A framework for cognitive interventions targeting everyday memory performance and memory self-efficacy

Feasibility, Acceptability, and Impact of a self-guided e-learning Memory and Brain Health Promotion Program for Healthy Older Adults

OBJECTIVES

To examine the feasibility (e.g., completion rate), acceptability (e.g., satisfaction), and participant-reported impact (e.g., memory concerns, behavior change, goal attainment) of a self-guided, e-learning adaptation of a validated, facilitator-guided, in-person memory intervention for older adults.

METHODS

Participants were 139 healthy older adults (mean age: 73 ± 7, 73% women). Participation tracking and pre/post questionnaires embedded within the e-learning program were used to assess feasibility, acceptability, and impact.

RESULTS

Sixty-eight percent of participants completed the program. Anonymous feedback data indicated a high level of satisfaction with the program, the pace and clarity of the learning modules, and the user interface. Suggested improvements included offering more interaction with others and addressing minor platform glitches. There was a 41% decrease in the prevalence of concern about memory changes from baseline to posttest. The majority of participants reported an increase in use of memory strategies and uptake of health-promoting lifestyle behaviors. All participants reported moderate-to-high satisfaction with personal goal attainment.

CONCLUSIONS

The program demonstrated good feasibility, acceptability, and lead to reduction in age-related memory concerns.

CLINICAL IMPLICATIONS

Self-guided, e-learning programming shows promise for fostering positive adaptation to age-related memory changes and improving the uptake of evidence-based strategies to promote brain health among older adults.

Application of a cognitive program with a comprehensive strategy feedback for Korean older adults

This study assesses the effect of a cognitive program with a comprehensive strategy feedback on the cognitive function and memory self-efficacy of community-dwelling older adults and explores its applicability in Korea. The study employed a group pre-posttest design on 10 cognitively normal older participants. The four-week cognitive program involved daily completion of cognitive tasks at home using CoTras-Pro 2 and remotely provided individual non-face-to-face feedback. Additionally, biweekly face-to-face group feedback sessions were conducted with five participants. The Korean version of the Montreal Cognitive Assessment, the Korean-Color Word Stroop Test, and the Memory Self-Efficacy Questionnaire were used. Post-interviews were conducted to collect feedback. The program exerted a notable positive impact on cognitive function and memory self-efficacy. A study designed as a large-scale program conducted in collaboration with community-based public and private organizations holds the potential to be modeled for similar intervention programs involving a large number of participants.

A randomized controlled trial to test the efficacy of a diabetes behavioral intervention to prevent memory decline in older blacks/African Americans with diabetes and mild cognitive impairment

BACKGROUND

The prevalence of dementia in Blacks/African Americans (AAs) is almost twice that of Whites. Inequities in access to health care, socioeconomic conditions, and diabetes contribute to this disparity. Poorly controlled diabetes, which is more prevalent in Blacks/AAs, causes microvascular disease and neurodegeneration and increases dementia risk. Improving glycemic control, therefore, may prevent cognitive decline. To address this issue, we developed Diabetes Regulation for Eyesight and Memory (DREAM), a community health worker (CHW)-led behavioral intervention to improve diabetes self-management and thereby prevent cognitive decline. DREAM consists of home-based diabetes education, goal setting, and telehealth visits with a diabetes nurse educator. Exploratory aims will investigate whether APOE genotype moderates and retinal biomarkers mediate treatment effects. This report describes the trial's rationale, methodology, and study procedures. (clinicaltrials.gov identifier NCT04259047).

METHODS

This randomized controlled trial will test the efficacy of DREAM to prevent decline in memory (primary outcome) in Blacks/AAs aged 65+ with poorly controlled diabetes and Mild Cognitive Impairment (MCI). Two hundred participants will be randomized to DREAM or an attention control condition, and will receive 11 in-home treatment sessions over two years. Outcome data are collected at 6, 12, 18, and 24 months. The primary outcome is verbal learning as measured by Hopkins Verbal Learning Test (HVLT) Total Recall scores. Participants will have retinal imaging at baseline, 12, and 24 months.

CONCLUSIONS

This research aims to prevent cognitive decline in older Blacks/AAs with diabetes and MCI. If successful, this research will preserve health in an underserved population and reduce racial health disparities.

