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Cognitive Rehabilitation Therapies for Alzheimer’s Disease: A Review of Methods to Improve Treatment Engagement and Self-Efficacy

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Abstract

Cognitive rehabilitation therapies for Alzheimer’s disease (AD) are becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. However, people with AD may have difficulty adhering to these cognitive treatments due to denial of memory deficits, compromised brain systems, cognitive incapacity for self-awareness, general difficulty following through on daily tasks, lack of motivation, hopelessness, and apathy, all of which may be either due to the illness or be secondary to depression. Cognitive rehabilitation training exercises are also labor intensive and, unfortunately, serve as a repeated reminder about the memory impairments and attendant functional consequences. In order for cognitive rehabilitation methods to be effective, patients must be adequately engaged and motivated to not only begin a rehabilitation program but also to remain involved in the intervention until a therapeutic dosage can be attained. We review approaches to cognitive rehabilitation in AD, neuropsychological as well as psychological obstacles to effective treatment in this population, and methods that target adherence to treatment and may therefore be applicable to cognitive rehabilitation therapies for AD. The goal is to stimulate discussion among researchers and clinicians alike on how treatment effects may be mediated by engagement in treatment, and what can be done to enhance patient adherence for cognitive rehabilitation therapies in order to obtain greater cognitive and functional benefits from the treatment itself.

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Acknowledgments

This work was supported by a grant from the Alzheimer’s Association (IIRG-09-131861) to JC.

We would like to thank Joanna Fiszdon, Ph.D., for her assistance in providing content on motivational interviewing as well as feedback on manuscript drafts. We would also like to thank Gennarina Santorelli, B.S., for her work on the section on hopelessness and defeatist beliefs.

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Authors and Affiliations

  1. Mental Health Services & Policy Research, Columbia University Medical Center, 1051 Riverside Dr, Mailbox 100, New York, NY, 10032, USA

    Jimmy Choi

  2. Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA, 92161, USA

    Elizabeth W. Twamley

  3. UC San Diego Department of Psychiatry, 140 Arbor Drive (0851), San Diego, CA, 92103, USA

    Elizabeth W. Twamley

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  1. Jimmy Choi
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  2. Elizabeth W. Twamley
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Correspondence to Jimmy Choi.

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Choi, J., Twamley, E.W. Cognitive Rehabilitation Therapies for Alzheimer’s Disease: A Review of Methods to Improve Treatment Engagement and Self-Efficacy. Neuropsychol Rev 23, 48–62 (2013). https://doi.org/10.1007/s11065-013-9227-4

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  • DOI: https://doi.org/10.1007/s11065-013-9227-4

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