- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04658394
Effect of Individual Reminiscence Therapy in the Elderly People With Neurocognitive Disorders
Effect of Individual Reminiscence Therapy in the Elderly People With Neurocognitive Disorders: A Multicentre Randomised Controlled Trial in Azores Archipelago
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Neurocognitive disorder (NCD) is one of the main causes of disability among older adults and its prevalence is increasing due to the ageing of the population. It is estimated that globally, neurocognitive disorders affect 44.35 million people and it is expected that by the year 2050 the number of those affected worldwide will triple up to 135.46 million.
The absence of an effective pharmacological treatment that halts or delays the development of the disease has aroused interest in non-pharmacological therapies (NPT) as a complement to pharmacological treatment that can improve the quality of life of people with neurocognitive disorders. One of the most researched NPT and with the greatest tradition in this field is Reminiscence Therapy (RT).
RT implies the discussion of past activities, events and experiences, usually with the help of triggers (e.g., photographs, home objects and other familiar items from the past, music, any object or stimulus) that serve to stimulate memories. In its application to dementias, RT is based on the fact that the memory deficit of people with dementia implies that they are able to remember events from their past life, especially from childhood to early adulthood, but not newer facts. It focuses on preserved capacities and memories, promotes communication and enables the person to connect with his past and recover his sense of personal identity. In this way, the RT can be understood as an intervention on the edge of those of cognitive orientation and those centred on emotion, with potential interactive effects on autobiographical memory and psychological well-being.
In simplified form, there are at least two approaches to RT. The first approach as a "life review" where participants are guided through significant experiences of their biography trying to give meaning to their lives. This type of RT is more structured and is usually conducted in an individual format. It may involve the production of "life books". This approach is considered to have an integrative function aimed at achieving a sense of validation, coherence and reconciliation with one's past. Another approach that call general or simple reminiscence, implies the stimulation of autobiographical memory during conversations on specific themes of the past (e.g, holidays, food and drink, work) using stimulus to trigger memories. It has been described as an unstructured autobiographical memory narration. This reminiscence format can be conducted both individually and in groups and promotes communication between participants who share their memories and stories.
In either format that RT is applied on, the introduction of triggering stimulus (e.g., photographs, music, old objects) to help memory is considered fundamental. These triggers can be generic, reflecting common experiences in the lives of people relevant to their age group (e.g., a school manual can serve as a reminder of the experience during their school stage), or specific, with stimulus related to the person's own experiences (e.g., photographs of an important vital event such as their wedding day or a journey during their youth).
As for the effectiveness of RT, according to a recent review by Cochrane, there is some evidence on its positive effects on cognition, QoL, communication and possibly on the mood of people with dementia, even if the benefits are small. Despite the distinction between the two different approaches to RT (general reminiscence vs. life history), the therapy modality does not seem to be as important to achieve positive effects as the individual or group format of the sessions and the context in which the intervention is administered (people living in the community or institutionalised).
In particular, according to the results of the review study, the RT seems to be able to generate a small benefit on cognitive function immediately after the intervention, although it usually does not continue after a longer follow-up period. Regarding the administration format, the individual RT seems slightly superior in its effects on cognition both immediately and after a follow-up period. In any case, its effects seem comparable to those of other cognitive stimulation modalities.
As for the effect of RT on quality of life (QoL), an individual RT study based on life review, showed an improvement in Qol-AD. The effects with a group modality do not seem consistent, showing little or no effect on QoL, although the key factor may be the context of application (community vs. institution), with better group RT results in institutionalised patients.
In a multicentre study conducted in Portugal with older adults with neurocognitive disorders, in individual format, there was a significant effect on the overall cognition, memory and QoL of the participants.
Group RT was associated with a likely effect on communication both after the intervention and in the follow-up. This effect was not replicated in the individual RT, with uncertain results.
Finally, despite the evidence on the effect of RT on the mood of elderly people without dementia, in the case of people with dementia only a small effect on mood was found for those participating in individual RT. In the portuguese multicentre studies there were no significant differences in depressive symptomatology.
