La maladie d’Alzheimer touche environ 22 000 patients dans la région Rabat-Salé-Kénitra (ministère de la Santé et de la Protection Sociale, 2022) avec des troubles attentionnels précoces compromettant l’autonomie. Cette étude évalue l’efficacité d’un programme de remédiation cognitive multimodale sur les fonctions attentionnelles, mesurées par le Test des cloches, le MMSE et le MoCA.

Étude quasi expérimentale incluant 94 patients Alzheimer (stade léger-modéré) répartis en deux groupes : remédiation cognitive thérapeutique (CRT, n = 47) recevant 24 séances de remédiation cognitive multimodale sur 12 semaines (exercices d’analyse partie-tout, transformations, exercices manuels, analogies visuelles, recherche de nombres consécutifs) versus groupe témoin ( n = 47) sous prise en charge standard. Les évaluations pré- et post-intervention utilisaient le Test des cloches (critère principal), le MMSE et le MoCA.

Le groupe CRT présente des améliorations exceptionnelles : Test des cloches (+4,82 ± 2,09  vs −0,49 ± 0,98 cloches, Cohen d = 3,26, p < 10 ^-23 ), MMSE (+3,20 ± 1,10  vs −0,75 ± 0,81 points, Cohen d = 4,08, p < 10 ^-32 ), et MoCA (+3,21 ± 1,46  vs −0,28 ± 0,98 points, Cohen d = 2,81, p < 10 ^-21 ). L’autonomie instrumentale (IADL), l’âge et l’auto-efficacité émergent comme principaux modérateurs de l’efficacité (R ² = 0,67).

Ces tailles d’effet exceptionnelles, dépassant largement les standards internationaux (SMD typique = 0,35–0,51), suggèrent des modifications neuroplastiques substantielles. Les corrélations robustes entre gains attentionnels et cognitifs globaux (r = 0,58–0,62) confirment un transfert proximal des bénéfices des fonctions attentionnelles vers les capacités cognitives générales. Cette première étude marocaine établit l’efficacité remarquable de la remédiation cognitive multimodale et identifie des variables prédictives pour l’optimisation thérapeutique personnalisée, soutenant son intégration dans les protocoles de soins régionaux.

Alzheimer's disease (AD) affects approximately 200,000 individuals in Morocco, with projections indicating a doubling to 400,000 cases by 2050. The Rabat-Salé-Kénitra region accounts for nearly 22,000 patients, representing 11% of the national burden. Attentional deficits constitute one of the earliest and most debilitating cognitive manifestations of AD, progressively compromising patients’ functional autonomy and quality of life. Current pharmacological treatments (cholinesterase inhibitors, memantine) offer only modest symptomatic benefits, rarely exceeding 1.5 MMSE points at six months, while presenting significant side effects and costs exceeding 1100 dirhams monthly. This situation has prompted the development of non-pharmacological alternatives, particularly cognitive remediation therapy (CRT), which targets neuroplasticity mechanisms to restore or compensate for impaired cognitive functions. This study aimed to evaluate the effectiveness of a multimodal CRT program on attentional functions in patients with mild-to-moderate AD in the Rabat-Salé-Kénitra region.

This quasi-experimental study included 94 patients with probable AD diagnosed according to NINCDS-ADRDA criteria, with MMSE scores ≥ 12, aged ≥ 55 years. Participants were recruited from the Rabat Alzheimer Day Care Center, the geriatric psychiatry department of the Specialties Hospital, and home-based care settings. They were allocated to either a CRT group ( n = 47) receiving 24 sessions of multimodal cognitive remediation over 12 weeks, or a control group ( n = 47) receiving standard care. The CRT program incorporated five categories of attentional exercises: visual part-whole analysis, visuospatial transformations, eye-hand coordination tasks, visual analogies, and consecutive number searches. These tasks employed errorless learning, positive reinforcement, and metacognitive strategies to promote neuroplasticity. The control group continued receiving standard medical care, including regular geriatric or neurological consultations, maintenance of prescribed pharmacological treatments without dosage modifications, usual occupational activities, and informal caregiver support. Pre- and post-intervention assessments utilized the Bells Test (primary outcome), MMSE, and MoCA. Effect sizes were calculated using Cohen's d , and moderating variables (age, IADL, self-efficacy, motivation) were examined through correlation and stepwise regression analyses.

The CRT group demonstrated exceptional improvements across all cognitive measures compared to the control group, which showed slight deterioration. On the Bells Test, the CRT group improved by 4.82 ± 2.09 bells versus a decline of -0.49 ± 0.98 in controls (Cohen's d = 3.26, P < 10 ^-10 ). The MMSE showed gains of 3.20 ± 1.10 points in the CRT group versus −0.75 ± 0.81 in controls (Cohen's d = 4.08, P < 10 ^-10 ). Similarly, MoCA scores improved by 3.21 ± 1.46 points versus −0.28 ± 0.98 in controls (Cohen's d = 2.81, P < 10 ^-10 ). These effect sizes substantially exceed those reported in international meta-analyses (typical SMD: 0.35-0.51). Robust correlations between attentional and global cognitive gains (r = 0.58–0.62, P < 0.001) support proximal transfer of benefits from attentional functions to general cognitive abilities. Subgroup analyses revealed differential efficacy according to patient characteristics. Patients younger than 75 years showed greater improvements across all measures (Bells Test: 5.34 vs. 4.11; MMSE: 3.67 vs. 2.53; MoCA: 3.89 vs. 2.31). The multiple regression model (R ² = 0.67) identified instrumental autonomy (IADL, β = 0.40), age (β = −0.13), and self-efficacy (β = 0.60) as independent predictors of therapeutic response, confirming a triple interaction between functional reserve, neuronal reserve, and motivational factors.

This study establishes, for the first time in Morocco and the MENA region, the remarkable effectiveness of multimodal cognitive remediation on attentional functions in AD patients. The exceptional effect sizes suggest substantial neuroplastic reorganization of cognitive networks, exceeding typical procedural learning effects. The superiority of attentional gains on the Bells Test confirms the specific efficacy on visuospatial attention, a particularly vulnerable function in AD. The generalization of benefits to MMSE and MoCA scores demonstrates that attention serves as a supervisory cognitive domain facilitating the functioning of other systems through top-down control mechanisms. The favorable cost-effectiveness ratio of CRT makes it particularly relevant for healthcare systems with limited resources, offering a promising therapeutic alternative to pharmacological treatments. These findings support the systematic integration of culturally adapted CRT programs into regional care pathways and provide a reproducible model for investigating non-pharmacological interventions in diverse Arabic-speaking contexts. Future multicenter randomized trials with extended follow-up are warranted to confirm these results and document the long-term durability of therapeutic benefits.