Back to cited text no. 66
    
67.
Stott J, Spector A. A review of the effectiveness of memory interventions in mild cognitive impairment (MCI). Int Psychogeriatr 2011;23:526-38.  Back to cited text no. 67
    
68.
Li H, Li J, Li N, Li B, Wang P, Zhou T. Cognitive intervention for persons with mild cognitive impairment: A meta-analysis. Ageing Res Rev 2011;10:285-96.  Back to cited text no. 68
    
69.
Oskoei AS, Nejati V, Ajilchi B. The effectiveness of cognitive rehabilitation on improving the selective attention in patients with mild cognitive impairment. J Behav Brain Sci 2013;3:474-8.  Back to cited text no. 69
    
70.
Hampstead BM, Gillis MM, Stringer AY. Cognitive rehabilitation of memory for mild cognitive impairment: A methodological review and model for future research. J Int Neuropsychol Soc 2014;1:1-17.  Back to cited text no. 70
    
71.
Salomone S, Caraci F, Leggio GM, Fedotova J, Drago F. New pharmacological strategies for treatment of Alzheimer′s disease: Focus on disease modifying drugs. Br J Clin Pharmacol 2012;73:504-17.  Back to cited text no. 71
    
72.
Small GW, Rabins PV, Barry PP, Buckholtz NS, DeKosky ST, Ferris SH, et al. Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer′s Association, and the American Geriatrics Society. JAMA 1997;278:1363-71.  Back to cited text no. 72
    
73.
Camp CJ, Bird MJ, Cherry KE. Retrieval strategies as a rehabilitation aid for cognitive loss in pathological aging. In: Cognitive Rehabilitation in Old Age. New York: Oxford University Press; 2000.  Back to cited text no. 73
    
74.
Clare L, Wilson BA, Carter G, Roth I, Hodges JR. Relearning face-name associations in early Alzheimer′s disease. Neuropsychology 2002;16:538-47.  Back to cited text no. 74
    
75.
Anderson J, Arens K, Arens K, Coppens P. Spaced retrieval vs memory tape therapy in memory rehabilitation for dementia of the Alzheimer′s type. Clin Gerontol 2001;24:123-39.  Back to cited text no. 75
    
76.
Clare L, Wilson BA, Carter G, Breen K, Gosses A, Hodges JR. Intervening with everyday memory problems in dementia of Alzheimer type: An errorless learning approach. J Clin Exp Neuropsychol 2000;22:132-46.   Back to cited text no. 76
    
77.
Dunn J, Clare L. Learning face-name associations in early-stage dementia: Comparing the effects of errorless learning and effortful processing. Neuropsychol Rehabil 2007;17:735-54.  Back to cited text no. 77
    
78.
Farina E, Fioravanti R, Chiavari L, Imbornone E, Alberoni M, Pomati S, et al. Comparing two programs of cognitive training in Alzheimer′s disease: A pilot study. Acta Neurol Scand 2002;105:365-71.  Back to cited text no. 78
    
79.
Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012;2:CD005562.  Back to cited text no. 79
    
80.
World Health Organization. Global Burden of Stroke; 2009. Available from: http://www.WHO.com; http://www.who.int/cardiovascular_diseases/en/cvd_atlas_08_physical_inactivity.pdf. [Last accessed on 2016 May 04].  Back to cited text no. 80
    
81.
Paul SL, Srikanth VK, Thrift AG. The large and growing burden of stroke. Curr Drug Targets 2007;8:786-93.  Back to cited text no. 81
    
82.
Abd-Elaziz SA, Khedr EM, Ahmed HA, Ibrahim HD. Effect of cognitive rehabilitation on improving cognitive function and activities of daily living among elderly patients with stroke at Assiut University hospital. J Educ Pract 2015;6:44-57.  Back to cited text no. 82
    
83.
Abd-Elaziz SAE, Khedr EM, Ahmed HAE, Ibrahim HDF. Effect of Cognitive Rehabilitation on Improving Cognitive Function and Activities of Daily Living among Elderly Patients with Stroke at Assiut University Hospital. Journal of Education and Practice 2015;6:44-57.  Back to cited text no. 83
    