Based on the above, this research proposal aims to evaluate the ability of individual RT within a general reminiscence format, to improve overall cognitive function, in particular memory, emotional state (depression and anxiety) and QoL of older adults with neurocognitive disorders attending social care and support services in the Azores archipelago.
It is proposed to evaluate the efficacy of the intervention in the endpoint assessment and the duration of the effects at three months follow-up. Furthermore, an analysis of results based on the diagnosis of the participants is proposed for those diagnoses with sufficient representation in the sample (more than 20 cases in each group). Additionally, it is proposed to analyze the factors that predict the response to the intervention (responder analysis). Finally, the results of this study will be compared and can be analyzed together with those of a previous study that used the same individual RT program and the same experimental design (clinicaltrials.gov ID: NCT04047238).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Aveiro
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Mealhada, Aveiro, Portugal, 3050-387
- Rsocialform - Geriatria, Lda.
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Faial
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Horta, Faial, Portugal, 9900-033
- Santa Casa da Misericórdia da Horta
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Flores
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Santa Cruz das Flores, Flores, Portugal
- Santa Casa da Misericórdia de Santa Cruz das Flores
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Pico
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Lajes, Pico, Portugal, 9930-126
- Santa Casa da Misericórdia de Lajes do Pico
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Madalena, Pico, Portugal, 9950-322
- Santa Casa da Misericórdia da Madalena do Pico
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Santa Maria
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Vila do Porto, Santa Maria, Portugal, 9580-528
- Santa Casa da Misericórdia de Vila do Porto
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São Jorge
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Calheta, São Jorge, Portugal, 9850-070
- Santa Casa da Misericórdia da Calheta
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Velas, São Jorge, Portugal, 9800-559
- Casa de Repouso João Inácio de Sousa
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São Miguel
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Arrifes, São Miguel, Portugal, 9500-377
- Casa do Povo de Arrifes
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Maia, São Miguel, Portugal, 9625-320
- Casa do Povo da Maia
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Ponta Delgada, São Miguel, Portugal
- Lar Luis Soares de Sousa de Ponta Delgada
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Terceira
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Angra Do Heroísmo, Terceira, Portugal, 9700-020
- Santa Casa da Misericórdia de Angra do Heroísmo
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Praia Da Vitória, Terceira, Portugal, 9760-438
- Lar D. Pedro V
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Having a formal diagnosis of a neurocognitive disorder according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition [DSM-5] criteria (participants diagnosis will be confirm in their health records at the institution).
- Having delivered the informed consent form, duly completed and signed, after prior information.
- Being able to communicate and understand.
- Possibility of gathering information about the participant's life history through family members or usual caregivers, using the socio-family questionnaire designed for that purpose.
- Being 65 years of age or older.
- Being a native Portuguese speaker.
- Regularly attending an institution that provides social care and support services for older adults (including people living in long-term care centres, people attending day and social centres and people receiving home support services).
Exclusion Criteria:
- Suffering from an acute or severe illness that prevent participation in the intervention sessions.
- Severe sensory and physical limitations that prevent participation.
- Low level of consciousness and minimal attention span.
- Presence of severe neuropsychiatric symptoms, such as agitation, psychosis, severe depressive and anxiety symptoms, apathy, or presence of uncontrolled delirium that prevent participation in the sessions.
- Traumatic life history or marked by adverse events that discourage participation in RT sessions; history of adverse reactions during RT sessions or similar activities.
- Have a serious or total functional dependence (assessed through the Barthel index).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Experimental: Intervention Group
Participants who meet the inclusion criteria will be randomly assigned to the intervention group receiving RT or to a control group receiving treatment as usual.
Participants in the intervention group will participate in two RT sessions per week for 13 weeks besides their treatment as usual.
The sessions will be based on the Book of the Past and the Present and they will follow the same protocol in every participant institution.
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Intervention group will receive two RT sessions per week for 13 weeks.
RT sessions will last approximately 50 minutes and will be developed according to the following structure: · Welcome to the patient and reality orientation therapy (7 minutes) · Conducting the main activity of reminiscence (40 minutes) · Closure, thank you for the participation and farewell until the next session (3 minutes) Reminiscence therapy sessions will have an individual format and will be conducted by a therapist previously trained in the protocol and the principles of RT.