Dementia-Free Older Adults with Subjective Cognitive Impairment Show Lower Mood and No Deficits of Spontaneous Memory Retrieval

The aim of the present study was to investigate whether spontaneous retrieval deficits could be found in individuals with Subjective Cognitive Impairment (SCI). The sample consisted of 52 participants over 65 years of age (mean age = 76.00; SD = 7.48) with 11 males. We asked 26 individuals with SCI and 26 individuals without SCI to perform a prospective memory (PM) task that had previously demonstrated spontaneous retrieval deficits in individuals with Mild Cognitive Impairment. The results did not demonstrate the expected differences in a PM task based on spontaneous retrieval [t(50) = -.05; p = .964, d = .01]. However, participants' mood did predict their subjective memory complaints (β = -.51; p < .001) and their subjective assessment of their future memory performance (r = -.38; p < .01). The findings are in line with numerous studies which have shown that SCI is more related to mood disturbance than to objective cognitive functioning.

Effect of early cognitive interventions on delirium in critically ill patients: a systematic review

PURPOSE

A systematic review of the literature was conducted to determine the effects of early cognitive interventions on delirium outcomes in critically ill patients.

SOURCE

Search strategies were developed for MEDLINE, EMBASE, Joanna Briggs Institute, Cochrane, Scopus, and CINAHL databases. Eligible studies described the application of early cognitive interventions for delirium prevention or treatment within any intensive care setting. Study designs included randomized-controlled trials, quasi-experimental trials, and pre/post interventional trials. Two reviewers independently extracted data and assessed risk of bias using Cochrane methodology.

PRINCIPAL FINDINGS

Four hundred and four citations were found. Seven full-text articles were included in the final review. Six of the included studies had an overall serious, high, or critical risk of bias. After application of cognitive intervention protocols, a significant reduction in delirium incidence, duration, occurrence, and development was found in four studies. Feasibility of cognitive interventions was measured in three studies. Cognitive stimulation techniques were described in the majority of studies.

CONCLUSION

The study of early cognitive interventions in critically ill patients was identified in a small number of studies with limited sample sizes. An overall high risk of bias and variability within protocols limit the utility of the findings for widespread practice implications. This review may help to promote future large, multi-centre trials studying the addition of cognitive interventions to current delirium prevention practices. The need for robust data is essential to support the implementation of early cognitive interventions protocols.

Memory training for adults with probable mild cognitive impairment: a pilot study

Background & Objectives: This pilot study aimed to evaluate the efficacy of memory training and health training intervention over a 24-month period in people with probable mild cognitive impairment (MCI). Research Design & Methods: Based on the accepted criteria, and the neuropsychiatric measures used in the trial, MCI was defined as a subjective change in cognition, impairment in episodic memory, preservation of independence of functional abilities, and no dementia. Without a neurological assessment, laboratory tests, and psychometric evaluation combined, some of our participants may have had dementia that we were unable to detect through neuropsychological testing. Of the 263 total participants, 39 met criteria for a diagnosis of MCI. There were 19 adults in the memory and 20 in health training conditions. Both groups received twenty hours of classroom content that included eight hours of booster sessions at three months post intervention. Hierarchical linear models (HLM) and standardized regression-based (SBR) analyses were used to test the efficacy of the intervention on immediate recall, delayed recall, subjective memory complaints, and memory self-efficacy. Age, education, depression, racial group, ethnic group, MMSE score, and baseline performance were included as covariates. Results: Over 24 months, the MCI group in the memory training condition showed better objective and subjective memory outcomes compared with the MCI group in the health training condition. Conclusions: Senior WISE Memory training delivered to individuals with MCI was able to forestall the participants' declining cognitive ability and sustain the benefit over two years in both subjective and objective memory function.

Subjective Age and Memory Performance Among Older Chinese Adults : A Moderated Mediation Model

This study aims to examine the mediating role of learning self-efficacy in the relationship between subjective age and memory performance as well as the moderating role of education in these indirect and direct relationships. A study was conducted with 200 older adults aged 60 to 81 years who completed measures of subjective age, learning self-efficacy, education, and memory performance. Analysis revealed that learning self-efficacy partially mediated the association between subjective age and memory performance. Further analysis found that the indirect associations between subjective age and memory through learning self-efficacy vary as a function of education. Implications and suggestions for future research are discussed.

Enhancing memory self-efficacy during menopause through a group memory strategies program

OBJECTIVE

Anxiety about memory during menopause can affect quality of life. We aimed to improve memory self-efficacy during menopause using a group memory strategies program.

