Case Study - Early Alzheimers Essay Example for Free

Case Study Early Alzheimers Essay This paper reviews the use of cognitive rehabilitation treatment of early stage of dementia Alzheimer’s type. The case study examines a 72 year old male patient diagnosed with early stage dementia of Alzheimer’s Type. This study used visual imagery, as well as cues and expanding rehearsal during the cognitive rehabilitation. The evaluation of cognitive rehabilitation treatment included the psychological, physiological, neurological assessments and self-reports. Results suggested that extended use of cognitive rehabilitation treatment ensued longer lasting improved cognitive functioning.  With the results of the study discussed, implications suggest that combining longer treatment of cognitive rehabilitation could help reduce the progression of early onset dementia of the Alzheimer’s Type. Case Study Clare, Wilson, Carter, Hodges, and Adams (2001) studied a 74-year old single man, named â€Å"VJ† who lived with his sister in a single case study. VJ was formerly employed in the construction industry. VJ started to attend the memory clinic in 1993. He was then diagnosed having an early stage of dementia of Alzheimer type (DAT). His sister joined him at the clinic. The researchers started with a process called, cognitive rehabilitation (CR) intervention. Cognitive rehabilitation (CR) focuses on memory functioning. Although CR was at first developed for patients with traumatic brain injuries, it was proven to be efficient for people experiencing cognitive difficulties (Savage, 2009, p. 31). In order to define CR, it is necessary to define cognition. Katz and Hadas (1995) quote Lidz in defining cognition, â€Å"†¦as the individuals capacity to acquire and use information to adapt to environmental demands† (p. 9). Sigelman and Rider (2012) say that cognition is, â€Å"the activity of knowing and the process through which knowledge is acquired and problems solved† (p. 210). Cognitive rehabilitation is quoted by Katz and Hadas (1995) â€Å"†¦the therapeutic process of increasing or improving an individuals capacity to process and use incoming information so as to allow increased functioning in everyday life, this includes both methods to restore cognitive functioning and compensatory techniques (p. 29). Interventions aimed in CR are divided into remedial and adaptive/functional strategies (Katz Hadas, 1995). The main aim of the remedial strategy is the individuals impaired capabilities. The functional strategies are aimed to enhance the strengths of the individual for functioning. The assumption these two strategies are built upon is, â€Å"†¦that functional activities require cognitive perceptual skills†¦Ã¢â‚¬  (Katz Hadas, 1995, p. 30) and cognitive impairments can be modified and treated in the adult dysfunctional brain which will enhance reorganisation or recovery of the brain. Based on these assumptions the remedial strategy is directed towards functional abilities by retraining perception skill components of behaviour, while the functional strategy in contrast assumes that the affected adult brain has limited recovery potential and that retraining of the brain should be focused on specific activities as required (Katz Hadas, 1995). The unique feature of all occupational therapy models, are the emphasis that treatment is based on purposeful activities that are analyzed and adapted to the patients cognitive and functional ability level. This therapy is not without controversy. As the critics of CR indicated, memory training for people with DAT increases frustration for the patients, because the improvement in cognition is short term (Clare et al. , 2001). Sigelman and Rider (2012) agree by saying, â€Å"†¦over time, individuals cannot recall even with the aid of cues and become increasingly frustrated† (p. 541). Neuroplasticity is possible before or in the early stages of AD, but diminishes in later phases of AD. Clare et al. 2001) found empirical research to prove that CR is an effective method of slowing the decline of cognitive functions in early AD. Questions about CR which remain to be answered include impact of CR on well-being and life quality, the ability to sustain longevity of gains in cognitive therapy and what type of contributions can CR make in AD? (Clare et al, 2001). Lately, â€Å"identifying cognitive markers of a preclinical phase of Alzheimer’s disease (AD) has been a major research focus in neuropsychology† (Jacobson et al. 2009, p. 278). Cognitive Rehabilitation Intervention Clare and colleagues, (2001) predicted in theory, that the possibility cognitive rehabilitation may be responsible for the maintenance of memory gains over time. The researchers set to prove through long-term follow-up data that memory retraining had lasting effects and showed gains beyond the treatment sessions as demonstrated by previous cognitive rehabilitation studies. The