The Reminiscence activities of each session will be carried out following the protocol proposed in the Book of the Past and the Present.
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No Intervention: Control Group
Participants assigned to the control group will maintain their usual treatment in the institution, participating in the activities previously assigned to their individual care plan.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Cognitive functioning evaluated through Mini-Mental State Examination [MMSE]
Time Frame: baseline
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Cognitive functioning is assessed using the MMSE which is a gold standard for assessing global cognitive function.
Scores range from 0 to 30, with higher scores indicating better cognitive functioning.
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baseline
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Change in cognitive functioning evaluated through Mini-Mental State Examination [MMSE]
Time Frame: 13 weeks after the beginning of the intervention
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Cognitive functioning is assessed using the MMSE which is a gold standard for assessing global cognitive function.
Scores range from 0 to 30, with higher scores indicating better cognitive functioning.
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13 weeks after the beginning of the intervention
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Change in cognitive functioning evaluated through Mini-Mental State Examination [MMSE]
Time Frame: 12 weeks after end of intervention
|
Cognitive functioning is assessed using the MMSE which is a gold standard for assessing global cognitive function.
Scores range from 0 to 30, with higher scores indicating better cognitive functioning.
|
12 weeks after end of intervention
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Quality of life evaluated through Quality of Life - Alzheimer's Disease [QoL-AD]
Time Frame: baseline
|
The QoL-AD is used to assess quality of life.
This 13-item scale assesses the quality of life in people diagnosed with dementia, gathering information from the patient about the following domains: perceived health, mood, physical condition, interpersonal relationships, hobbies, decision-making skills, and life as a whole.
Scores range from 13 to 52, with higher scores indicating better quality of life.
It has good psychometric characteristics and its use has been recommended to evaluate psychosocial interventions.
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baseline
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Change in quality of life evaluated through Quality of Life - Alzheimer's Disease [QoL-AD]
Time Frame: 13 weeks after the beginning of the intervention
|
The QoL-AD is used to assess quality of life.
This 13-item scale assesses the quality of life in people diagnosed with dementia, gathering information from the patient about the following domains: perceived health, mood, physical condition, interpersonal relationships, hobbies, decision-making skills, and life as a whole.
Scores range from 13 to 52, with higher scores indicating better quality of life.
It has good psychometric characteristics and its use has been recommended to evaluate psychosocial interventions.
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13 weeks after the beginning of the intervention
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Change in quality of life evaluated through Quality of Life - Alzheimer's Disease [QoL-AD]
Time Frame: 12 weeks after end of intervention
|
The QoL-AD is used to assess quality of life.
This 13-item scale assesses the quality of life in people diagnosed with dementia, gathering information from the patient about the following domains: perceived health, mood, physical condition, interpersonal relationships, hobbies, decision-making skills, and life as a whole.
Scores range from 13 to 52, with higher scores indicating better quality of life.
It has good psychometric characteristics and its use has been recommended to evaluate psychosocial interventions.
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12 weeks after end of intervention
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Anxiety symptomatology assessed through the Geriatric Anxiety Inventory [GAI]
Time Frame: baseline
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It assesses, in several contexts, the severity of anxiety symptoms in the older adults.
It consists in 20 dichotomous response items (I agree/disagree) and refers to the subject's feelings in the week prior to the evaluation.
One (1) point is assigned to each agree answer and the overall score is obtained by adding the scores of all items.
Scores over 10/11 points indicate symptoms of severe anxiety.
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baseline
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Change in anxiety symptomatology assessed through the Geriatric Anxiety Inventory [GAI]
Time Frame: 13 weeks after the beginning of the intervention
|
It assesses, in several contexts, the severity of anxiety symptoms in the older adults.
It consists in 20 dichotomous response items (I agree/disagree) and refers to the subject's feelings in the week prior to the evaluation.
One (1) point is assigned to each agree answer and the overall score is obtained by adding the scores of all items.
Scores over 10/11 points indicate symptoms of severe anxiety.
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13 weeks after the beginning of the intervention
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Change in anxiety symptomatology assessed through the Geriatric Anxiety Inventory [GAI]
Time Frame: 12 weeks after end of intervention
|
It assesses, in several contexts, the severity of anxiety symptoms in the older adults.