METHODS

The program was run five times for a total of 32 peri- and postmenopausal women, age between 47 and 60 years, recruited from hospital menopause and gynecology clinics. The 4-week intervention consisted of weekly 2-hour sessions, and covered how memory works, memory changes related to ageing, health and lifestyle factors, and specific memory strategies. Memory contentment (CT), reported frequency of forgetting (FF), use of memory strategies, psychological distress, and attitude toward menopause were measured. A double-baseline design was applied, with outcomes measured on two baseline occasions (1-month prior [T1] and in the first session [T2]), immediately postintervention (T3), and 3-month postintervention (T4). To describe changes in each variable between time points paired sample t tests were conducted. Mixed-effects models comparing the means of random slopes from T2 to T3 with those from T1 to T2 were conducted for each variable to test for treatment effects.

RESULTS

Examination of the naturalistic changes in outcome measures from T1 to T2 revealed no significant changes (all Ps > 0.05). CT, reported FF, and use of memory strategies improved significantly more from T2 to T3, than from T1 to T2 (all Ps < 0.05). Neither attitude toward menopause nor psychological distress improved significantly more postintervention than during the double-baseline (all Ps > 0.05). Improvements in reported CT and FF were maintained after 3 months.

CONCLUSIONS

The use of group interventions to improve memory self-efficacy during menopause warrants continued evaluation.

Memory Self-Efficacy and Memory Performance in Older Adults

Abstract. The present research examined the role persistence plays in mediating the positive impact of memory self-efficacy (MSE, i.e., one’s confidence in one’s own memory abilities) on older adults’ memory performance. In three studies, 81 to 264 older adults completed an MSE scale and carried out an explicit episodic memory task, during which we recorded their study time as an indicator of task persistence. We found that higher MSE was indirectly related to better memory performance through greater persistence during encoding, as measured by longer study time. Indirect effects were of medium size, with point estimates ranging from 0.64 to 0.85. This mediation effect was independent of factors that could be confounded with study time: chronological age, memory span, prior level of memory performance, episodic memory ability, and use of learning strategies (encoding strategies and self-testing). When confronted with difficult memory tasks, older adults who lack confidence in their memory abilities cease their efforts prematurely, which contributes to a decrease in their performance. Encouraging older adults to persist in the face of difficulties during encoding and retrieval may help alleviate the negative impact of low MSE on memory performance and allow researchers and clinicians to more accurately estimate older adults’ true memory abilities.

"Keep your brain fit!" Effectiveness of a psychoeducational intervention on cognitive functioning in healthy adults: A randomised controlled trial

A psychoeducational intervention (Keep your brain fit!) was designed for the middle-aged and older working population. The intervention focuses on increasing knowledge and awareness about cognitive ageing and teaching strategies to cope with cognitive changes. The primary aim of this study was to investigate the effectiveness of the e-health intervention in terms of subjective cognitive functioning. As secondary aims, objective cognitive functioning and psychological well-being were also measured. A randomised controlled trial that included people aged 40 to 65 years was conducted. A maximum of 4 weeks was allowed to complete the intervention. The outcome measures were obtained from an online test battery that was administered at baseline, post-test and at 4-week follow-up. A total of 376 participants completed the whole study. After the intervention, the experimental group reported more feelings of stability concerning memory functioning and perceived greater locus of control over memory compared to the control group. These effects were maintained at the 4-week follow-up. Taking into account the relatively low costs and easy accessibility of this e-health intervention, we consider the programme to be a valuable contribution to public healthcare interventions for middle-aged and older adults.

Memory training plus yoga for older adults

Previous tests of the SeniorWISE intervention with community-residing older adults that were designed to improve affect and cognitive performance were successful and positively affected these outcomes. In this study, we tested whether adding yoga to the intervention would affect the outcomes. Using a quasiexperimental pre-post design, we delivered 12 hours of SeniorWISE memory training that included a 30-minute yoga component before each training session. The intervention was based on the four components of self-efficacy theory: enactive mastery experience, vicarious experience, verbal persuasion, and physiologic arousal. We recruited 133 older adults between the ages of 53 and 96 years from four retirement communities in Central Texas. Individuals were screened and tested and then attended training sessions two times a week over 4 weeks. A septuagenarian licensed psychologist taught the memory training, and a certified yoga instructor taught yoga. Eighty-three participants completed at least 9 hours (75%) of the training and completed the posttest. Those individuals who completed made significant gains in memory performance, instrumental activities of daily living, and memory self-efficacy and had fewer depressive symptoms. Thirteen individuals advanced from poor to normal memory performance, and seven improved from impaired to poor memory performance; thus, 20 individuals improved enough to advance to a higher functioning memory group. The findings from this study of a memory training intervention plus yoga training show that the benefits of multifactorial interventions had additive benefits. The combined treatments offer a unique model for brain health programs and the promotion of nonpharmacological treatment with the goals of maintaining healthy brain function and boosting brain plasticity.

