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dementia_treatment

Dementia treatment

The immediate cure is not a possible solution, at least at the moment, but science has found a number of new ways to retard and under specific conditions to halt its development. A potential, and constantly evolving scientific field is the use of Computerized Cognitive Rehabilitation (CCR) and Virtual Environments (Vr.E). According to the existing literature, subjecting patients to various neuro-rehabilitative conditions within 3D virtual environments, allows them to obtain significant therapeutic benefits in which both transferability and durations over time are observed, in relation to the training period of the intervention. In the present study we examine whether “Serious Games (SGs)” - (learning and rehabilitating games in virtual and augmented reality) - have utilitarian value in the field of cognitive neurorehabilitation, concerned with demented population. For research purposes, we have conducted a number of case studies, based on 10 elderly patients, suffering from moderate or mild severity impairment of higher cortical functions, attributed to various types of dementias (Vascular, Alzheimer's disease, DLB dementia and mixed dementia). Each participant underwent rehabilitative intervention through our SG for a total of 10 hours within 4-5 weeks period. At the end of the cognitive rehabilitation program, patients' performance was assessed based in standard neuropsychological tests (measuring: working memory, memory retention, attention, problem solving, rigid thinking and executive function) and the results were compared with measurements taken before, during, and at the end of the intervention. Our experimental hypothesis states that there will be a significant difference between the results of cognitive performance of the patients between the pre- and post- rehabilitative period, consequential of the Interactive Computer-based Training (ICT). In conclusion, a review and brief analysis of the relevant literature was carried out in order to investigate the specification of potentially beneficial variables and to appreciate as much as possible the multifactorial causes related to this particular rehabilitation method of the corresponding suffering population. The ultimate purpose of our research is the design and creation of a prospective interactive cognitive rehabilitation training SG, able to combine both the neuro-rehabilitative character of the controlled virtual environment, as well as the potential realism that is also attributed to it (factual validity under high experimental realism). The results showed a relative improvement in the total of the cognitive variables under consideration after the completion of the neuro-rehabilitative program, while a parallel review of the literature on the subject revealed methodological considerations similar to those of the present study 1).

Reality orientation therapy can be considered routine care for the maintenance and improvement of cognitive functions in older populations with dementia. Health professionals and caregivers can be further educated and trained to regularly perform reality orientation therapy to improve the cognition of older people with dementia 2).

Hardenacke et al. 3) reviewed the literature and presented an overview of human and animal studies investigating the effects of DBS on cognitive functions with the primary aim to assess the potential of using DBS in the therapy of dementia. The available clinical evidence in human case studies comprises only a total of three investigations. The primary intent was to enhance cognitive functions in patients with dementia utilizing through DBS 4) 5) 6).

They also identified five further potentially interesting studies dealing with the effects of DBS on several cognitive functions in other patient groups 7) 8) 9) 10).

Considering the average low complication rate in a cohort of approximately 100,000 Parkinson patients treated with DBS globally 11) 12) DBS seems to be a feasible and safe treatment for patients with dementia. Independently of the target structure being stimulated, patients recovered quickly from surgery and only rarely experienced cognitive deterioration caused by the intervention.

1)
Fasilis T, Patrikelis P, Siatouni A, Alexoudi A, Veretzioti A, Zachou L, Gatzonis SS. A pilot study and brief overview of rehabilitation via virtual environment in patients suffering from dementia. Psychiatriki. 2018 Jan-Mar;29(1):42-51. doi: 10.22365/jpsych.2018.291.42. PubMed PMID: 29754119.
2)
Chiu HY, Chen PY, Chen YT, Huang HC. Reality orientation therapy benefits cognition in older people with dementia: A meta-analysis. Int J Nurs Stud. 2018 Jun 15;86:20-28. doi: 10.1016/j.ijnurstu.2018.06.008. [Epub ahead of print] PubMed PMID: 29960104.
3)
Hardenacke K, Shubina E, Bührle CP, Zapf A, Lenartz D, Klosterkötter J, Visser-Vandewalle V, Kuhn J. Deep brain stimulation as a tool for improving cognitive functioning in Alzheimer's dementia: a systematic review. Front Psychiatry. 2013 Dec 4;4:159. doi: 10.3389/fpsyt.2013.00159. Review. PubMed PMID: 24363647; PubMed Central PMCID: PMC3850165.
4)
Laxton AW, Tang-Wai DF, McAndrews MP, Zumsteg D, Wennberg R, Keren R, et al. A phase I trial of deep brain stimulation of memory circuits in Alzheimer’s disease. Ann Neurol (2010) 68(4):521–3410.1002/ana.22089
5)
Fontaine D, Deudon A, Lemaire JJ, Razzouk M, Viau P, Darcourt J, et al. Symptomatic treatment of memory decline in Alzheimer’s disease by deep brain stimulation: a feasibility study. J Alzheimers Dis (2013) 34(1):315–2310.3233/JAD-121579
6)
Freund HJ, Kuhn J, Lenartz D, Mai JK, Schnell T, Klosterkoetter J, et al. Cognitive functions in a patient with Parkinson-dementia syndrome undergoing deep brain stimulation. Arch Neurol (2009) 66(6):781–510.1001/archneurol.2009.102
7)
Suthana N, Haneef Z, Stern J, Mukamel R, Behnke E, Knowlton B, et al. Memory enhancement and deep-brain stimulation of the entorhinal area. N Engl J Med (2012) 366(6):502–1010.1056/NEJMoa1107212
8)
Hamani C, McAndrews MP, Cohn M, Oh M, Zumsteg D, Shapiro CM, et al. Memory enhancement induced by hypothalamic/fornix deep brain stimulation. Ann Neurol (2008) 63(1):119–2310.1002/ana.21295
9)
Stefani A, Pierantozzi M, Ceravolo R, Brusa L, Galati S, Stanzione P. Deep brain stimulation of pedunculopontine tegmental nucleus (PPTg) promotes cognitive and metabolic changes: a target-specific effect or response to a low-frequency pattern of stimulation? Clin EEG Neurosci (2010) 41(2):82–610.1177/155005941004100207
10)
Koubeissi MZ, Kahriman E, Syed TU, Miller J, Durand DM. Low-frequency electrical stimulation of a fiber tract in temporal lobe epilepsy. Ann Neurol (2013) 74(2):223–3110.1002/ana.23915
11)
Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schafer H, Botzel K, et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med (2006) 355(9):896–90810.1056/NEJMoa060281
12)
Voges J, Waerzeggers Y, Maarouf M, Lehrke R, Koulousakis A, Lenartz D, et al. Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery – experiences from a single centre. J Neurol Neurosurg Psychiatry (2006) 77(7):868–7210.1136/jnnp.2005.081232
dementia_treatment.txt · Last modified: 2018/07/02 15:54 by administrador