Eficacia de la rehabilitación del reconocimiento de emociones combinada con estimulación cognitiva en personas con enfermedad de Alzheimer

Abstract

Abstract The ability to recognize emotional expression is essential for social interactions, adapting to the environment, and quality of life. Emotion recognition is impaired in people with Alzheimer’s disease (AD), thus rehabilitation of these skills has the potential to elicit significant benefits. However, no specific rehabilitation programmes have been developed for this population. The aim of this thesis was to develop a rehabilitation of emotion recognition (RER) intervention and to analyse its efficacy. The intervention was designed based on a person centred approach. As it was the first time that this type of treatment was offered to people with AD, its efficacy could not be taken for granted. As a consequence, for ethical reasons it was decided to combine RER with a well-established treatment as cognitive stimulation therapy (CsT) to ensure a therapeutic benefit to the participants of the study. There was a lack of emotion recognition tests specifically validated for older adults. For this reason, it was necessary to create an emotion recognition test (Affect-Gradior, a picture based computerized test of emotion recognition) to measure the efficacy of the intervention, carrying out a usability study and a pilot validation with 212 participants (69 healthy older adults, 84 people with AD and 59 people with amnestic mild cognitive impairment). Affect-Gradior proved to be a valid instrument for the assessment of the facial recognition of emotions in older adults with and without cognitive impairment. The pilot validation study proposed the inclusion of emotion recognition tests in screening for dementia and amnestic mild cognitive impairment based on improved diagnostic accuracy. We analysed the efficacy of the combined treatment of RER and CsT over the capacity to recognize the facial expression of emotions, the cognitive functions, apathy, anosognosia, mood and activities of daily living of people with mild AD. For this purpose, we carried out a controlled trial comparing an experimental group (n = 12) that received 20 sessions of RER combined with 20 sessions of CsT, with a control group (n = 12) that received 40 sessions of CsT and a treatment as usual group (n = 12). The results of the study showed that there is capacity to improve the recognition of facial expressions of emotions through specific rehabilitation in people with mild AD. The emotions that were more sensitive to the treatment were disgust, surprise and the neutral expression. Gains associated to the rehabilitation intervention were maintained at a one month follow-up. The combined treatment of RER and CsT was also effective to improve the cognitive functions of people with AD. The cognitive areas that were more sensitive to treatment were orientation, attention, concentration and executive functions. Furthermore, the combined treatment was effective to prevent the progression of apathy, anosognosia and depression and to improve the basic activities of daily living of the participants. All in all, the results of this study suggest that there is capacity to improve the recognition of facial expressions of emotions through specific rehabilitation in people with AD. To the best of our knowledge the rehabilitation of emotion recognition ability in people with dementia of any type has not been investigated, making this the first experimental study in this area. These findings have implications for the design of better interventions for people with AD as RER combined with CsT may lead to improvements in different areas of their functioning.