Elsevier

Comprehensive Psychiatry

Volume 44, Issue 3, May–June 2003, Pages 213-219
Comprehensive Psychiatry

Interactive computer-training as a therapeutic tool in Alzheimer’s disease

https://doi.org/10.1016/S0010-440X(03)00006-3Get rights and content

Abstract

The current study sought to evaluate a novel kind of interactive computer-based cognitive training (ICT) in Alzheimer’s disease (AD). AD patients (N = 9), age- and gender-matched patients with a major depressive episode (N = 9), and healthy control subjects (N = 10) were trained to use an ICT program that relates to activities of daily living (ADL). Digital photographs of a shopping route were implemented in a close-to-reality simulation on a computer touch-screen. The task was to find a predefined shopping route, to buy three items, and to answer correctly 10 multiple-choice questions addressing knowledge related to the virtual tasks. Training performance was rated using the number of mistakes (wrong way), time needed for the tasks, number of correct multiple-choice answers, and of repeat of instruction. Compared to normal controls and depressed patients, AD patients performed significantly worse with regard to all variables. Within a 4-week training period including 12 sessions, however, substantial training gains were observed, including a significant reduction of mistakes. Training effects were sustained until follow-up 3 weeks later. The performance of the depressed patients and the normal controls improved as well, with no difference between the two groups. Self-reported effects revealed that the training was well perceived. Thus, the task performance of AD patients improved substantially and subjects appeared to have liked this approach to ICT. New interactive media, therefore, may yield interesting opportunities for rehabilitation and (psycho)therapeutic interventions.

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Subjects and procedures

Subjects were nine patients with the diagnosis of probable AD according to DSM-III-R12 and National Institute of Neurological and Communicative Disorders and Stroke (NINCDS)- Alzheimer’s Disease and Related Disorders Association (ADRDA) criteria,13 nine patients with a major depressive episode (DSM-III-R), and 10 age-matched healthy normal control subjects. Demographic and clinical data are given in Table 1. In each group there were seven female subjects, two males in the AD and major

Training variables

Compared to the depressed patients and control subjects, the AD patients performed significantly worse in all four training variables [latency: F(1,16) = 4.57, P < .027; repeat of instruction: F(2,15) = 5 26, P < .02; mistakes: F(2,15) = 7.0, P < .007; multiple-choice questions: F(2,15) = 5.20, P < .02]. Multiple post-hoc Scheffé tests did not reveal any significant differences between patients with depression and the control group (Fig 2).

To determine changes within each individual group

Discussion

The objective of this study was to investigate the feasibility of a computerized training approach, that relates to activities of daily living in AD patients, and to compare the results with a psychiatric and a healthy control group. As regards the demented patients, in this study we replicated and confirmed results of previous studies with this novel approach to computer-based training in AD patients. With regard to all measured training variables there was a uniform trend towards an improved

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    E.S. is supported by grants from the Swiss National Science Foundation, SNF no. 63-58040.99.

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