Login to MyKarger

New to MyKarger? Click here to sign up.

Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Research Article

Open Access Gateway

Cognitive Interventions in Mild Alzheimer's Disease: A Therapy-Evaluation Study on the Interaction of Medication and Cognitive Treatment

Schecker M.a · Pirnay-Dummer P.a, c · Schmidtke K.b, d · Hentrich-Hesse T.a · Borchardt D.a

Author affiliations

aNeurolinguistisches Labor NLL, Forschungsbereich ‘Kognitive und Klinische Neurowissenschaften', Kinder- und Jugendpsychiatrie, and bZentrum für Geriatrie und Gerontologie Freiburg, Universitätskliniken Freiburg, and cInstitut für Erziehungswissenschaft, Universität Freiburg, Freiburg i.Br., and dOrtenau Klinikum, Offenburg, Germany

Corresponding Author

Prof. Dr. Michael Schecker

Neurolinguistisches Labor NLL

Kinder- und Jugendpsychiatrie, Universitätskliniken Freiburg, Prof. Dr. E. Schulz

Hauptstrasse 1, DE-79104 Freiburg i.Br. (Germany)

E-Mail michael.schecker@zfn-brain.uni-freiburg.de

Related Articles for ""

Dement Geriatr Cogn Disord Extra 2013;3:301-311

Do you have an account?

Login Information

Contact Information

By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.

I have read the Karger Terms and Conditions and agree.


Background/Aims: Many studies have shown that not only pharmacological treatment but also cognitive stimulation in the early stages of Alzheimer's disease (AD) improves language processing and (other) cognitive functions, stabilizes Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) functions and increases the subjective quality of life (wherein a combination of pharmacological intervention and cognitive stimulation could provide greater relief of clinical symptoms than either intervention given alone). Today, it is no longer the question of whether cognitive stimulation helps but rather what kind of stimulation helps more than others. Methods: A sample of 42 subjects with mild AD (all medicated with an acetylcholinesterase inhibitor and well adjusted) underwent clinical and cognitive evaluation and participated in a 6-month study with 2 experimental groups (i.e. ‘client-centered' global stimulation vs. cognitive training) and a control group. Since the test performance also depends on the individual test, we used a wide variety of tests; we z-transformed the results and then calculated the mean value for the global cognitive status (using the Mini-Mental State Examination) as well as for the single functional areas. Results: Between-group differences were found, they were overall in favor of the experimental groups. Different functional areas led to different treatment and test patterns. Client-centered, global, cognitive therapy stimulated many cognitive functions and thus led to a better performance in language processing and ADL/IADL. The subjective quality of life increased as well. The cognitive training (of working memory) improved only the ADL/IADL performance (more, however, than client-centered, global, cognitive stimulation) and stabilized the level of performance in the other three functional areas.