It consists in 20 dichotomous response items (I agree/disagree) and refers to the subject's feelings in the week prior to the evaluation.
One (1) point is assigned to each agree answer and the overall score is obtained by adding the scores of all items.
Scores over 10/11 points indicate symptoms of severe anxiety.
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12 weeks after end of intervention
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Mood assessed through the Geriatric Depression Scale-15 [GDS-15]
Time Frame: baseline
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The GDS-15 is used to measure mood.
It is considered a reliable tool to screen depressive symptoms in older people.
With a dichotomous format (yes/no answers), this scale assesses depression in older people.
Scores range from 0 to 15, with higher scores indicating more severe depressive symptoms.
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baseline
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Change in mood assessed through the Geriatric Depression Scale-15 [GDS-15]
Time Frame: 13 weeks after the beginning of the intervention
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The GDS-15 is used to measure mood.
It is considered a reliable tool to screen depressive symptoms in older people.
With a dichotomous format (yes/no answers), this scale assesses depression in older people.
Scores range from 0 to 15, with higher scores indicating more severe depressive symptoms.
|
13 weeks after the beginning of the intervention
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Change in mood assessed through the Geriatric Depression Scale-15 [GDS-15]
Time Frame: 12 weeks after end of intervention
|
The GDS-15 is used to measure mood.
It is considered a reliable tool to screen depressive symptoms in older people.
With a dichotomous format (yes/no answers), this scale assesses depression in older people.
Scores range from 0 to 15, with higher scores indicating more severe depressive symptoms.
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12 weeks after end of intervention
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Executive functions evaluated throught Frontal Assessment Battery [FAB]
Time Frame: baseline
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The FAB is used to assess executive function in several subtests: conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy.
Scores range from 0 to 18, with higher scores indicating better executive functioning.
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baseline
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Change in executive functions evaluated throught Frontal Assessment Battery [FAB]
Time Frame: 13 weeks after the beginning of the intervention
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The FAB is used to assess executive function in several subtests: conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy.
Scores range from 0 to 18, with higher scores indicating better executive functioning.
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13 weeks after the beginning of the intervention
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Change in executive functions evaluated throught Frontal Assessment Battery [FAB]
Time Frame: 12 weeks after end of intervention
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The FAB is used to assess executive function in several subtests: conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy.
Scores range from 0 to 18, with higher scores indicating better executive functioning.
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12 weeks after end of intervention
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Memory function evaluated through Memory Alteration Test [MAT]
Time Frame: baseline
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The MAT is used to assess memory function.
It is an easy and quick instrument that assesses five memory domains: temporal orientation, encoding, semantic memory, free recall, and cued recall.
Total scores range from 0 to 50, with higher scores indicating better memory.
It has good psychometric properties and is highly sensitive to mild cognitive decline.
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baseline
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Change in memory function evaluated through Memory Alteration Test [MAT]
Time Frame: 13 weeks after the beginning of the intervention
|
The MAT is used to assess memory function.
It is an easy and quick instrument that assesses five memory domains: temporal orientation, encoding, semantic memory, free recall, and cued recall.
Total scores range from 0 to 50, with higher scores indicating better memory.
It has good psychometric properties and is highly sensitive to mild cognitive decline.
|
13 weeks after the beginning of the intervention
|
Change in memory function evaluated through Memory Alteration Test [MAT]
Time Frame: 12 weeks after end of intervention
|
The MAT is used to assess memory function.
It is an easy and quick instrument that assesses five memory domains: temporal orientation, encoding, semantic memory, free recall, and cued recall.
Total scores range from 0 to 50, with higher scores indicating better memory.
It has good psychometric properties and is highly sensitive to mild cognitive decline.
|
12 weeks after end of intervention
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sociodemographic information gathered through the sociodemographic questionnaire
Time Frame: baseline
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Participants' answers in the sociodemographic questionnaire designed specifically for this study.
It gathers information about gender, age, marital status, formal education, which social response the participant attends, medical comorbidities and cognitive symptoms and will be administered to all participants.
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baseline
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Functional dependence evaluated through Barthel Index [IB]
Time Frame: before baseline (exclusion criteria)
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This is a 10-item self-administered scale that evaluates the functional capacity to conduct daily life activities.
