Cognitive behavioural group therapy in mild cognitive impairment: intervention with a cognitive or behavioural/psychological focus?

At present there is no curative treatment for dementia and Alzheimer's disease (AD), nor any therapeutic approach to prevent the conversion of mild cognitive impairment (MCI) to dementia. In the past years, extensive research has increased our knowledge of the aetiology of AD, other dementing disorders and predementia syndromes, and several hypotheses have emerged from the epidemiological research (1). There is emerging evidence of a possible role of environmental and lifestyle related factors, as was proposed recently for age-related changes in cognitive function, predementia syndromes and the cognitive decline of degenerative (AD) or vascular origin (3). These factors include education, expertise and experience, leisure-time and professional activities (3), suggesting that cognitive training may play a critical role in normal ageing, dementia and predementia syndromes. In fact, given the lack of effective pharmacological therapies, lifestyle changes may be potential non-pharmacological treatment options for pre-dementia syndromes, e.g. MCI (2). On the other hand, among non-pharmacological interventions , MCI syndrome could represent an ideal target for cog-nitive training, retaining a large range of cognitive capacities to learn and apply new strategies on memory skills (3). In the years preceding the operationalization of diagnostic criteria for MCI (1), a programme of cognitive stimulation for healthy elderly subjects with mild memory impairments focused on visuo-verbal, verbal and spatial memory and the utilization of " memory strategies " , showing an improvement in memory test scores, and demonstrating the positive effects of cognitive training on memory performance, compared with no improvement in the control group (4). Moreover, cognitive training may delay functional and cognitive decline in patients with MCI. A possible important outcome in this kind of study could be a delayed progression from MCI to dementia. In fact, studies on cognitive training used cognitive symptoms as end-points, while progression to dementia and functional decline may be more attractive outcomes for this research. Nonetheless, functional measures that are sensible to MCI should be used. In fact, in non-pharmacological intervention with a cognitive focus, there is also some debate on the approach for patients with MCI, i.e. cognitive rehabilitation or cognitive training (3). Given that activities of daily living (ADL) are the focus of cognitive rehabilitation, a target such as ADL in MCI patients could be difficult to identify for cognitive rehabilitation. In fact, all recent relevant studies on cognitive intervention in MCI have been based on cognitive training (3). In particular, a study on cholinesterase inhibitors …