Loading...
Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: a multi-centre randomised controlled trial (the GREAT trial)
Clare, L. Kudlicka, A. Jones, R.W. Bayer, A. Leroi, I. Kopelman, M.D. James, I.A. Culverwell, A. Pool, J.
Clare, L.
Kudlicka, A.
Jones, R.W.
Bayer, A.
Leroi, I.
Kopelman, M.D.
James, I.A.
Culverwell, A.
Pool, J.
Publication Date
2019
End of Embargo
Supervisor
Rights
© 2019 The Authors. This is an Open Access article under the terms of the Creative Commons CC-BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/legalcode)
Peer-Reviewed
Yes
Open Access status
openAccess
Accepted for publication
2019-01-28
Institution
Department
Awarded
Embargo end date
Collections
Additional title
Abstract
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 multi-centre 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’s, vascular or mixed dementia and mild-to-moderate cognitive
impairment (MMSE score ≥ 18), and with a family member willing to contribute. Participants
allocated to CR received ten weekly sessions over three months and four maintenance sessions over
six months. Participants were followed up three and nine months post-randomisation by blinded
researchers. The primary outcome was self-reported goal attainment at three months. Secondary
outcomes at three and nine 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 three months, and 426 (CR=208) at nine months. At three months there
were statistically-significant large positive effects for participant-rated goal attainment (d=0.97, 95%
CI 0.75 to 1.19), corroborated by informant ratings (d=1.11, 0.89 to 1.34). These effects were
maintained at nine months for both participant (d=0.94, 0.71 to 1.17) and informant ratings (d=0.96,
0.73 to 1.2). The observed gains related to goals directly targeted in the therapy. There were no
significant differences in secondary outcomes.
Conclusions: Cognitive rehabilitation enables people with early-stage dementia to improve their
everyday functioning in relation to individual goals targeted in the therapy.
Version
Published version
Citation
Clare L, Kudlicka A, Oyebode JR et al (2019) Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: a multi-centre randomised controlled trial (the GREAT trial). Cognitive rehabilitation in early-stage dementia: the GREAT trial. International Journal of Geriatric Psychiatry. 34(5): 702-721.
Link to publisher’s version
Link to published version
Link to Version of Record
Type
Article