© 2013 S. Karger AG, Basel


  1. Clare L, Woods RT: Cognitive training and cognitive rehabilitation for people with early-stage Alzheimer's disease: a review. Neuropsychol Rehabil 2004;14:385-401.
  2. Spector A, Woods B, Orrell M: Cognitive stimulation for the treatment of Alzheimer's disease. Expert Rev Neurother 2008;8:751-757.
  3. Clare L, Woods B: Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev 2009;4:CD003260.
  4. Yu F, Rose K, Burgener S, Cunningham C, Buettner L, Beattie E, Bossen A, Buckwalter K, Fick D, Fitzsimmons S, Kolanowski A, Specht J, Richeson N, Testad I, McKenzie S: Cognitive training for early-stage Alzheimer's disease and dementia. J Gerontol Nurs 2009;35:23-29.
    External Resources
  5. Kuckuk R: Kognitive Stimulation bei Demenzen vom Alzheimer-Typ (DAT) in frühen bis mittleren Stadien: Eine qualitative Analyse internationaler Forschungsergebnisse; Dissertation, Universität Freiburg i.Br., 2010.
  6. Chapman SB, Weiner MF, Rackley A, Hynan LS, Zients J: Effects of cognitive-communication stimulation for Alzheimer's disease patients treated with donepezil. J Speech Lang Hear Res 2004;47:1149-1163.
    External Resources
  7. Bottino CM, Carvalho IA, Alvarez AM, Avila R, Zukauskas PR, Bustamante SE, Andrade FC, Hototian SR, Saffi F, Camargo CH: Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study. Clin Rehabil 2005;19:861-869.
  8. Möller G: Therapeutische Möglichkeiten bei Alzheimer-Demenz: Evaluation des integrativen/interaktiven Hirnleistungstrainings (IHT) der Heiliggeistspitalstiftung Freiburg; Dissertation, Universität Freiburg i.Br., 2001.
  9. Requena C, Maestú F, Campo P, Fernández A, Ortiz T: Effects of cholinergic drugs and cognitive training on dementia: 2-year follow-up. Dement Geriatr Cogn Disord 2006;22:339-345.
  10. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
  11. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state'. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
  12. Yesavage JA, Brink TL, Rose TL, Lum O, Huang VS, Adey M, Leirer VO: Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17:37-49.
  13. Almor A, Kempler D, MacDonald MC, Andersen ES, Tyler LK: Why do Alzheimer patients have difficulty with pronouns? Working memory, semantics, and reference in comprehension and production in Alzheimer's disease. Brain Lang 1999;67:202-227.
  14. Stuss DT, Benson DF: The Frontal Lobes. New York, Raven Press, 1986.
  15. Stuss DT, Alexander MP: Is there a dysexecutive syndrome? Philos Trans R Soc Lond B Biol Sci 2007;362:901-915.
  16. Shulman KI, Gold DP: Clock drawing and dementia in the community. A longitudinal study. Int J Geriatr Psychiatry 1993;8:487-496.
    External Resources
  17. Mahoney FI, Barthel DW: Functional evaluation: the Barthel index. MD State Med J 1965;14:61-65.
    External Resources
  18. Bös K: Barthel-Index; in Bös K (ed): Handbuch Motorische Tests: Sportmotorische Tests, motorische Funktionstests, Fragebogen zur körperlich-sportlichen Aktivität und sportpsychologische Diagnoseverfahren. Göttingen and Bern, Hogrefe, 2001, pp 305-307.
  19. Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.
    External Resources
  20. Franz M, Plüddemann K, Gruppe H, Gallhofer B: Modifikation und Anwendung der Münchner Lebensqualitäts Dimensionen-Liste bei schizophrenen Patienten; in Müller HJ, Engel RR, Hopf P (eds): Befunderhebung in der Psychiatrie: Negativsymptomatik, Lebensqualität und andere neue Entwicklungen. Wien, Springer, 1996, pp 103-111.
    External Resources
  21. Heinisch M, Ludwig M, Bullinger M: Psychometrische Testung der ‘Münchner Lebensqualitäts Dimensionen Liste' (MLDL); in Bullinger M, Ludwig M, von Steinbüchel N (eds): Lebensqualität bei kardiovaskulären Erkrankungen: Grundlagen, Messverfahren und Ergebnisse. Göttingen and Bern, Hogrefe, 1991, pp 73-90.
  22. Heinisch M, Ludwig M, Bullinger M: MLDL. Münchner Lebensqualitäts Dimensionen Liste; in Strauss B, Schumacher J (eds): Klinische Interviews und Ratingskalen. Göttingen and Bern, Hofgrefe, 2005, pp 224-226.
  23. Morris JC, Mohs RC, Rogers H, Fillenbaum G, Heyman A: Consortium to Establish a Registry for Alzheimer's Disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease. Psychopharmacol Bull 1988;24:641-652.
    External Resources
  24. Welsh KA, Butters N, Mohs RC, Beekly D, Edland S, Fillenbaum G, Heyman A: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). 5. A normative study of the neuropsychological battery. Neurology 1994;44:609-614.
  25. Berres M, Monsch AU, Bernasconi F, Thalmann B, Stähelin HB: Normal ranges of neuropsychological tests for the diagnosis of Alzheimer's disease. Stud Health Technol Inform 2000;77:195-199.
    External Resources
  26. Thalmann B, Monsch AU, Schneitter M, Bernasconi F, Aebi C, Camachova Davet Z, et al: The CERAD neuropsychological assessment battery (CERAD-NAB) - A minimal data set as a common tool for German-speaking Europe. Neurobiol Aging 2000;21(suppl 1):30.
  27. Aebi C: Validierung der neuropsychologischen Testbatterie CERAD-NP: eine Multi-Center Studie; Dissertation, Universität Basel, 2002.
  28. Ehrensperger MM, Berres M, Taylor KI, Monsch AU: Early detection of Alzheimer's disease with a total score of the German CERAD. J Int Neuropsychol Soc 2010;16:910-920.
  29. Rosen WG, Mohs RC, Davis KL: A new rating scale for Alzheimer's disease. Am J Psychiatry 1984;141:1356-1364.
    External Resources
  30. Rosen WG, Mohs RC, Davis KL: ADAS. Alzheimer's Disease Assessment Scale; in Strauss B, Schumacher J (eds): Klinische Interviews und Ratingskalen. Göttingen and Bern, Hogrefe, 2005, pp 29-33.
  31. Hindmarch I, Lehfeld H, de Jongh P, Erzigkeit H: The Bayer Activities of Daily Living Scale (B-ADL). Dement Geriatr Cogn Disord 1998;9(suppl 2):20-26.
  32. Erzigkeit H, Lehfeld H, Peña-Casanova J, Bieber F, Yekrangi-Hartmann C, Rupp M, Rappard F, Arnold K, Hindmarch I: The Bayer-Activities of Daily Living Scale (B-ADL): results from a validation study in three European countries. Dement Geriatr Cogn Disord 2001;12:348-358.
  33. Smith SC, Lamping DL, Banerjee S, Harwood R, Foley B, Smith P, Cook JC, Murray J, Prince M, Levin E, Mann A, Knapp M: Measurement of health-related quality of life for people with dementia: development of a new instrument (DEMQOL) and an evaluation of current methodology. Health Technol Assess 2005;9:1-93, iii-iv.
    External Resources
  34. Banerjee S, Smith SC, Lamping DL, Harwood RH, Foley B, Smith P, Murray J, Prince M, Levin E, Mann A, Knapp M: Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia. J Neurol Neurosurg Psychiatry 2006;77:146-148.
  35. Spiegel R, Brunner C, Ermini-Fünfschilling D, Monsch AU, Notter M, Puxty J, Tremmel L: A new behavioral assessment scale for geriatric out- and in-patients: the NOSGER (Nurses' Observation Scale for Geriatric Patients). J Am Geriatr Soc 1991;39:339-347.
    External Resources
  36. Spiegel R: NOSGER. Nurses' Obersavtion Scale for Geriatric Patients; in Strauss B, Schumacher J (eds): Klinische Interviews und Ratingskalen. Göttingen and Bern, Hogrefe, 2005, pp 276-279.

Article / Publication Details

First-Page Preview
Abstract of Original Research Article

Published online: September 24, 2013
Issue release date: January – December

Number of Print Pages: 11
Number of Figures: 4
Number of Tables: 5

eISSN: 1664-5464 (Online)

For additional information: https://www.karger.com/DEE

Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.