Development and psychometric testing of a breast cancer survivor self-efficacy scale

PURPOSE/OBJECTIVES

To describe the development of a self-efficacy instrument that measures perceived ability to manage symptoms and quality-of-life problems resulting from the diagnosis and treatment of breast cancer.

DESIGN

Items were developed and content validity assessed. A 14-item scale was psychometrically evaluated using internal consistency reliability and several types of construct validity.

SAMPLE

1,127 female breast cancer survivors (BCSs).

METHODS

Written consents were mailed to the research office. Data were collected via mail and telephone.

MAIN RESEARCH VARIABLES

Demographics, symptom bother, communication with healthcare provider, attention function, fear of recurrence, depression, marital satisfaction, fatigue, sexual functioning, trait and state anxiety, and overall well-being.

FINDINGS

Data demonstrated that the breast cancer self-efficacy scale (BCSES) was reliable, with an alpha coefficient of 0.89, inter-item correlations ranging from 0.3-0.6, and item-total correlation coefficients ranging from 0.5-0.73. Three of 14 items were deleted because of redundancy as identified through high (> 0.7) inter-item correlations. Factor analysis revealed that the scale was unidimensional. Predictive validity was supported through testing associations between self-efficacy and theoretically supported quality-of-life variables, including physical, psychological, and social dimensions, as well as overall well-being.

CONCLUSIONS

The BCSES demonstrated high internal consistency reliability, unidimensionality, and excellent content and construct validity. This scale should be integrated into interventions that target self-efficacy for managing symptoms in BCSs.

IMPLICATIONS FOR NURSING

Nurses working with BCSs may use this tool to assess areas in which survivors might need to build confidence to adequately cope with their specific survivorship concerns.

KNOWLEDGE TRANSLATION

The use of the BCSES can inform nurse researchers about the impact of an intervention on self-efficacy in the context of breast cancer survivorship, improving the ability to deliver effective interventions. The scale is brief and easy to administer. Results of this study demonstrate clear psychometric reliability and validity, suggesting that the BCSES should be put to use immediately in interventions targeting the quality of life of BCSs.

Effects of a comprehensive educational group intervention in older women with cognitive complaints: a randomized controlled trial

OBJECTIVE

This study presents a new comprehensive educational group intervention that offers psycho-education about cognitive aging and contextual factors (i.e., negative age stereotypes, beliefs, health, and lifestyle), focuses on skills and compensatory behavior, and incorporates group discussion. Its effects were investigated in community-dwelling older women who report normal age-related cognitive complaints.

METHODS

A randomized controlled trial with an experimental and waiting-list control condition was carried out in a sample of 50 women aged 60-75 years. As the main problem of these individuals were perceived cognitive deficits without actual cognitive decrements, metacognition served as the primary outcome measure.

OBJECTIVE

cognitive functioning and psychological well-being were secondary outcome measures. A double baseline and a follow-up assessment were carried out.

RESULTS

Participants in the experimental condition reported significantly fewer negative emotional reactions toward cognitive functioning (U = 164.500, p = 0.004). The reported effect size (δ = -0.473) could be interpreted as large.

CONCLUSIONS

This new comprehensive educational group intervention reduces negative emotional reactions toward cognitive functioning, which seems a prerequisite for improved subjective cognitive functioning and well-being. It can potentially contribute the well-being of an important and large group of older adults.

Symptom management of affective and cognitive disturbance with a group of cancer survivors

Cancer survivors 65 years of age and older experience treatment-induced memory impairments. However, clinicians do not intervene for these cognitive problems. This article describes the findings from a pilot study of a memory versus health training intervention and its adaptability for cancer survivors for symptom management.

