High-Ecological Cognitive Intervention to Improve Cognitive Skills and Cognitive-Functional Performance for Older Adults With Mild Cognitive Impairment

A Multicomponent Cognitive Intervention May Improve Self-Reported Daily Function of Adults With Subjective Cognitive Decline

IMPORTANCE

Limited evidence exists to support cognitive intervention improving the daily function of adults with subjective cognitive decline (SCD).

OBJECTIVE

To examine the preliminary efficacy of a group-based multicomponent cognitive intervention that integrates Lifestyle Redesign® (LR) techniques.

DESIGN

Single-arm two-period crossover trial; 16-wk waiting period, 16-wk intervention, and 16-wk follow-up.

SETTING

Memory clinic in a medical center, Taiwan.

PARTICIPANTS

Purposive sample of adults ages >55 yr with SCD.

INTERVENTION

Sixteen 1.5-hr weekly multicomponent sessions of cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention.

OUTCOMES AND MEASURES

Primary outcomes were (1) self-reported daily function, measured with the Activities of Daily Living Questionnaire (ADLQ) and Cognitive Failure Questionnaire; (2) performance-based daily function, measured with the Brief University of California San Diego Performance-Based Skills Assessment-Traditional Chinese Version; and (3) functional cognition, measured with the Contextual Memory Test (CMT) and Miami Prospective Memory Test. Secondary outcomes included cognitive functions, anxiety, and depression.

RESULTS

Seventeen participants completed the intervention; 4 missed the follow-up. The generalized estimating equations model showed significant changes from baseline to pretest (control) and pretest to posttest (intervention) on the ADLQ (p = .014) and CMT-delayed (p = .003). Effects remained at the 16-wk follow-up. After adjusting for the effects of covariates, the self-reported daily function of participants ages ≤ 63 yr improved more than that of other participants (p = .003).

CONCLUSIONS AND RELEVANCE

Multicomponent cognitive interventions integrating LR techniques may improve self-reported daily function and context-dependent memory function of adults with SCD, with efficacy sustained at follow-up. What This Article Adds: A group-based multicomponent cognitive intervention consisting of cognitive training, cognitive rehabilitation, psychoeducation, and lifestyle intervention may provide benefits for the daily function and cognitive function of adults with SCD.

Functional Neural Correlates of Semantic Fluency Task Performance in Mild Cognitive Impairment and Alzheimer's Disease: An FDG-PET Study

BACKGROUND

Total score (TS) of semantic verbal fluency test (SVFT) is generally used to interpret results, but it is ambiguous as to specific neural functions it reflects. Different SVFT strategy scores reflecting qualitative aspects are proposed to identify specific cognitive functions to overcome limitations of using the TS.

OBJECTIVE

Functional neural correlates of the TS as well as the other strategy scores in subjects with mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia using Fluorine-18-Fluorodeoxyglucose positron emission tomography (FDG-PET).

METHODS

Correlations between various SVFT scores (i.e., TS, mean cluster size, switching (SW), hard switching, cluster switching (CSW)) and cerebral glucose metabolism were explored using voxelwise whole-brain approach. Subgroup analyses were also performed based on the diagnosis and investigated the effects of disease severity on the associations.

RESULTS

Significant positive correlation between TS and cerebral glucose metabolism was found in prefrontal, parietal, cingulate, temporal cortex, and subcortical regions. Significantly increased glucose metabolism associated with the SW were found in similar but smaller regions, mainly in the fronto-parieto-temporal regions. CSW was only correlated with the caudate. In the subgroup analysis conducted to assess different contribution of clinical severity, differential associations between the strategy scores and regional glucose metabolism were found.

CONCLUSION

SW and CSW may reflect specific language and executive functions better than the TS. The SVFT is influenced by brain dysfunction due to the progression of AD, as demonstrated by the SW with larger involvement of temporal lobe for the AD, and CSW with significant association only for the MCI.

Multi-component cognitive intervention for older adults with mixed cognitive levels: implementation and preliminary effectiveness in real-world settings

BACKGROUND

In most controlled studies of multi-component cognitive intervention, participants' cognitive levels are homogenous, which is contrary to real-world settings. There is a lack of research studying the implementation of evidence-based cognitive intervention in communities. This study describes the implementation and preliminary effectiveness of a Multi-component Cognitive Intervention using Simulated Everyday Tasks (MCI-SET) for older adults with different cognitive levels in real-world settings.

METHODS

Single group, pre-intervention assessment, post-intervention assessment, and 3-month follow-up research design. MCI-SET consists of 12 two-hour weekly sessions that include motor-cognitive tasks, cognitive training, and cognitive rehabilitation. One hundred and thirty participants, > = 65 and frail, dependence on > = one instrumental daily activity, or with confirmed dementia, from eight community centers were included. The primary outcome is general cognition (Montreal Cognitive Assessment-Taiwan, MoCA-T). Secondary outcomes are memory (Miami Prospective Memory Test, Digits Forward, Digits Backward), attention (Color Trail Test-Part 1), executive function (Color Trail Test-Part 2), and general function (Kihon Checklist-Taiwan).

RESULTS

Pre-intervention workshop for group leaders, standardized activity protocols, on-site observation, and ten weekly conferences were conducted to ensure implementation fidelity. MCI-SET had an 85% retention rate and 96% attendance rate. The participants had a mean age of 78.26 ± 7.00 and a mean MoCA-T score of 12.55 ± 7.43. 73% were female. General cognition (Hedges' g = 0.31), attention (Hedges' g = 0.23), and general function (Hedges' g = 0.31), showed significant post-intervention improvement with small effect size. Follow-ups showed maintained improvement in general cognition (Hedges' g = 0.33), and delayed effect on attention (Hedges' g = 0.20), short-term memory (Hedges' g = 0.38), and executive function (Hedges' g = 0.40). Regression analysis indicated that the intervention settings (day care centers vs neighborhood centers), the pre-intervention cognitive levels, and the pre-intervention general function of the participants were not associated with the outcomes.

CONCLUSIONS

MCI-SET is feasible and can improve the cognitive skills and general functions of older adults with heterogeneous cognitive skills or disabilities. It is essential to tailor programs to fit the interests of the participants and the culture of local communities. Group leaders must also have the skills to adjust the cognitive demands of the tasks to meet the heterogeneous cognitive levels of participants.

TRIAL REGISTRATION

This study was retrospectively registered at clinicaltrials.gov (Identifier: NCT04615169 ).