Goal-setting can help people with early-stage dementia improve function

Large trial shows that cognitive rehabilitation helped people mildly affected by dementia to improve their goal setting and attainment. Disappointingly, this wasn’t accompanied by improvements in self-efficacy, depression and anxiety, cognitive functioning, quality of life or carer stress | Health Technology Assessment | via NIHR

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Goal-setting as part of cognitive rehabilitation delivered by occupational therapists helped people with early dementia progress towards independence in daily tasks, with benefits lasting for nine months. This approach focuses on the everyday tasks needing concentration and memory and prioritising those that matter most to individuals, from using the cooker or answering the phone. The intervention was well-received, but the cost-effectiveness is not clear, because quality of life continued to deteriorate.

Therapists delivered ten sessions of cognitive rehabilitation over three months, with another four sessions over the next six months. Rehabilitation was intended to identify goals important to the person with dementia and their carer (including basic self-care and participation in events). The therapist identified barriers to achievement and worked on helping people to overcome them.

Compared to people with early dementia treated with usual care, those given cognitive rehabilitation were more likely to show progress towards their goals after three months. However, secondary outcomes such as quality of life did not show improvement for patients or carers, meaning that the intervention was not cost-effective by usual measures.

Full details at National Institute for Health Research

Clare L, Kudlicka A, Oyebode J R et al.| Goal-oriented cognitive rehabilitation for early-stage Alzheimer’s and related dementias: the GREAT RCT | Health Technol Assess. 2019;23(10).

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