Resumen
Antecedentes: Este estudio investiga los efectos de intervenciones cognitivas en funciones ejecutivas y atención en pacientes con Alzheimer moderado, comparando método tradicional y basado en tecnología con un grupo control. Método: Se realizó un ensayo controlado aleatorio con 112 participantes, divididos en tres grupos: intervención tradicional, intervención basada en tecnología y grupo control. Se llevaron a cabo 16 sesiones, evaluando mediante pruebas estandarizadas y aplicando modelos lineales jerárquicos mixtos para ajustar factores confusos y efectos aleatorios. Resultados: Las intervenciones mostraron ser efectivas en la mejora de funciones ejecutivas. El modelo para dígitos hacia atrás y para la fluidez categórica se optimizó con MMSE, resaltando los beneficios de un buen rendimiento cognitivo y los impactos negativos de la edad en la fluidez categórica. La variable de abstracción de similitudes mostró efectos beneficiosos de la educación y el rendimiento cognitivo. Conclusiones: El entrenamiento cognitivo se revela como una herramienta valiosa para mejorar funciones ejecutivas y atención en Alzheimer moderado, sugiriendo beneficios prácticos significativos. Futuras investigaciones deberían centrarse en los mecanismos de transferencia de habilidades para optimizar las intervenciones y mejorar la calidad de vida de los afectados.
Citas
Amieva, H., Lafont, S., Rouch-Leroyer, I., Rainville, C., Dartigues, J. F., Orgogozo, J. M., & Fabrigoule, C. (2004). Evidencing inhibitory deficits in Alzheimer’s disease through interference effects and shifting disabilities in the Stroop test. Archives of Clinical Neuropsychology, 19, 791–803. https://doi.org/10.1016/j.acn.2003.09.006
Bahar-Fuchs, A., Martyr, A., Goh, A. M., Sabates, J., & Clare, L. (2019). Cognitive training for people with mild to moderate dementia. The Cochrane Database of Systematic Reviews, 3, Article CD013069. https://doi.org/10.1002/14651858.CD013069.pub2
Bates, D., Maechler, M., Bolker, B., & Walker, S. (2023). Lme4: Linear mixed-effects models using Eigen and S4. https://github.com/lme4/ lme4/
Belleville, S., Clément, F., Mellah, S., Gilbert, B., Fontaine, F., & Gauthier, S. (2011). Training-related brain plasticity in subjects at risk of developing Alzheimer’s disease. Brain, 134, 1623–1634. https://doi.org/10.1093/brain/awr037
Clare, L., Kudlicka, A., Oyebode, J. R., Jones, R. W., Bayer, A., Leroi, I., Kopelman, M., James, I. A., Culverwell, A., Pool, J., Brand, A., Henderson, C., Hoare, Z., Knapp, M., & Woods, B. (2019). Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: A multicentre randomised controlled trial (the GREAT trial). International Journal of Geriatric Psychiatry, 34, 709–721. https://doi.org/10.1002/gps.5076
Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168. https://doi.org/10.1146/annurev-psych-113011-143750 Diamond, A., & Ling, D. S. (2016). Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not. Developmental Cognitive Neuroscience, 18, 34–48. https://doi.org/10.1016/j. dcn.2015.11.005
Farah, M. J. (2015). The unknowns of cognitive enhancement. Science, 350(6259), 379–380. https://doi.org/10.1126/science.aad5893
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. https://doi.org/10.1016/0022-3956(75)90026-6
Gavelin, H. M., Lampit, A., Hallock, H., Sabatés, J., & Bahar-Fuchs, A. (2020). Cognition-oriented treatments for older adults: A systematic overview of systematic reviews. Neuropsychology Review, 30, 167– 193. https://doi.org/10.1007/s11065-020-09434-8
Godefroy, O., Martinaud, O., Narme, P., Joseph, P.-A., Mosca, C., Lhomée, E., Meulemans, T., Czernecki, V., Bertola, C., Labauge, P., Verny, M., Bellmann, A., Azouvi, P., Bindschaedler, C., Bretault, E., Boutoleau-Bretonniere, C., Robert, P., Lenoir, H., Krier, M., Roussel, M., & GREFEX Study Group (2018). Dysexecutive disorders and their diagnosis: a position paper. Cortex, 109, 322-335. https://doi.org/10.1016/j.cortex.2018.09.026
Golden, C. J. (2010). Stroop test de colores y palabras [Stroop color and word test]. TEA ediciones.
