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Although non-drug interventions are widely used in patients with Alzheimer's disease, few large scale randomized trials involving a long-term intervention and several cognitive-oriented approaches have been carried out. ETNA3 trial compares the effect of cognitive training, reminiscence therapy, and an individualized cognitive rehabilitation program in Alzheimer's disease to usual care.
This is a multicenter (40 French clinical sites) randomized, parallel-group trial, with a two-year follow-up comparing groups receiving standardized programs of cognitive training (group sessions), reminiscence therapy (group sessions), individualized cognitive rehabilitation program (individual sessions), and usual care (reference group). Six hundred fifty-three outpatients with Alzheimer's disease were recruited. The primary efficacy outcome was the rate of survival without moderately severe to severe dementia at two years. Secondary outcomes were cognitive impairment, functional disability, behavioral disturbance, apathy, quality of life, depression, caregiver's burden, and resource utilization.
No impact on the primary efficacy measure was evidenced. For the two group interventions (i.e. cognitive training and reminiscence), none of the secondary outcomes differed from usual care. The larger effect was seen with individualized cognitive rehabilitation in which significantly lower functional disability and a six-month delay in institutionalization at two years were evidenced.
These findings challenge current management practices of Alzheimer's patients. While cognitive-oriented group therapies have gained popularity, this trial does not show improvement for the patients. The individualized cognitive rehabilitation intervention provided clinically significant results. Individual interventions should be considered to delay institutionalization in Alzheimer's disease.
Some studies have shown the presence of psychopathological disorders in transient global amnesia.
To determine whether transient global amnesia is associated with psychopathological disorders and to assess the influence of these psychopathological disorders on memory impairments.
Levels of anxiety and depression before and during transient global amnesia were rated. Memory performances were assessed by means of original episodic memory tasks and working memory tasks. These data were collected in 17 individuals observed during the very acute phase, 18 individuals examined in the peri-acute phase and 26 controls.
During the acute phase, participants with transient global amnesia displayed a higher level of anxiety and a more depressed mood than controls. An alteration of emotional state, as measured by the Adjective Mood Scale, was correlated with deficits in anterograde memory.
Transient global amnesia comprises sudden changes in people's emotional state, which has a major impact on and interacts with episodic memory impairment.