researchers used 11 Polaroid photos of VJ’s club members to teach the face-name associations. This was performed by the method of combining visual imagery, vanishing cues, and expanding rehearsal (Clare et al. , 2001). The researchers took VJ to the familiar environment of the club to do generalisation sessions using the photos and found the initial recall was 20% and raised to 98% over time and became 100% at the one, three, six and nine months follow-up sessions. VJ practiced every day using the photographs. â€Å"In the early stages of Alzheimer’s disease, free recall tasks are difficult but memory is good if cues to recall are provided†¦Ã¢â‚¬  (Sigelman Rider, 2012, p. 41), like the photos in this case study. After the ninth months, the researchers took the photos away to use them only once a month, at the club with VJ. VJ was to recall the first names of the people in the photos with zero feedback given to VJ. After the first and second year, magnetic resonance imaging (MRI) was completed. At the same times neuropsychological assessment were completed to evaluate the results of changes in cognitive functioning compared to the initial and post-intervention assessments. Several tests were used in the neuropsychological assessment such as the Mini-Mental State Examination (MMSE); National Adult Reading Test (NART); Standard Progressive Matrices (SPM); Speed and Capacity of Language Processing (SCOLP); Visual Object and Space Perception Battery (VOSP); Unfamiliar Face Matching; Digit span, forwards and backwards; Rivermead Behavioural Memory Test (RBMT); Doors and People; Famous Faces and Famous Names. Self-report measures were used as well to assess VJ’s perceptions of memory problems, behaviour, affect and VJ’s sister on caregiver strain. The following measures were used: Memory Symptoms Questionnaire; Hospital Anxiety and Depression Scale (HADS); Caregiver Strain Index (CSI) VJ’s sister rated herself on strain experienced (Clare et al. , 2001). The initial and post-intervention neuropsychological assessments shown VJ’s general cognitive abilities before he contracted DAT were in the high average ranges, his post-intervention scores were above average, though speed of processing was slower. VJ’s perceptual skills and processing of unfamiliar faces were in normal ranges. Memory was severely impaired, having difficulty recalling names of famous people. Overall there was not much of a change between the initial and post-intervention assessments, but only a mild decline in abstract reasoning and speed of processing information. While some of VJ’s cognitive functions remained the same, â€Å"†¦a gradual decline in abstract reasoning, speed of information processing, working memory, episodic memory, and semantic memory over the study period was evident. MMSE scores, too, showed a mild decline†¦assessment of coronal T1 images (MRI) revealed mild, but definite, bilateral hippocampal atrophy as indicated by enlargement of the temporal horn of the lateral ventricle and reduction in height of the hippocampal formation† (Clare et al. , 2001, p. 486-487). After all the results were taken in consideration it seems that this case study provides the evidence that long-term maintenance of specific gains can be achieved with a CR procedure. The use of CR in dementia was criticised as not being an intervention that can assure any gains beyond the treatment sessions. It is clear from the results of this study that this claim is untrue. Another case study in 2003 was done with the same interventions. The same results were found and support the finding that CR maybe a valuable comprehensive intervention for persons with early identified dementia of the Alzheimer type (Clare, Wilson, Carter, Hodges, 2003). Conclusions The results of this case study indicate the importance of length in cognitive rehabilitation for individuals diagnosed with early staged dementia of the Alzheimer’s type. The use of cognitive rehabilitation over an extended period of treatment allowed the researchers to evaluate the importance of visual imagery, recall and extended rehearsal strategies in treatment. The positive results indicated possible development in the treatment of diagnosed patients, as well as duration and techniques applied. Future studies will need to focus on the exact parameters of duration for treatment with cognitive rehabilitation in patients diagnosed with early stage dementia of Alzheimer’s Type. Implications arrived from the longevity of treatment could also improve the overall quality of treatment, evidence to substantiate financial support/funding for treatment and improve motivation and expectations from patients and family members. The importance to involve cognitive stimulation with patients diagnosed with early stages of Alzheimer’s disease is apparent in subsequent research and continues to be implicated in other similar cognitive dysfunctions.