DESIGN AND METHODS

A convenience sample of older adults was enrolled in a longitudinal study of a memory and health training intervention and tested on five occasions for 2 years postintervention. The memory training was designed to increase cognitive performance, reduce anxiety, decrease negative attributions, promote health, and increase memory self-efficacy. In this analysis, we included change over time for the first four of the five data collection points. We calculated means and standard deviations on the memory measures for cancer survivors in the intervention (n = 8) and comparison (n = 14) groups. The analysis consisted of a mixed design analysis of variance comparing the two intervention groups across four periods for 12 months.

RESULTS

The typical cancer survivor in the sample was a 74-year-old Caucasian female; 14% were minorities. Because of the small sample, some of the effects were not statistically significant. Moderate to large effects were revealed in everyday and verbal memory performance scores, memory self-efficacy, strategy use, and memory complaints. There were also moderate effects for group-by-time interactions on the visual memory performance measure, the memory self-efficacy measure, the depression, the trait anxiety measure, and the complaints subscale. The memory intervention group tended to improve more than the health training group, although this was not always consistent. The results suggested that the participants benefited from the memory training intervention.

IMPLICATIONS

Clinicians are often at a loss on how to intervene with cancer survivors who are experiencing cognitive problems following chemotherapy treatment. Evidenced-based interventions for this aspect of symptom management are almost nonexistent. The Cognitive Behavioral Model of Everyday Memory (CBMEM), derived from Self-Efficacy theory provides an evidence-based intervention for symptom management.

The SeniorWISE study: improving everyday memory in older adults

We tested whether at-risk older adults receiving memory training showed better memory self-efficacy, metamemory, memory performance, and function in instrumental activities of daily living than participants receiving a health promotion training comparison condition. We followed participants for 26 months. The sample was mostly female (79%) and Caucasian (71%), with 17% Hispanics and 12% African Americans; average age was 75 years, and average education was 13 years. The memory training group made greater gains on global cognition and had fewer memory complaints, but both groups generally maintained their performance on the other cognitive measures and instrumental activities of daily living (IADLs) throughout the 24-month study period. Black and Hispanic participants made greater gains than Whites did on some memory performance measures but not on memory self-efficacy. The unexpected finding that minority elders made the largest gains merits further study. This study contributed to the knowledge base of geropsychiatric nursing by providing evidence for an effective psychosocial intervention that could be delivered by advanced practice nurses.

Differential benefits of memory training for minority older adults in the SeniorWISE study

PURPOSE

Cognitive training improves mental abilities in older adults, but the benefit to minority elders is unclear. We conducted a subgroup analysis of subjects in the SeniorWISE (Wisdom Is Simply Exploration) trial to examine this issue.

DESIGN AND METHODS

SeniorWISE was a Phase 3 randomized trial that enrolled 265 nondemented community-dwelling older adults aged 65 years and older between 2001 and 2006. Participants were randomly assigned to 12 hr of either memory or health training.

RESULTS

The sample was 79% female, 71% Caucasian, 17% Hispanic, and 12% African American. On the Rivermead Behavioural Memory Test (RBMT), 28% of the sample scored normal, 47% scored poor, and 25% impaired. Memory performance changed differently over time depending on the demographic characteristics of participants. Both Hispanics and Blacks performed better than Whites on visual memory, and Blacks performed better over time on instrumental activities of daily living. On all performance measures, lower pretest scores were associated with relatively greater improvements over time.

IMPLICATIONS

Our analyses suggested that minority participants received differential benefits from the memory training; however, this remains speculative because the 3 ethnic groups in the sample were not equivalent in size. The question of why Black and Hispanic participants often made greater improvements needs further exploration.

A Novel Approach to Treating Anxiety and Enhancing Executive Skills in an Older Adult with Parkinson's Disease

Scientific interest in the nonmotoric symptoms of Parkinson's disease (PD) has increased dramatically, and psychiatric symptoms (e.g., cognitive impairment, anxiety and mood disorders) are now considered prime targets for treatment optimization. Psychiatric complications in PD are quite common, affecting as many as 60 to 80% of patients. This study describes the case of a 74 year-old male with PD who presented with complaints of anxiety and trouble with memory and attention. A combined cognitive behavior therapy and cognitive enhancement intervention was delivered in ten 90-to-120 minute sessions. The patient showed a reduction in anxiety symptoms that was of sufficient magnitude to meet criteria for 'responder' status. His cognitive skills were mostly unchanged, despite the rigorous rehabilitation practice. Implications for treatment and strategies for enhancing therapeutic benefits are discussed.