The influence of apathy on cognitive performance and cognitive rehabilitation in the elderlyThe REHACOP program

Resumo

Aging is a natural process which entails a series of age-related cognitive changes. These cognitive changes, derived largely from the loss of neuronal connections, are reflected in a worse performance in attention, memory, processing speed (PS), language, reasoning, visuospatial skills, and executive functions (EF). In addition, worse cognitive performance in the elderly is associated with a greater number of subjective cognitive and functional complaints. Furthermore, these cognitive changes are related to worse quality of life (QoL) and clinical variables like depression or apathy, which are also risk factors for developing mild cognitive decline and dementia. Dementia is one of the most prevalent diseases worldwide, and increasing life expectancy requires the creation of interventions that slow down or prevent cognitive impairment. Non-pharmacological therapies, and specifically cognitive rehabilitation, have proven to be an effective intervention for improving the performance of some cognitive functions in the short and long term. However, its efficacy in clinical and functional variables is not clear.The present thesis its composed of two scientific studies. The main objective of the first research study addresses the impact of apathy on cognitive performance in the elderly by The Lille Apathy Rating Scale (LARS). Additionally, the influence of apathy symptoms on cognitive functions were analyzed. The second is to determine the effectiveness of a comprehensive cognitive rehabilitation program in the elderly. Specifically, the efficacy of the intervention was determined by improvement in cognitive performance, reduction in clinical symptoms and subjective complaints (SC) and by an improvement in QoL.The findings in the first study showed that apathy correlated negatively with different cognitive functions. Furthermore, the findings revealed that apathy symptoms explain performance in attention, PS, verbal fluency, visual and verbal memory, working memory (WM), EF, and general cognition. The second study revealed that, after three months’ intervention, participants who completed the intervention showed significant improvements in neurocognition and QoL, as well as a significant reduction in apathy symptoms and SC.In conclusion, the findings in the present thesis provide evidence of the influence of apathy on cognitive performance in different cognitive functions. Moreover, the results not only support the evidence of the efficacy of cognitive rehabilitation in cognitive performance, but also provide new findings regarding their efficacy in clinical and functional variables.