Introduction
cognitive impairment, dementia, Parkinsonian dementias, Dementia, Alzheimer’s
SYNDROME
Dementia is a progressive syndrome characterised by gradual decline in cognitive and functional ability and capacity for independent living. There are currently no disease-modifying treatments. Globally there are over 55 million people living with dementia. The number is forecast to rise to over 150 million by 2050 [One such intervention that could be impactful if widely implemented is cognitive rehabilitation (CR). CR is a goal-oriented individualised behavioural therapy addressing the impact of cognitive impairment on everyday functioning that has been adapted for people with mild-to-moderate dementia [The main research evidence for the benefits of this approach for people with Alzheimer’s, vascular, mixed and Parkinsonian dementias comes from single-site and multi-centre trials conducted in the UK and France. These trials have demonstrated improvements in functional ability in relation to goals targeted in the intervention [In the final stages of the UK GREAT trial, pilot work in the form of a small-scale feasibility study focused on how to implement GREAT CR in routine service provision at three National Health Service trial sites [We applied this strategy to conduct a translational implementation study addressing the following questions:
Implementation objectivesHow readily can community-based services engage in providing GREAT CR?What barriers and facilitators affect the implementation of GREAT CR?What is the potential for scaling up the implementation?Intervention objectivesIs GREAT CR effective when delivered as part of routine services?What are the views of people with dementia, carers, and practitioners about GREAT CR?What is the per-person cost to services of delivering GREAT CR?