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Nonpharmacological interventions for cognitive impairments following primary progressive aphasia: A systematic review of the literature

Intervenções não-farmacológicas para distúrbios cognitivos na Afasia Progressiva Primária: uma revisão sistemática da literatura

ABSTRACT

This study provided a systematic review on nonpharmacological interventions applied to patients diagnosed with Primary Progressive Aphasia (PPA) and its variants: Semantic (SPPA), Nonfluent (NFPPA) and Logopenic (LPPA) to establish evidence-based recommendations for the clinical practice of cognitive rehabilitation for these patients.

Methods:

A PubMed and LILACS literature search with no time restriction was conducted with the keywords PPA (and its variants) AND rehabilitation OR training OR intervention OR therapy OR treatment OR effectiveness. To develop its evidence-based recommendations, a research committee identified questions to be addressed and determined the level of evidence for each study according to published criteria (Cicerone et al., 2000). Overall evidence for treatments was summarized and recommendations were derived.

Results:

Our search retrieved articles published from 1995 to 2013: 21 for SPPA, 8 for NFPPA, 3 for LPPA and 8 for PPA with no specification. Thirty-five studies were rated as Class III, consisting of studies with results obtained from one or more single-cases and that used appropriate single-subject methods with adequate quantification and analysis of results. The level of evidence of three functional interventions could not be established. One study was rated as Class II and consisted of a nonrandomized case-control investigation.

Conclusion:

Positive results were reported in all reviewed studies. However, in order to be recommended, some investigation regarding the intervention efficacy was required. Results of the present review allows for recommendation of some nonpharmacological interventions for cognitive deficits following PPA as Practice Options. Suggestions for further studies on PPA interventions and future research are discussed.

Key words:
primary progressive aphasia; treatment; speech and language therapy; intervention; cognitive rehabilitation

RESUMO

Este estudo ofereceu uma revisão sistemática de intervenções não-farmacológicas aplicadas a pacientes com Afasia Progressiva Primária (APP) e suas variantes: Semântica (APPS), Não-fluente (APPNF) e Logopênica (APPL) com o objetivo de estabelecer recomendações baseadas em evidências para a prática clínica de reabilitação cognitiva para estes pacientes.

Métodos:

Conduziu-se busca por literatura, sem restrição de período, no PubMed e LILACS com as palavras-chave PPA (e variantes) AND rehabilitation OR training OR intervention OR therapy OR treatment OR effectiveness. Para desenvolver recomendações baseadas em evidências um comitê de pesquisadores identificou as questões relevantes para investigação e determinou o nível de evidência para cada estudo de acordo com critérios publicados (Cicerone et al., 2000). A evidência total para os tratamentos foi sumarizada e recomendações redigidas.

Resultados:

Foram encontrados artigos publicados de 1995 a 2013: 21 para APPS, 8 para APPNF, 3 para APPL e 8 para APP sem especificações. Trinta e cinco estudos foram classificados como Classe III, consistindo de resultados obtidos com um ou mais indivíduos e utilizando metodologia apropriada para estudo de casos. O nível de evidência de três intervenções funcionais não pôde ser estabelecido. Um estudo foi classificado como Classe II e consistiu de pesquisa caso-controle não-randomizada.

Conclusão:

Resultados positivos foram reportados em todos os trabalhos analisados mas, para serem recomendados, os tratamentos requerem investigação em relação a sua eficácia. Resultados da presente revisão permitiram recomendação de algumas intervenções como Opções Práticas. Ademais, apresentamos sugestões para futuros estudos de intervenção em APP.

Palavras-chave:
afasia progressiva primária; terapia fonoaudiológica; tratamento; intervenção; reabilitação cognitiva

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Publication Dates

  • Publication in this collection
    Jan-Mar 2013

History

  • Received
    07 Nov 2012
  • Accepted
    12 Jan 2013
Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
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