84.
Nair RD, Lincoln NB. Cognitive rehabilitation for memory deficits following stroke. Cochrane Database Syst Rev 2007;3:CD002293.  Back to cited text no. 84
    
85.
Galletly C, Rigby A. An overview of cognitive remediation therapy for people with severe mental illness. ISRN Rehabil 2013;2013:984932.  Back to cited text no. 85
    
86.
Gold JM, Harvey PD. Cognitive deficits in schizophrenia. Psychiatr Clin North Am 1993;16:295-312.  Back to cited text no. 86
    
87.
Goldberg TE, Torrey EF, Gold JM, Bigelow LB, Ragland RD, Taylor E, et al. Genetic risk of neuropsychological impairment in schizophrenia: A study of monozygotic twins discordant and concordant for the disorder. Schizophr Res 1995;17:77-84.  Back to cited text no. 87
    
88.
Saykin AJ, Shtasel DL, Gur RE, Kester DB, Mozley LH, Stafiniak P, et al. Neuropsychological deficits in neuroleptic naive patients with first-episode schizophrenia. Arch Gen Psychiatry 1994;51:124-31.  Back to cited text no. 88
    
89.
Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 1996;153:321-30.  Back to cited text no. 89
    
90.
Mueser KT. Cognitive impairment, symptoms, social functioning, and vocational rehabilitation in schizophrenia. In: Kashima H, Falloon IR, Mizuno M, Asai M, editors. Comprehensive Treatment of Schizophrenia: Linking Neurobehavioral Findings to Psychosocial Approaches. Tokyo: Springer-Verlag; 2002. p. 344-51.  Back to cited text no. 90
    
91.
McGurk SR, Mueser KT, Pascaris A. Cognitive training and supported employment for persons with severe mental illness: One-year results from a randomized controlled trial. Schizophr Bull 2005;31:898-909.  Back to cited text no. 91
    
92.
Bell M, Bryson G, Greig T, Corcoran C, Wexler BE. Neurocognitive enhancement therapy with work therapy: Effects on neuropsychological test performance. Arch Gen Psychiatry 2001;58:763-8.  Back to cited text no. 92
    
93.
Brenner HD, Hodel B, Roder V, Corrigan P. Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia. Schizophr Bull 1992;18:21-6.  Back to cited text no. 93
    
94.
Hogarty GE, Flesher S, Ulrich R, Carter M, Greenwald D, Pogue-Geile M, et al. Cognitive enhancement therapy for schizophrenia: Effects of a 2-year randomized trial on cognition and behavior. Arch Gen Psychiatry 2004;61:866-76.  Back to cited text no. 94
    
95.
Spaulding WD, Reed D, Sullivan M, Richardson C, Weiler M. Effects of cognitive treatment in psychiatric rehabilitation. Schizophr Bull 1999;25:657-76.  Back to cited text no. 95
    
96.
Twamley EW, Jeste DV, Bellack AS. A review of cognitive training in schizophrenia. Schizophr Bull 2003;29:359-82.  Back to cited text no. 96
    
97.
McGurk SR, Wykes T. Cognitive remediation and vocational rehabilitation. Psychiatr Rehabil J 2008;31:350-9.  Back to cited text no. 97
    
98.
McGurk SR, Twamley EW, Sitzer DI, McHugo GJ, Mueser KT. A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry 2007;164:1791-802.  Back to cited text no. 98
    
99.
Vauth R, Corrigan PW, Clauss M, Dietl M, Dreher-Rudolph M, Stieglitz RD, et al. Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation. Schizophr Bull 2005;31:55-66.  Back to cited text no. 99
    
100.
Wexler BE, Bell MD. Cognitive remediation and vocational rehabilitation for schizophrenia. Schizophr Bull 2005;31:931-41.  Back to cited text no. 100
    
101.
Wykes T, Huddy V, Cellard C, McGurk SR, Czobor P. A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. Am J Psychiatry 2011;168:472-85.  Back to cited text no. 101
    



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