Statistically significant large positive effects were observed for participant-rated goal attainment at 3 months (d = 0.97).
Participants receiving reported improvements in achieving personal goals compared to those receiving usual treatment.
Informant ratings also supported these findings, indicating a corroboration of participant-reported improvements.
The positive effects on goal attainment were maintained at the 9-month follow-up.
Improvements were specifically related to the goals that were targeted during the cognitive rehabilitation sessions.
No significant differences were found in secondary outcomes, such as quality of life and mood.
Simplified
OBJECTIVES: To determine whether individual goal-oriented (CR) improves everyday functioning for people with mild-to-moderate dementia.
DESIGN AND METHODS: Parallel group multicentre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer, vascular or mixed dementia, and mild-to-moderate cognitive impairment (Mini-Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self-reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition and study partner stress and quality of life.
RESULTS: We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant-rated goal attainment (d = 0.97; 95% CI, 0.75-1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89-1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71-1.17) and informant (d = 0.96; 95% CI, 0.73-1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes.
CONCLUSIONS: CR enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.
Key numbers
2.84
Participant-Rated Goal Attainment Improvement
Mean change in goal attainment ratings on a 0 to 10 scale.
3.09
Informant-Rated Goal Attainment Improvement
Mean change in ratings by study partners at 3 months.
90%
Retention Rate
Retention rate at 9 months post-randomization.
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All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare no support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.
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