Comparing Five Activities to Improve Quality of Life for Patients with Mild Cognitive Impairment [Internet]

Excerpt

Background: People with mild cognitive impairment (pwMCI) are often advised by health care providers to engage in behavioral strategies to help combat cognitive decline. The comparative effectiveness of these behavioral interventions is not well understood.

Objectives: To determine the outcomes of highest importance to pwMCI and then examine the impact of 5 behavioral interventions' comparative effectiveness on these outcomes.

Aim 1: Conduct a survey of a convenience clinical sample of behavioral intervention program completers.

Aim 2:: Conduct a multisite cluster randomized multicomponent comparative effectiveness trial using a fractional factorial design. pwMCI and their partners (ie, spouses, adult children, or friends) were instrumental in the decision to use this design.

Setting: Four academic medical outpatient centers: Mayo Clinic Minnesota, Mayo Clinic Arizona, Mayo Clinic Florida, and the University of Washington.

Aim 1: A total of 116 respondents from a pool of 230 program completers.

Aim 2: A total of 272 pwMCI who met prevailing National Institute on Aging-Alzheimer Association criteria for MCI.

Aim 1: None.

Aim 2: The intervention program was modeled on the Mayo Clinic Healthy Action to Benefit Independence and Thinking (HABIT) program, a 50-hour group intervention that includes cognitive rehabilitation with a compensatory memory support system (calendaring system), computerized cognitive training (CCT), yoga, patient and partner support groups, and wellness education (WE). In the present study, 1 of 5 interventions was randomly selected not to be included for a given group. pwMCI and their partners were followed to 12 months postintervention with 1-day booster sessions occurring at 6 and 12 months.

Main Outcomes and Measures: As determined by the results from aim 1, quality of life (QOL) of the pwMCI was the primary outcome in aim 2 as selected based on the preference rankings of previous HABIT completers. Mood, self-efficacy, and memory-based activities of daily living (mADL) were also ranked highly. All measures of these outcomes were focused on the pwMCI at 12 months of follow-up.

Aim 1: As noted, QOL had the highest average ranking, with self-efficacy (in handling memory difficulties) ranked second and mADL and mood tied for third (P < .01 compared with next ranked items).

Aim 2: There was no statistically significant overall difference between intervention groups on QOL. The greatest effect size (ES) for QOL was between the no-CCT and no-WE groups at 0.34. In secondary analyses, WE had a greater impact on mood than did CCT (ES, 0.53), and yoga had a greater impact on mADL than did support groups (ES, 0.43). Yoga was also associated with 2 functional status measures compared with WE (ESs, 0.52 and 0.69) and caregiver burden (ES, 0.31).

Conclusions: Although there was no overall difference between study arms on patient QOL at 12 months postintervention, results from pairwise comparisons of groups of 4 program components raise the possibility that knowledge-based interventions like WE may be more impactful on patient well-being (eg, QOL and mood), whereas skill-based interventions like yoga and compensation-based calendar training (the memory support system) may be likely to assist with the maintenance of functional status. It seems highly likely that different outcomes are likely to be optimized by different combinations of interventions. The findings serve as a preliminary foundation for continued pursuit of personalized approaches to behavioral interventions for pwMCI guided by patients' values and preferences.

Limitations: The findings should be interpreted cautiously because of the homogeneous sample, limited power, and multiple comparisons used, and because comparative effectiveness designs tend to produce smaller ESs than placebo-controlled studies.