Effect of Scene-Based Training on Cognitive Function in Patients With Alzheimer's Disease

Effect of Scenario-Based Reenactment Training on Orientation Impairment in Patients With Mild to Moderate Alzheimer' s Disease

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, including impairments in orientation, memory, and daily functioning. Orientation dysfunction, involving difficulties in recognizing time, place, and person, is a common and clinically significant feature in patients with mild to moderate AD.

This study aims to evaluate the effectiveness of a scenario-based reenactment training program in improving cognitive function and orientation ability in patients with mild to moderate Alzheimer's disease. The intervention is based on patients' real-life experiences and uses personalized visual materials (e.g., photos and videos) to reconstruct familiar scenarios, thereby enhancing cognitive stimulation and environmental recognition.

In this prospective controlled study, participants will be assigned to either a scenario-based training group or a usual care group. The intervention group will receive structured training sessions three times per week for 3 months, followed by a 6-month follow-up period. The control group will receive standard care without structured cognitive training.

The primary outcome is global cognitive function assessed by the Montreal Cognitive Assessment (MoCA). Secondary outcomes include orientation function, depressive symptoms, anxiety levels, quality of life, and intervention feasibility. This study aims to provide evidence for a practical, non-pharmacological intervention to improve cognitive and functional outcomes in patients with Alzheimer's disease.

Study Overview

• Status: Completed
• Conditions: Cognitive Dysfunction; Alzheimer Disease; Mild Cognitive Impairment
• Intervention / Treatment: Behavioral: Scenario-Based Reenactment Training; Other: Usual Care

Detailed Description

Alzheimer's disease (AD) is a chronic neurodegenerative disorder characterized by progressive cognitive decline, significantly affecting patients' independence and quality of life. Among the various cognitive deficits, orientation impairment-defined as the inability to accurately recognize time, place, and person-is a key clinical feature associated with increased risks of disorientation, wandering, and functional dependency.

Current pharmacological treatments offer limited benefits in reversing cognitive decline, highlighting the importance of non-pharmacological interventions. Scenario-based reenactment training is an emerging cognitive intervention strategy that reconstructs familiar real-life contexts to activate autobiographical memory, enhance environmental recognition, and improve cognitive function.

This study is designed as a single-center, prospective controlled trial to evaluate the effectiveness of scenario-based reenactment training in patients with mild to moderate Alzheimer's disease. Eligible participants are assigned to either an intervention group or a usual care group. The intervention group receives structured scenario-based training, delivered three times per week for 3 months, using personalized visual materials such as photographs and videos derived from patients' real-life experiences. The control group receives standard medical and nursing care without structured cognitive intervention.

The primary outcome is global cognitive function assessed using the Montreal Cognitive Assessment (MoCA). Secondary outcomes include orientation function derived from validated cognitive assessment domains, depressive symptoms measured by the Geriatric Depression Scale-15 (GDS-15), anxiety levels assessed by the Geriatric Anxiety Inventory-20 (GAI-20), and health-related quality of life evaluated using the SF-36 (PCS and MCS components). Additional outcomes include patient satisfaction, caregiver involvement, intervention adherence, and adverse events.

Assessments are conducted at baseline and at predefined follow-up time points over a 6-month period. The study aims to determine whether scenario-based reenactment training can improve cognitive function, enhance orientation ability, and promote better emotional and functional outcomes. The findings are expected to support the development of a feasible, scalable, and patient-centered non-pharmacological intervention model for the management of Alzheimer's disease.

• Study Type: Interventional
• Enrollment (Actual): 126
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Zhejiang
    • Hangzhou, Zhejiang, China, 310012
      • Tongde Hospital of Zhejiang Province

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age ≥ 60 years
• Diagnosis of mild to moderate Alzheimer's disease according to DSM-5 criteria
• Ability to communicate and complete cognitive assessments
• Stable caregiver available to assist with intervention and follow-up
• Visual and auditory function adequate to participate in assessments (with or without correction)
• Willingness to participate and provide informed consent (by patient or legal guardian)

Exclusion Criteria:

