Multicomponent Cognitive Intervention Research Articles

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

Limited evidence exists to support cognitive intervention improving the daily function of adults with subjective cognitive decline (SCD). To examine the preliminary efficacy of a group-based multicomponent cognitive intervention that integrates Lifestyle Redesign® (LR) techniques. Single-arm two-period crossover trial; 16-wk waiting period, 16-wk intervention, and 16-wk follow-up. Memory clinic in a medical center, Taiwan. Purposive sample of adults ages >55 yr with SCD. Sixteen 1.5-hr weekly multicomponent sessions of cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention. 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. 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). 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.

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

BackgroundIn 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.MethodsSingle 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).ResultsPre-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.ConclusionsMCI-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 registrationThis study was retrospectively registered at clinicaltrials.gov (Identifier: NCT04615169).

Efficacy of a Multicomponent Cognitive Intervention in Adults With Subjective Cognitive Decline and Mild Cognitive Impairments

Efficacy of a Multicomponent Cognitive Intervention in Adults With Subjective Cognitive Decline and Mild Cognitive Impairments

Assessing Differential Effects of a Multi-Component Cognitive Intervention for Persons With Multiple Sclerosis

Assessing Differential Effects of a Multi-Component Cognitive Intervention for Persons With Multiple Sclerosis

Physical Exercise with Multicomponent Cognitive Intervention for Older Adults with Alzheimer's Disease: A 6-Month Randomized Controlled Trial

Aims: This study aimed to investigate the effect of 6-month physical exercise with a multicomponent cognitive program (MCP) on the cognitive function of older adults with moderate to severe Alzheimer's disease (AD). Methods: We included 33 participants with AD in a 6-month randomized controlled trial. The intervention group participated in physical exercise and received a MCP. The control group received only the MCP. Before and after the intervention, cognitive outcomes were assessed using the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), Mini-Mental State Examination, and the Clock Drawing Test. Physical performance was evaluated by exercise time, the number of pedal rotation, total load, grip strength, and the Berg Balance Scale (BBS). Results: In all cognitive measures, there were no significant improvements between the two groups after 6 months in the baseline value-adjusted primary analysis. However, the ADAS-cog score was significantly lower between the two groups in secondary analysis adjusted for baseline value, age, sex, and education years. All physical outcomes were significantly higher in the intervention group except for total load compared with baseline measurements. Conclusion: This study indicates that it is possible to improve cognitive function in older adults with moderate to severe AD through 6-month physical exercise with a multicomponent cognitive intervention.

Effects of Age, APOE ε4, Cognitive Reserve and Hippocampal Volume on Cognitive Intervention Outcome in Amnestic Mild Cognitive Impairment

Here we studied intervention outcome and potential predictors for cognitive intervention effects in patients with amnestic mild cognitive impairment (aMCI), a population at risk of Alzheimer’s disease. We included 100 aMCI patients (cognitive intervention group, n=69; active control group, n=31) that underwent a previously established 6-month group-based multicomponent cognitive intervention or an active control condition. As a primary endpoint we defined changes in global cognition (Alzheimer’s Disease Assessment Scale – Cognitive Subscale, ADAS-Cog). Secondary endpoints were changes in verbal and visual episodic memory (California Verbal Learning Test, CVLT; Face Name Learning Test, FNL). Overall, we found no improvements in our primary outcome ADAS-Cog. Group by time interactions were found for CVLT learning (p=0.031), with improvements in the intervention group and deteriorations in the control group. The intervention group deteriorated in FNL learning (p=0.001) and the control group deteriorated in FNL recall (p=0.048). The main focus of the study was, however, whether intervention outcome was predicted by factors that are known to affect disease progression. As predictors we selected age, APOE carrier status, cognitive reserve, and hippocampal volume. In linear regression analyses, lower hippocampal volume predicted deteriorations in ADAS-Cog (p=0.035) and CVLT recall (p=0.016), whereas younger age (p=0.011) and APOE e4 non-carrier status (p=0.024) predicted improvements in CVLT learning. Lower cognitive reserve predicted deteriorations in FNL recall (p=0.008). Regarding the modest intervention effects, our results challenge a general recommendation of cognitive interventions in aMCI. Rather, our findings suggest that younger patients, APOE e4 non-carriers, and patients with higher CR and higher hippocampal volume have a higher likelihood to benefit from a cognitive intervention, which could be useful for the selection of patients for future intervention trials.

