Cognitive Rehabilitation and Exposure/Sorting Therapy for Late-Life Hoarding: Effects on Neuropsychological Performance

Objectives: Hoarding disorder (HD) is characterized by urges to save items, difficulty discarding possessions, and excessive clutter and has been associated with executive functioning deficits. A randomized controlled trial comparing Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST) with a care management control condition demonstrated the efficacy of CREST in reducing hoarding symptoms in older adults. The purpose of the current study was to assess whether CREST may also lead to improved executive functioning. Method: All participants were administered a neurocognitive battery at baseline and posttreatment. Linear mixed models with random intercepts were used to evaluate change in global neuropsychological functioning as well as change in individual executive functioning variables. Results: There was no significant group by time interaction for the Global Deficit score; however, there were significant group by time interactions on two of the executive functioning variables examined, such that participants in the CREST condition demonstrated significant improvement in cognitive flexibility and inhibition over time compared with the participants in the care management condition. Discussion: Our initial findings support the notion that CREST may be able to improve task switching, an important component of executive functioning, in older adults with HD.