The Efficacy of Cognitive Rehabilitation on Cognitive Distortion, Depression, and Life Expectancy of the Elderly with Mild Alzheimer's

Document Type : Original Article

Authors

1 Department of Positive Islamic Psychology, Payame Noor University, Behshahr Branch, Behshahr, Iran.

2 Department of Psychology, Islamic Azad University, Roudehen Branch, Roudehen, Iran.

3 Department of Psychology, Islamic Azad University, Semnan Branch, Semnan, Iran.

4 Department of Psychology, Islamic Azad University, Ardabil Branch, Ardabil, Iran.

Abstract

The present study aimed to evaluate the effectiveness of cognitive distortion, depression, and life expectancy of the elderly with mild Alzheimer's. The present study was a quasi-experimental interventional study with pre-test and post-test conducted on the elderly with mild Alzheimer's disease who were referred to day rehabilitation centers in Ardabil in 2025. Of these, 36 elderly individuals with mild Alzheimer's disease were selected via convenience sampling and randomly assigned to either the experimental group (n=18) or the control group (n=18). The experimental group received ten 60-minute sessions of a computer-based cognitive rehabilitation program. Data were collected using the Cognitive Distortions Questionnaire, Beck Depression Inventory, and Snyder's Hope Scale. The data were analyzed using multivariate analysis of covariance (SPSS-28). The findings revealed that cognitive rehabilitation significantly decreases unrealistic relationship expectations (F=34.31), interpersonal rejection (F=21.22), interpersonal misperception (F=30.49), and depression (F=32.28), and increases agency thinking (F=17.24), and pathways thinking (F=24.20) in the elderly with mild Alzheimer’s disease (P<0.01). The findings of the present study collectively highlight the comprehensive efficacy of cognitive rehabilitation in elderly individuals with mild Alzheimer’s disease. By targeting cognitive distortions, alleviating depressive symptoms, and fostering healthier lifestyle practices, the intervention demonstrates multidimensional benefits that extend beyond isolated cognitive improvements.