Preliminary evaluation of a multicomponent cognitive intervention program for people with amnestic mild cognitive impairment and their family partners

Preliminary evaluation of a multicomponent cognitive intervention program for people with amnestic mild cognitive impairment and their family partners

Long-Term Observation of a Multicomponent Cognitive Intervention in Mild Cognitive Impairment

Recent studies demonstrated benefits of cognitive intervention in mild cognitive impairment (MCI), but few studies have determined long-term effects on cognition, conversion rate to Alzheimer's disease, and the role of early intervention. A 6-month multicomponent cognitive group intervention was applied in participants with single- or multiple-domain amnestic MCI (defined according to Petersen's criteria). One group (n = 12) received the intervention at the beginning of the study period and was compared with an active control group (n = 12) who received it after an 8-month time lag. Follow-up assessments were conducted at 15 and 28 months (study period was August 2007-December 2009). The primary outcome was change in cognitive function as determined by changes in scores on the Mini-Mental State Examination and the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), and the secondary outcomes were change in specific cognitive and noncognitive functions and conversion to Alzheimer's disease (according to DSM-IV/NINCDS-ADRDA criteria and NAI-AA criteria for probable Alzheimer's dementia with increased level of certainty). Eighteen participants completed the study after 28 months. Long-term data revealed a stable intervention effect on the primary outcome ADAS-cog in the early-intervention group (P = .024). The participants in the later-intervention (control) group appeared to benefit to a lesser extent from the cognitive intervention compared to those who received it earlier. Only participants in the later-intervention group (6 of 12) converted to Alzheimer's disease during the 28-month study period. Benefits of our 6-month cognitive intervention on global cognitive status appear to be preserved over extended follow-up periods. Early cognitive intervention may delay conversion to Alzheimer's disease. Findings in a small sample encourage the use of the intervention in larger-scale studies. ClinicalTrials.gov identifier: NCT00544856.

Long-term observation of a multicomponent cognitive intervention in amnestic mild cognitive impairment (aMCI)

Recent studies demonstrated benefits through cognitive intervention (CI) in subjects with amnestic mild cognitive impairment (aMCI). However, few studies determined long-term effects, conversion rate of MCI-subjects into AD, and the role of early intervention. We evaluated a long-term observation of an early and 8-month time-lagged multicomponent CI on subjects with aMCI with follow-up assessments up to 24 months. Primary outcome were changes in global cognitive functions (Alzheimer's Disease Assessment Scale, ADAS-cog, and Mini Mental Status Examination, MMSE), secondary outcome were change in specific cognitive and non-cognitive functions and conversion into AD. 24 aMCI-subjects were randomly assigned to a 6-months CI (n = 12) and an active control condition (n = 12). Following the control condition participants attended to the CI with 8-month time-lag (IG 2) compared to early intervention (IG 1). 18 participants completed the study after 24 months. Data of 1- and 2-year follow-up revealed a stable intervention-effect on the primary outcome ADAS-cog in the IG 1 (p = .024). Compared to early beginners, IG 2 seemed to benefit from CI to a lesser extent. Only participants of the IG 2 (6 of 12) converted into AD. Cognitive benefits of the CI on global cognitive status appear to be preserved over extended follow-up periods. Early CI may be able to delay conversion to AD. Findings in a small sample of subjects encourage the use of the CI in larger scales studies to confirm effects.

Effects of a 6-Month Cognitive Intervention Program on Brain Metabolism in Amnestic Mild Cognitive Impairment and Mild Alzheimer's Disease

The effect of cognitive intervention on brain metabolism in Alzheimer's disease (AD) is largely unexplored. Therefore, we aimed to investigate clinical cognitive parameters and 18FDG PET to test for effects of a cognitive intervention in patients with amnestic mild cognitive impairment (aMCI) or mild AD. Patients with aMCI (n = 24) or mild AD (n = 15) were randomly assigned either to cognitive intervention groups (IGs), receiving weekly sessions of group-based multicomponent cognitive intervention, or active control groups (CGs), receiving pencil-paper exercises for self-study. We obtained resting-state FDG-PET scans and neuropsychological testing at baseline and after six-months. Normalized FDG-PET images were analyzed using voxel-based SPM5 approaches to determine longitudinal changes, group-by-time interactions, and correlations with neuropsychological outcome parameters. Primary global cognitive outcome was determined by analyses of covariance with MMSE and ADAS-cog scores as dependent measures. Both, aMCI and AD subgroups of CGs showed widespread bilateral cortical declines in FDG uptake, while the AD subgroup of IGs showed discrete decline or rather no decline in case of the aMCI subgroup. Group by time analyses revealed strongest attenuation of metabolic decline in the aMCI subgroup of the IGs, involving left superior temporal- and anterior cingulate gyrus. However, correlation analyses revealed only weak non-significant associations between increased FDG uptake and improvement in primary or secondary outcome parameters. Concurrently, there was significant improvement in global cognitive status in the aMCI subgroup of the IGs. A six-month cognitive intervention imparted cognitive benefits in patients with aMCI, which were concurrent with an attenuated decline of glucose metabolism in cortical regions affected by neurodegenerative AD.

Long-term effects of a multicomponent cognitive intervention in amnestic mild cognitive impairment (aMCI)

Long-term effects of a multicomponent cognitive intervention in amnestic mild cognitive impairment (aMCI)