• Severe psychiatric disorders (e.g., severe depression, schizophrenia)
• Severe cardiovascular, cerebrovascular, or other systemic diseases affecting participation
• History of neurological disorders other than Alzheimer's disease (e.g., Parkinson's disease, stroke with major deficits)
• Severe sensory impairment (vision or hearing) that interferes with intervention or assessment
• Inability to complete study procedures or comply with follow-up
• Participation in other interventional clinical trials within the past 3 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Scenario-Based Reenactment Training; Participants receive structured scenario-based reenactment training in addition to usual care. The intervention is based on patients' real-life experiences and utilizes personalized visual materials such as photographs and videos to reconstruct familiar scenarios. Training is conducted three times per week for 3 months, with each session lasting approximately 30-45 minutes. The program targets temporal, spatial, and person orientation to improve cognitive function.	Behavioral: Scenario-Based Reenactment Training; Scenario-based reenactment training is a structured, personalized cognitive intervention designed to improve orientation and cognitive function in patients with Alzheimer's disease. The intervention is based on patients' real-life experiences and utilizes individualized visual materials, such as photographs and videos, to reconstruct familiar temporal, spatial, and interpersonal scenarios. Participants engage in guided recognition, recall, and contextual judgment tasks targeting orientation domains (time, place, and person). The intervention is delivered three times per week for 3 months, with each session lasting approximately 30-45 minutes. Training is conducted by trained healthcare providers or caregivers, both in hospital and home settings, with ongoing supervision to ensure consistency and adherence.
Active Comparator: Usual Care; Participants receive standard medical and nursing care without structured cognitive intervention. Routine care includes pharmacological treatment, basic nursing support, and general health education.	Other: Usual Care; Participants receive standard medical and nursing care without structured cognitive intervention. Routine care includes pharmacological treatment, basic nursing support, and general health education.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Global Cognitive Function Assessed by Montreal Cognitive Assessment (MoCA)	Global cognitive function will be assessed using the Montreal Cognitive Assessment (MoCA), a validated 30-point scale ranging from 0 to 30, with higher scores indicating better cognitive performance. The MoCA evaluates multiple cognitive domains including attention, executive function, memory, language, visuospatial ability, and orientation.	Baseline and 3 months after intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Orientation Function Assessed by MoCA Orientation Subscore	Orientation function will be assessed using the orientation subscore of the Montreal Cognitive Assessment (MoCA), which evaluates temporal and spatial orientation. The orientation subscore ranges from 0 to 6, with higher scores indicating better orientation ability.	Baseline and 3 months after intervention
Depressive Symptoms Assessed by GDS-15	Depressive symptoms will be assessed using the 15-item Geriatric Depression Scale (GDS-15), with scores ranging from 0 to 15, where higher scores indicate more severe depressive symptoms.	Baseline and 3 months after intervention
Anxiety Levels Assessed by GAI-20	Anxiety levels will be assessed using the Geriatric Anxiety Inventory-20 (GAI-20), with scores ranging from 0 to 20, where higher scores indicate greater anxiety severity.	Baseline and 3 months after intervention
Cognitive Outcome Transitions	Cognitive outcome transitions will be categorized based on changes in MoCA scores as follows: improvement (increase ≥2 points), stability (change within ±1 point), and decline (decrease ≥2 points).	Baseline to 3 months
Intervention Adherence	Intervention adherence will be assessed as the proportion of completed training sessions relative to the total prescribed sessions during the intervention period.	During the 3-month intervention period
Patient Satisfaction	Patient satisfaction will be evaluated using a categorical scale (very satisfied, satisfied, neutral/dissatisfied).	3 months after intervention
Adverse Events	Adverse events, including but not limited to dizziness, discomfort, and visual fatigue, will be recorded and categorized throughout the study period.	Baseline to 6 months

Collaborators and Investigators

• Sponsor: Zhejiang Provincial Tongde Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): December 30, 2024
• Study Completion (Actual): June 30, 2025

Study Registration Dates

• First Submitted: April 14, 2026
• First Submitted That Met QC Criteria: April 20, 2026
• First Posted (Actual): April 23, 2026

Study Record Updates

• Last Update Posted (Actual): April 23, 2026
• Last Update Submitted That Met QC Criteria: April 20, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Alzheimer's disease; cognitive function; MoCA; cognitive intervention; non-pharmacological intervention; scenario-based training; orientation impairment; reenactment therapy
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Dementia; Tauopathies; Neurodegenerative Diseases; Cognitive Dysfunction; Alzheimer Disease
• Other Study ID Numbers: TDH-AD-2022-163JY

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Individual participant data may be made available upon reasonable request to the corresponding author, subject to approval by the study team and institutional regulations. Data will be de-identified to protect participant privacy.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No