The Effectiveness of Montessori-Based Dementia Programming on Cognitive Functions in People with Alzheimer's disease

Alzheimer's disease is a chronic neurodegenerative disease, it associated with progressive cognitive impairment and memory loss, and it can be seen in 5 to 10 percent of people over 65. Due to the increase in the population of the elderly in Iran and the risk of developing Alzheimer's disease, the development of pharmacological and non-pharmacological treatments is essential for the improvement and control of this disease. Among treatment options, there is a Cognitive rehabilitation protocol called Montessori-based Dementia Programming. That is a non-pharmacological treatment, designed by Dr. Cameron Camp, adapted from the ideas of Maria Montessori, in a targeted framework to improve the cognitive functions of people with Alzheimer's disease. This study aimed to investigate the effectiveness of Montessori-based dementia programming on cognitive function in people with Alzheimer's disease. The research method was a semi-experimental pre-test and post-test with a control group. 58 Alzheimer's patients selected as available sampling. They randomly assigned into two groups: the experimental group (interventional technique: Montessori-based dementia programming) and control group (No intervention). The measurement tools included the following: a) Mini-Mental State Examination or MMSE test (developed by Folstein et al., 1975) is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. To examine the validity and reliability of the test Using Receiver Operating Characteristic (ROC) curve, an optimal cut-off point of 22 showed a sensitivity of %90 and specificity of %93.5. It seems that F-MMSE has acceptable validity and a cut-off point of 22 can reliably differentiate patients with dementia from healthy subjects. b) Clinical Dementia Rating or CDR test (developed by Hughes et al., 1982 and Edited by Morris et al., 1993) is a numeric scale used to quantify the severity of symptoms of dementia. The CDR in one aspect is a 5-point scale used to characterize six domains of cognitive and functional performance applicable to Alzheimer disease and related dementias: Memory, Orientation, Judgment & Problem Solving, Community Affairs, Home & Hobbies, and Personal Care. P-CDR showed an acceptable level of face validity. Cronbach's alpha and Test-retest reliability founded as 73%, 89%, respectively (α=0.05). c) The Mini-Cog test (Developed by Borson et al., 2000) is a 3-minute instrument and 5-point to screen for cognitive impairment in older adults. The Mini-Cog uses a three-item recall test for memory and a simply scored clock-drawing test (CDT). Validity and reliability of the Mini-Cog determined using the Pearson product-moment correlation coefficient (Pearson’s r), Cronbach’s alpha and Receiver Operating Characteristic (ROC) curve analysis, The Persian version of Mini-Cog showed good inter-rater reliability (r=0.86, P<0.01). In that research, sensitivity, and specificity reported as 88%, 62.8%, respectively. Data were analyzed using SPSS-24 software and multivariate covariance analysis. Due to the significance of the Kolmogorov-Smirnov test and the ANOVA test were higher than 0.05, so the distribution of data was normal. Levin's findings also showed that the homogeneous assumption of covariance of data and the slope of regression established. The results of multivariate analysis of covariance revealed that there was a significant difference between the experimental (MBDP group) and control groups in cognitive functions (Mini-Mental State Examination (F=44.53, P=0.001), Clinical Dementia Rating (18.92, P=0.001) and the Mini-Cog (12.99, P=0.001)). In the Montessori-based dementia programming group (MBDP group); MMSE and Mini-Cog Scores significantly increased, and CDR Scores decreased, so it showed that the MBDP was effective. Montessori-based dementia programming, as an effective non-pharmacologic intervention, can be used to improve the cognitive Functions in people with Alzheimer's disease. This method of rehabilitation by challenging the mind and stimulating the five senses and supporting on the brain plasticity can enhance the functions of the brain and help the social welfare of a person with Alzheimer's disease. The MBDP technique seeks to engage the senses and evoke positive emotions. It involves the stimulation of the cognitive, social, and functional skills of each. Also, MBDP prevents the next consequences of Alzheimer's disease-like depression, anxiety, lack of confidence, Agitation and others.