The activities are quoted differently, 0, 1, 2 or 3 points can be assigned.
The total score ranges from 0 (totally dependent) to 20 (totally independent), with a total of 0-8 being total dependency; 9-12 being serious dependency; 13-19 being moderate dependency; 20 being total independence.
This instrument has item-total correlations between .66 and .93,
and has a high internal consistency (Cronbach alpha of .96).
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before baseline (exclusion criteria)
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Susana I Justo Henriques, PhD, Nursing School of Coimbra
- Principal Investigator: Enrique Pérez Sáez, PhD, National Reference Centre for Alzheimer's and Dementia Care, Imserso, Spain
- Principal Investigator: João L. Alves Apóstolo, PhD, Nursing School of Coimbra
Publications and helpful links
General Publications
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- Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982-1983;17(1):37-49. doi: 10.1016/0022-3956(82)90033-4.
- Subramaniam P, Woods B. The impact of individual reminiscence therapy for people with dementia: systematic review. Expert Rev Neurother. 2012 May;12(5):545-55. doi: 10.1586/ern.12.35.
- Sarkamo T, Tervaniemi M, Laitinen S, Numminen A, Kurki M, Johnson JK, Rantanen P. Cognitive, emotional, and social benefits of regular musical activities in early dementia: randomized controlled study. Gerontologist. 2014 Aug;54(4):634-50. doi: 10.1093/geront/gnt100. Epub 2013 Sep 5.
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- Akanuma K, Meguro K, Meguro M, Sasaki E, Chiba K, Ishii H, Tanaka N. Improved social interaction and increased anterior cingulate metabolism after group reminiscence with reality orientation approach for vascular dementia. Psychiatry Res. 2011 Jun 30;192(3):183-7. doi: 10.1016/j.pscychresns.2010.11.012. Epub 2011 May 4.
- Amieva H, Robert PH, Grandoulier AS, Meillon C, De Rotrou J, Andrieu S, Berr C, Desgranges B, Dubois B, Girtanner C, Joel ME, Lavallart B, Nourhashemi F, Pasquier F, Rainfray M, Touchon J, Chene G, Dartigues JF. Group and individual cognitive therapies in Alzheimer's disease: the ETNA3 randomized trial. Int Psychogeriatr. 2016 May;28(5):707-17. doi: 10.1017/S1041610215001830. Epub 2015 Nov 17.
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- Barrios H, Verdelho A, Narciso S, Goncalves-Pereira M, Logsdon R, de Mendonca A. Quality of life in patients with cognitive impairment: validation of the Quality of Life-Alzheimer's Disease scale in Portugal. Int Psychogeriatr. 2013 Jul;25(7):1085-96. doi: 10.1017/S1041610213000379. Epub 2013 Mar 27.
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- Charlesworth G, Burnell K, Crellin N, Hoare Z, Hoe J, Knapp M, Russell I, Wenborn J, Woods B, Orrell M. Peer support and reminiscence therapy for people with dementia and their family carers: a factorial pragmatic randomised trial. J Neurol Neurosurg Psychiatry. 2016 Nov;87(11):1218-1228. doi: 10.1136/jnnp-2016-313736. Epub 2016 Aug 12.
- Dempsey L, Murphy K, Cooney A, Casey D, O'Shea E, Devane D, Jordan F, Hunter A. Reminiscence in dementia: a concept analysis. Dementia (London). 2014 Mar 1;13(2):176-92. doi: 10.1177/1471301212456277. Epub 2012 Aug 17.
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- Ribeiro O, Paul C, Simoes MR, Firmino H. Portuguese version of the Geriatric Anxiety Inventory: transcultural adaptation and psychometric validation. Aging Ment Health. 2011 Aug;15(6):742-8. doi: 10.1080/13607863.2011.562177. Epub 2011 Jun 9.
- Subramaniam P, Woods B. Towards the therapeutic use of information and communication technology in reminiscence work for people with dementia: a systematic review. International Journal of Computers in Healthcare. 2010; 1: 106-125. doi: 10.1504/IJCIH.2010.037457.
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Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 21112020
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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