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Main Subjects


Beck, A. T., Steer, R. A., & Brown, G. (1996). Beck depression inventory–II. Psychological assessment.
Chang, C. H., Yeh, C. H., Chang, C. C., & Lin, Y. C. (2022). Interactive somatosensory games in rehabilitation training for older adults with mild cognitive impairment: usability study. JMIR serious games, 10(3), e38465.
Cutuli, D., Giacovazzo, G., Decandia, D., & Coccurello, R. (2022). Alzheimer’s disease and depression in the elderly: A trajectory linking gut microbiota and serotonin signaling. Frontiers in Psychiatry, 13, 1010169.
Dominguez, L. J., Veronese, N., Parisi, A., Seminara, F., Vernuccio, L., Catanese, G., & Barbagallo, M. (2024). Mediterranean diet and lifestyle in persons with mild to moderate Alzheimer’s disease. Nutrients, 16(19), 3421.
Franco-Martín, M. A., Diaz-Baquero, A. A., Bueno-Aguado, Y., Cid-Bartolomé, M. T., Parra Vidales, E., Perea Bartolomé, M. V., ... & van der Roest, H. G. (2020). Computer-based cognitive rehabilitation program GRADIOR for mild dementia and mild cognitive impairment: New features. BMC medical informatics and decision making, 20(1), 274.
Hamamci, Z., & Büyüköztürk, Ş. (2004). The interpersonal cognitive distortions scale: Development and psychometric characteristics. Psychological reports, 95(1), 291-303.
He, D., Cao, S., Le, Y., Wang, M., Chen, Y., & Qian, B. (2022). Virtual reality technology in cognitive rehabilitation application: bibliometric analysis. JMIR serious games, 10(4), e38315.
Irazoki, E., Contreras-Somoza, L. M., Toribio-Guzmán, J. M., Jenaro-Río, C., Van der Roest, H., & Franco-Martín, M. A. (2020). Technologies for cognitive training and cognitive rehabilitation for people with mild cognitive impairment and dementia. A systematic review. Frontiers in psychology, 11, 648.
Jemimah, S., Chabib, C. M. M., Hadjileontiadis, L., & AlShehhi, A. (2023). Gut microbiome dysbiosis in Alzheimer’s disease and mild cognitive impairment: A systematic review and meta-analysis. PLoS One, 18(5), e0285346.
Justo-Henriques, S. I., Pérez-Sáez, E., Carvalho, J. O., Lemos, R., & Ribeiro, Ó. (2025). Effects of an individual cognitive stimulation intervention on global cognition, memory, and executive function in older adults with mild to moderate Alzheimer’s disease. The Clinical Neuropsychologist, 39(6), 1506-1524.
Kang, H. (2021). Sample size determination and power analysis using the G* Power software. Journal of educational evaluation for health professions, 18.
Kim, H., Jeong, W., Kwon, J., Kim, Y., Park, E. C., & Jang, S. I. (2021). Association between depression and the risk of Alzheimer’s disease using the Korean National Health Insurance Service-Elderly Cohort. Scientific reports, 11(1), 22591.
Kovač, N., Ratković, K., Watson, P., Farahani, H., & Bagheri Sheykhangafshe, F. (2025). Machine learning classification models for predicting chronic pain. Current Psychology, 44(18), 15409-15422.
Kudlicka, A., Martyr, A., Bahar-Fuchs, A., Sabates, J., Woods, B., & Clare, L. (2023). Cognitive rehabilitation for people with mild to moderate dementia. Cochrane Database of Systematic Reviews, (6).
Lanctot, K. L., Hahn-Pedersen, J. H., Eichinger, C. S., Freeman, C., Clark, A., Tarazona, L. R. S., & Cummings, J. (2024). Burden of illness in people with Alzheimer's disease: a systematic review of epidemiology, comorbidities and mortality. The journal of prevention of Alzheimer's disease, 11(1), 97-107.
Lee, R., Kim, J. H., Kim, W. W., Hwang, S. H., Choi, S. H., Kim, J. H., ... & Nah, S. Y. (2024). Emerging evidence that ginseng components improve cognition in subjective memory impairment, mild cognitive impairment, and early Alzheimer's disease dementia. Journal of Ginseng Research, 48(3), 245-252.
Mandal, P. K., Goel, A., Bush, A. I., Punjabi, K., Joon, S., Mishra, R., ... & Shandilya, S. (2022). Hippocampal glutathione depletion with enhanced iron level in patients with mild cognitive impairment and Alzheimer’s disease compared with healthy elderly participants. Brain communications, 4(5), 215.
Manenti, R., Gobbi, E., Baglio, F., Macis, A., Ferrari, C., Pagnoni, I., ... & Cotelli, M. (2020). Effectiveness of an innovative cognitive treatment and telerehabilitation on subjects with mild cognitive impairment: a multicenter, randomized, active-controlled study. Frontiers in aging neuroscience, 12, 585988.
Mooldijk, S. S., Yaqub, A., Wolters, F. J., Licher, S., Koudstaal, P. J., Ikram, M. K., & Ikram, M. A. (2022). Life expectancy with and without dementia in persons with mild cognitive impairment in the community. Journal of the American Geriatrics Society, 70(2), 481-489.
Mostert, C. M., Mekkaoui, N. E., Ali, S., Trepel, D., Ranchod, K., Udeh‐Momoh, C., ... & Merali, Z. (2025). Investing in equitable healthy aging: Why Africa must reform social pension schemes to improve Alzheimer's disease and dementia outcomes. Alzheimer's & Dementia, 21(2), e14527.
Mukherjee, U., Sehar, U., Brownell, M., & Reddy, P. H. (2024). Mechanisms, consequences and role of interventions for sleep deprivation: Focus on mild cognitive impairment and Alzheimer’s disease in elderly. Ageing Research Reviews, 100, 102457.
