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Group and individual cognitive therapies in Alzheimer's disease: the ETNA3 randomized trial

Published online by Cambridge University Press:  17 November 2015

Hélène Amieva ,
Philippe H. Robert ,
Anne-Sophie Grandoulier ,
Céline Meillon ,
Jocelyne De Rotrou ,
Sandrine Andrieu ,
Claudine Berr ,
Béatrice Desgranges ,
Bruno Dubois  and
Chantal Girtanner
...Show all authors
Hélène Amieva*
Affiliation:
INSERM, U897-Epidemiology-Biostatistics, University of Bordeaux, F-33076, Bordeaux, France CHU Bordeaux, Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), France
Philippe H. Robert
Affiliation:
CHU Nice, Memory Center of Nice (Centre Mémoire de Ressources et de Recherche), France
Anne-Sophie Grandoulier
Affiliation:
CHU Bordeaux, Pôle de Santé Publique, USMR and CIC-EC 7, F-33000, Bordeaux, France
Céline Meillon
Affiliation:
CHU Bordeaux, Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), France
Jocelyne De Rotrou
Affiliation:
AP-HP, Hôpital Broca, Service de Gérontologie, F-75013, Paris, France
Sandrine Andrieu
Affiliation:
INSERM, UMR1027, University of Toulouse III, F-31000, Toulouse, France CHU Toulouse, Department of epidemiology and public health, F-31000, Toulouse, France
Claudine Berr
Affiliation:
INSERM, UMR 1061, University of Montpellier, F-33400 Montpellier, France CHU Montpellier, Memory Center of Montpellier (Centre Mémoire de Ressources et de Recherche), Department of Neurology, F-33400 Montpellier, France
Béatrice Desgranges
Affiliation:
INSERM, U1077, Université de Caen Basse-Normandie, Ecole Pratique des Hautes Etudes, CHU de Caen, France
Bruno Dubois
Affiliation:
INSERM UMR S975, Hôpital de la Salpêtrière, F-75651 Paris cedex 13, France
Chantal Girtanner
Affiliation:
CHU de Saint-Étienne, Hôpital Charité, Service de gérontologie clinique, France
Marie-Eve Joël
Affiliation:
University of Paris-Dauphine, Laboratoire d’Economie et de Gestion des Organisations de Santé (LEDa-LEGOS), Paris, France
Benoit Lavallart
Affiliation:
Direction Générale de la Santé, Paris, France
Fati Nourhashemi
Affiliation:
INSERM, UMR1027, University of Toulouse III, F-31000, Toulouse, France CHU Toulouse, Department of epidemiology and public health, F-31000, Toulouse, France
Florence Pasquier
Affiliation:
CHU Lille, Memory Center of Lille (Centre Mémoire de Ressources et de Recherche), France
Muriel Rainfray
Affiliation:
CHU Bordeaux, Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), France
Jacques Touchon
Affiliation:
INSERM, UMR 1061, University of Montpellier, F-33400 Montpellier, France CHU Montpellier, Memory Center of Montpellier (Centre Mémoire de Ressources et de Recherche), Department of Neurology, F-33400 Montpellier, France
Geneviève Chêne
Affiliation:
INSERM, U897-Epidemiology-Biostatistics, University of Bordeaux, F-33076, Bordeaux, France CHU Bordeaux, Pôle de Santé Publique, USMR and CIC-EC 7, F-33000, Bordeaux, France
Jean-François Dartigues
Affiliation:
INSERM, U897-Epidemiology-Biostatistics, University of Bordeaux, F-33076, Bordeaux, France CHU Bordeaux, Memory Center of Bordeaux (Centre Mémoire de Ressources et de Recherche), France
*
Correspondence should be addressed to: Prof Hélène Amieva INSERM U897 Epidemiology and Biostatistics, Université Bordeaux Segalen, 146 Rue Léo Saignat, 33076 Bordeaux cedex, France. Phone: +33 5 57 57 15 10. Email: Helene.Amieva@isped.u-bordeaux2.fr.
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Abstract

Background:

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.

Methods:

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.

Results:

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.

Conclusions:

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.

Keywords

non-drug therapiesAlzheimerdementiacognitive trainingreminiscenceindividualized cognitive rehabilitation
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 5 , May 2016 , pp. 707 - 717
Copyright
Copyright © International Psychogeriatric Association 2015 

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