Improvement of functional status after cognitive activation therapy (CAT) in Alzheimer's disease patients

Non-pharmacological approaches have been shown to be useful to treat cognitive decline in dementia, however the functional impact of such protocols has not been fully established. Aim of the study is to quantify the efficacy of CAT on functional status of subjects with mild to moderate Alzheimer's Disease (AD). CAT protocol was developed starting from previous experiences: Reality Orientation Therapy, Reminiscence, errorless learning principles with the addition of social educational animation. The treatment, divided in 18 sessions of 4 hours each, was organized in a small group of patient (3-5). In order to evaluate the effect on simple and complex abilities of everyday life we used the Direct Assessment of Functional Status (DAFS) at the beginning and at the end of each treatment. The activities evaluated by the DAFS were different from the abilities trained during the CAT. Cognitive changes and perceived health status were tested with MMSE and SF-12 respectively. 206 patients in stable treatment with cholinesterase inhibitors or memantine (3 months minimum) were recruited (MMSE score 14-24). The CAT group (206) was compared with a control group (40) with similar age, gender, functional and cognitive status, and drug therapy. The statistical elaboration was performed using the SPSS package.