Implementation outcomes of the ACT Trial in older adults with amnestic Mild Cognitive Impairment

Abstract

AbstractBackgroundPreventing Alzheimer’s disease is a public health priority to address its substantial social and healthcare impacts. Exercise and cognitive training interventions are promising but show mixed effects on cognition in older adults with and without mild cognitive impairment (MCI), which is at least partially attributable to varied quality in trial implementation. The purpose of this study was to evaluate the implementation outcomes of the 3‐site Aerobic exercise and Cognitive training (ACT) trial that tests the cognitive effects and underlying mechanisms.MethodThe ACT Trial enrolled 146 older adults with amnestic MCI (aMCI). Participants were randomized equally to ACT, aerobic exercise only, cognitive training only, or attention control ed for six months and followed for another 12 months. Participants completed a 3‐step screening process that included a 30‐minute phone screen (step 1), a 120‐minute in‐person screening (step 2), medical clearance (step 3), and a 60‐minute graded exercise test and MRI (steps 4a & 4b). The implementation outcomes included durations between each screening step, from phone screen to enrollment, from enrollment to the first intervention section. Implementation outcomes were compared across sites using ANOVA.ResultThe mean age was 73.57±5.49 years, with 47.95% female, 91.78% white, 91.09% had a college degree or higher, and a mean Montreal Cognitive Assessment (MoCA) score of 23.38±2.16. The duration from step 1 to step 2 was 20.23±31.21 days, step 2 to step 3 was 24.42±41.27 days, step 3 to step 4a was 36.84±76.86 days, step 4a to step 4b was 25.84±60.75 days, and the duration from step 4b to enrollment was 25.60±60.17 days. The duration from step 1 to enrollment is 121.16±109.16 days. ANOVA results indicate no significant differences in implementation outcomes across the three sites.ConclusionThe screening took longer than projected regarding completing a participant’s in‐person screening (step 2) and obtaining medical clearance from the participant’s provider (step 3). The major contributors to longer screen duration were delays in receiving faxed documentation from medical providers. Future trials need to build in adequate screening duration to ensure screening success.