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[Management of cognitive deficits in patients with Alzheimer's disease].

Recently, an increasing number of studies has shown that some aspects of cognitive functions in Alzheimer patients may be selectively affected by Alzheimer's disease (AD) while others are preserved. They have also demonstrated the heterogeneity of cognitive deficits within AD patients. Furthermore, several researches put into evidence optimizing factors for the cognitive performance of demented patients. Such a cognitive approach to AD has allowed a renewal of rehabilitation strategies, taking daily difficulties into consideration. It mainly consists of optimizing the patient functioning at every stage of the disease course, by exploiting preserved abilities and performance enhancing factors. For example, the clinical management of memory problems in AD patients could be centered on three directions: 1. Temporary facilitation of information encoding or retrieval by the use of optimizing factors shown during detailed cognitive examinations; 2. New knowledge teaching by the use of preserved memory abilities; 3. Arrangement of the patient surroundings with external cues and use of physical supports to compensate for defective functions (e.g. an external memory aid, such as a diary), so as to reduce the impact of cognitive deficits in daily living activities. Such a management of cognitive problems naturally implies the active participation of a caregiver both during the evaluation and the rehabilitation. The caregiver can be of help at different stages: arranging the patient daily environment according to his/her cognitive deficits, and removing sources of confusion; helping the patient with the use of external aids; favoring optimizing factors and preserved abilities utilization; interacting with the patient in good conditions, preventing the call to impaired capacities. Therefore, adapted structures should be put into place to allow these interventions and an enlightenment of caregiver burden, for example day care centers reproducing real life environment, where optimizing strategies could be specifically trained.