Guarino, A., Favieri, F., Boncompagni, I., Agostini, F., Cantone, M., & Casagrande, M. (2019). Executive functions in Alzheimer disease: A systematic review. Frontiers in Aging Neuroscience, 10, Article 437. https://doi.org/10.3389/fnagi.2018.00437
Hill, N. T., Mowszowski, L., Naismith, S. L., Chadwick, V. L., Valenzuela, M., & Lampit, A. (2017). Computerized cognitive training in older adults with mild cognitive impairment or dementia: A systematic review and meta-analysis. American Journal of Psychiatry, 174, 329–340. https://doi.org/10.1176/appi.ajp.2016.16030360
Irazoki, E., Contreras-Somoza, L. M., Toribio-Guzmán, J. M., Jenaro-Río, C., van der Roest, H., & Franco-Martín, M. A. (2020). Technologies for cognitive training and cognitive rehabilitation for people with mild cognitive impairment and dementia. A systematic review. Frontiers in Psychology, 11, Article 648. https://doi.org/10.3389/fpsyg.2020.00648
Levy, G., Jacobs, D. M., Tang, M. X., Côté, L. J., Louis, E. D., Alfaro, B., Mejia, H., Stern, Y., & Marder, K. (2002). Memory and executive function impairment predict dementia in Parkinson’s disease. Movement Disorder, 17, 1221–1226. https://doi.org/10.1002/mds.10280
Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tranel, D. (2012).
Neuropsychological assessment. Oxford University Press.
McDonough, I. M., Wood, M. M., & Miller, W. S., Jr (2019). A review on the trajectory of attentional mechanisms in aging and the Alzheimer’s disease continuum through the attention network test. The Yale Journal of Biology and Medicine, 92, 37–51.
McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack Jr, C. R., Kawas, C. H., Klunk, W. E., Koroshetz, W. J., Manly, J. J., Mayeux,
R., Mohs, R. C., Morris, J. C., Rossor, M. N., Scheltens, P., Carrillo, M. C., Thies, B., Weintraub, S., & Phelps, C. H. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers & Dementia, 7, 263–269. https://doi.org/10.1016/j.jalz.2011.03.005
Peña-Casanova, J. (2005). Test Barcelona revisado [Revised Barcelona Test]. Masson.
Raz, N., Ghisletta, P., Rodrigue, K. M., Kennedy, K. M., & Lindenberger, U. (2010). Trajectories of brain aging in middle-aged and older adults: Regional and individual differences. Neuroimage, 51, 501–511. https://doi.org/10.1016/j.neuroimage.2010.03.020
Reisberg, B., Ferris, S. H., de Leon, M. J., & Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. The American Journal of Psychiatry, 139, 1136–1139. https://doi.org/10.1176/ajp.139.9.1136
Reuter-Lorenz, P. A., Festini, S. B., & Jantz, T. K. (2021). Executive functions and neurocognitive aging. In K. W. Schaie & S. L. Willis (Eds.), Handbook of the psychology of aging (pp. 67–81). Academic Press.
Salat, D. H., Kaye, J. A., & Janowsky, J. S. (2001). Selective preservation and degeneration within the prefrontal cortex in aging and Alzheimer disease. Archives of Neurology, 58, 1403–1408. https://doi.org/10.1001/archneur.58.9.1403
Simons, D. J., Boot, W. R., Charness, N., Gathercole, S. E., Chabris, C. F., Hambrick, D. Z., & Stine-Morrow, E. A. L. (2016). Do “Brain- Training” Programs Work? Psychological Science in the Public Interest, 17, 103–186. https://doi.org/10.1177/1529100616661983
Smits, L. L., van Harten, A. C., Pijnenburg, Y. A., Koedam, E. L., Bouwman, F. H., Sistermans, N., Reuling, I. E. W., Prins, N. D. Lemstra, A. W., Scheltens P., & van der Flier, W. M. (2015). Trajectories of cognitive decline in different types of dementia. Psychological Medicine, 45, 1051–1059. https://doi.org/10.1017/S0033291714002153
Tucker, A., & Stern, Y. (2011). Cognitive reserve in aging. Current Alzheimer Research, 8, 354–360. https://doi.org/10.2174/156720511795745320
von Bastian, C. C., Belleville, S., Udale, R. C., Reinhartz, A., Essounni, M., & Strobach, T. (2022). Mechanisms underlying training-induced cognitive change. Nature Reviews Psychology, 1, 30–41. https://doi.org/10.1038/s44159-021-00001-3
Wechsler, D. (2001). Escala de Inteligencia Wechsler para Adultos-III (WAIS-III) [Wechsler Adult Intelligence Scale-III (WAIS-III)]. TEA ediciones.