Treatment of problem solving in Alzheimer's disease: A short report

Abstract

Background: Treatments to help persons with Alzheimer's disease (AD) improve and/or compensate for deteriorating functional abilities have largely focused on cognitive rather than executive functions. Problem solving is an executive function integral to most activities of daily living that is compromised by AD. Successful treatment of problem‐solving deficits in persons with AD could potentially increase the amount of time a patient might remain at home by maintaining functional skills and possible delay institutionalisation.

Aims: This preliminary experimental study sought to determine the effects of treatment on problem solving by three participants with a diagnosis of AD.

Methods & Procedures: The study used a multiple probe design across participants. A single dependent variable, percentage of constraint questions, was used to measure the effects of treatment on solving of problems from the Rapid Assessment of Problem Solving Test (RAPS; Marshall, Karow, Morelli, Iden, & Dixon, 2003a). Problems on the RAPS require the individual to identify a target picture in a 32‐picture array by asking yes/no questions, and the goal is to do this by asking as few questions as possible. Following baseline, participants were treated individually over 12 sessions. Treatment demonstrated how constraint questions (questions that eliminate more that one item from consideration regardless of whether they are answered yes or no) rather than guesses were useful in solving word problems that mimicked those of the RAPS. Additional probe measures, also using problems from the RAPS, were obtained throughout treatment, and 2 and 4 weeks after treatment (maintenance).

Outcomes and Results: All participants increased their asking of constraint questions and decreased guessing from baseline. These increases were apparent during treatment and maintenance. Improvement following treatment was due to participant's use of categorisation skills to ask constraint questions instead of guessing.

Conclusions: Improvements in solving problems of the RAPS were attained for all participants with only 12 brief treatment sessions. The treatment provided was relatively passive, participants were not trained to criterion levels, and all participants were treated identically. That treatment led to increased use of categorisation strategies by the participants is promising, categorisation skills often being compromised in AD. Results suggest that components of executive functions such as problem solving may be amenable to treatment in persons with AD, and that there is a need to generate testable hypotheses regarding treatment of problem solving by AD patients in the future.