Nissim, N. R., Pham, D. V. H., Poddar, T., Blutt, E., & Hamilton, R. H. (2023). The impact of gamma transcranial alternating current stimulation (tACS) on cognitive and memory processes in patients with mild cognitive impairment or Alzheimer's disease: A literature review. Brain stimulation, 16(3), 748-755.
Nukhat, A., Salim, A. B. Z., & Shaffie, M. D. F. (2024). Cognitive distorions and depression among older adults: Moderating role of resilience. Revista de Gest£ o Social e Ambiental, 18(2).
Osawa, A., Maeshima, S., Kamiya, M., Ueda, I., Itoh, N., Kondo, I., & Arai, H. (2025). Intervention Effects of the Holistic Physio-Cognitive Rehabilitation for Alzheimer Disease and Mild Cognitive Impairment. Annals of Geriatric Medicine and Research, 29(2), 207.
Park, S., Amano, T., Park, S., & Kim, B. (2025). Prevalence of Mild Cognitive Impairment and Alzheimer’s Disease and Related Dementias Among Older Residents of Publicly Subsidized Housing in the United States: Systematic-Review and Meta-Analysis. Journal of Gerontological Social Work, 1-16.
Perra, A., Galetti, A., Zaccheddu, R., Locci, A., Piludu, F., Preti, A., & Carta, M. G. (2023). A recovery-oriented program for people with bipolar disorder through virtual reality-based cognitive remediation: results of a feasibility randomized clinical trial. Journal of Clinical Medicine, 12(6), 2142.
Quintana-Hernández, D. J., Rojas-Hernández, J., Santana-del Pino, A., Céspedes Suarez, C., Pellejero Silva, M., Miró-Barrachina, M. T., & Borkel, L. F. (2023). Mindfulness prevents depression and psychopathology in elderly people with mild to moderate Alzheimer’s disease: a randomized clinical trial. Journal of Alzheimer’s Disease, 91(1), 471-481.
Rajji, T. K., Bowie, C. R., Herrmann, N., Pollock, B. G., Bikson, M., Blumberger, D. M., & PACt-MD Study Group. (2020). Design and rationale of the PACt-MD randomized clinical trial: prevention of Alzheimer’s dementia with cognitive remediation plus transcranial direct current stimulation in mild cognitive impairment and depression. Journal of Alzheimer’s Disease, 76(2), 733-751.
Rallabandi, V. S., Seetharaman, K., & Alzheimer's Disease Neuroimaging Initiative (ADNI. (2023). Classification of cognitively normal controls, mild cognitive impairment and Alzheimer’s disease using transfer learning approach. Biomedical Signal Processing and Control, 79, 104092.
Sáiz-Vázquez, O., Gracia-García, P., Ubillos-Landa, S., Puente-Martínez, A., Casado-Yusta, S., Olaya, B., & Santabárbara, J. (2021). Depression as a risk factor for Alzheimer’s disease: a systematic review of longitudinal meta-analyses. Journal of Clinical Medicine, 10(9), 1809.
Schäfer, S., Tröger, J., & Kray, J. (2024). Modern scores for traditional tests-Review of the diagnostic potential of scores derived from word list learning tests in mild cognitive impairment and early Alzheimer's Disease. Neuropsychologia, 201, 108908.
Shabahang, R., Emadi, S.J., Bagheri Sheykhangafshe, F., Hossein Khanzadeh, A.A., Mousavi, S.M. (2020). The Effectiveness of CBTAC Protocol on Burdens of Alzheimer’s Disease on Caregivers and their Sense of Coherence. International Clinical Neuroscience Journal, 7(2), 81-87.
Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., ... & Harney, P. (1991). The will and the ways: development and validation of an individual-differences measure of hope. Journal of personality and social psychology, 60(4), 570.
Sritana, N., & Phungpinij, A. (2024). Analysis of Oral Microbiota in Elderly Thai Patients with Alzheimer’s Disease and Mild Cognitive Impairment. International Journal of Environmental Research and Public Health, 21(9), 1242.
Tortora, C., Di Crosta, A., La Malva, P., Prete, G., Ceccato, I., Mammarella, N., ... & Palumbo, R. (2024). Virtual reality and cognitive rehabilitation for older adults with mild cognitive impairment: A systematic review. Ageing Research Reviews, 93, 102146.
Wang, C., Wang, Z., Herrero, M. T., Xu, T., Chu, F., Zeng, H., & Tao, M. (2025). Early diagnosis of mild cognitive impairment and Alzheimer’s disease using multimodal feature-based deep learning models in a Chinese elderly population. Asian Journal of Psychiatry, 104632.
Wei, C., Zhao, J., Hu, R., & Wei, X. (2025). Association between depressive status and mild cognitive impairment in middle-aged and elderly Chinese adults from CHARLS study. Frontiers in Psychiatry, 16, 1516341.
Xiaopeng, Z., Jing, Y., Xia, L., Xingsheng, W., Juan, D., Yan, L., & Baoshan, L. (2025). Global burden of Alzheimer's disease and other dementias in adults aged 65 years and older, 1991–2021: population-based study. Frontiers in Public Health, 13, 1585711.
Zandpour, M., Lind, M., Sharp, C., Hasani, J., Bagheri Sheykhangafshe, F., & Borelli, J. L. (2024). Attachment-based mentalization profiles of Iranian children: a mixed-method approach. Children, 11(2), 258.
Zhang, J., Xia, J., Liu, X., & Olichney, J. (2023). Machine learning on visibility graph features discriminates the cognitive event-related potentials of patients with early Alzheimer’s disease from healthy aging. Brain Sciences, 13(5), 770.