Goal-oriented Cognitive Rehabilitation in Early-stage Alzheimer’s and Related Dementias: Multi-centre Single-blind Randomised Controlled Trial
The GREAT trial (short title: Living Well with Memory Difficulties) is a large multi-centre trial led by Professor Linda Clare. The trial is co-ordinated from the University of Exeter and is taking place in eight areas in England and Wales. Professor Jan Oyebode from the School of Dementia Studies, University of Bradford, co-ordinates the Birmingham centre.
The trial will provide definitive evidence about whether goal-oriented cognitive rehabilitation is a clinically-effective and cost-effective intervention for people with early-stage dementia and their family, friends and/or carers.
The study is funded by the Health Technology Assessment Programme of the National Institute for Health Research (HTA reference 11/15/04). We expect the results to be available in 2017.
Why is the GREAT trial important?
There are over 750,000 people with dementia, and this figure is expected to double by 2040. People with dementia experience memory difficulties that can affect activities, relationships and enjoyment of life. As we cannot currently cure or remove memory difficulties, it is important to find out how people with memory difficulties as well as their friends, family and/or carers can live as well as possible despite these difficulties.
Early intervention offers the possibility of helping people with early-stage dementia and their carers to manage the impact of the disease on their everyday life and reduce or delay the progression of disability. Providing definitive evidence that cognitive rehabilitation helps people with dementia and their carers to live well with memory difficulties would mean that this intervention can be implemented as part of routine healthcare.
The results of the study will guide practice within the NHS and will be used to help develop the services provided by memory clinics. Towards the end of the trial we will offer training to memory clinic teams so that they can provide this kind of support. We will also develop a self-management guide for people attending memory clinics that they can use at home. We expect the results to be available in 2017.
What is goal-oriented cognitive rehabilitation (CR)?
Goal-oriented CR involves working with a therapist (an experienced health professional) to try to manage the impact that memory difficulties can have on everyday life, such as activities, relationships, and enjoyment of life. The aim of CR is to reduce functional disability by drawing on retained strengths and supporting adaptive behaviour. Achievable and personally-meaningful goals relating to everyday activities are identified. These are areas where the person with dementia wishes to see improvements. A therapist works with the person and the carer to help achieve these goals. Initial evidence from a pilot study suggested that this new treatment was helpful for people who had attended a memory clinic and also for their family members.
How will we find out whether cognitive rehabilitation is helpful?
We are asking everyone who takes part in the GREAT study to complete some questionnaires and memory tasks on several occasions; half of the people receive cognitive rehabilitation while the other half continue with their usual treatment. We will then compare the responses on the questionnaires and memory tasks between these two groups of participants to find out how helpful the visits from the therapist delivering cognitive rehabilitation were to participants and their friends and family members. To answer our research questions, we need 480 people with memory difficulties to take part in the study.
The GREAT Team
The GREAT study takes place in eight research centres across England and Wales. Each centre has a lead investigator (an experienced academic clinicians overseeing the day to day work of the research centre), a part-time research assistant, and a part-time therapist (for example, an occupational therapist or clinical psychologist). For the centre run by University of Bradford, the lead investigator is Professor Jan Oyebode, the research assistant is Ms Helen Cunnae and the therapist is Ms Jayne Hughes.