RESUMEN
OBJECTIVES: To examine the feasibility and preliminary effectiveness of (1) combining cognitive training, mind-body physical exercise, and nurse-led risk factor modification (CPR), (2) nurse-led risk factor modification (RFM), and (3) health advice (HA) on reducing cognitive decline among older adults with mild cognitive impairment (MCI). METHODS: It was a 3-arm open-labeled pilot randomized controlled trial in the primary care setting in Hong Kong. Nineteen older adults with MCI were randomized to either CPR (n = 6), RFM (n = 7), or HA (n = 6) for 6 months. The primary outcome was the feasibility of the study. Secondary outcomes included the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), the Montreal Cognitive Assessment Hong Kong version (HK-MoCA), the Clinical Dementia Rating (CDR), the Disability Assessment for Dementia (DAD), quality of life, depression, anxiety, physical activity, health service utilization, and diet. RESULTS: Nineteen out the 98 potential patients were recruited, with a recruitment rate of 19% (95% CI [12-29]%, P = 0.243). The adherence rate of risk factor modification was 89% (95% CI [65-98]%, P = 0.139) for CPR group and 86% (95% CI [63-96]%, P = 0.182) for RFM group. In the CPR group, 53% (95% CI [36-70]%, P = 0.038) of the Tai Chi exercise sessions and 54% (95% CI [37-71]%, P = 0.051) of cognitive sessions were completed. The overall dropout rate was 11% (95% CI [2-34]%, P = 0.456). Significant within group changes were observed in HK-MoCA in RFM (4.50 ± 2.59, P = 0.008), cost of health service utilization in CPR (-4000, quartiles: -6800 to -200, P = 0.043), fish and seafood in HA (-1.10 ± 1.02, P = 0.047), and sugar in HA (2.69 ± 1.80, P = 0.015). Group × time interactions were noted on HK-MoCA favoring the RFM group (P = 0.000), DAD score favoring CPR group (P = 0.027), GAS-20 favoring CPR group (P = 0.026), number of servings of fish and seafood (P = 0.004), and sugar (P < 0.001) ate per day. CONCLUSIONS: In this pilot study, RFM and the multi-domain approach CPR were feasible and had preliminary beneficial effects in older adults with MCI in primary care setting in Hong Kong. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR1800015324).
RESUMEN
The aim of our study was to identify the incidence rate of and the risk factors for mild cognitive impairment (MCI) among Chinese older adults with multimorbidity in primary care in Hong Kong. Older adults aged 60 years and above with multimorbidity were recruited from the public primary care clinics in Hong Kong. Incidence rates were calculated with the person-years. Cox proportional hazard regression models were used to predict the risk factors for MCI. Sensitivity analysis was performed using multiple imputation. Among 462 participants included in the main analysis, 45 progressed from normal to MCI with an incidence rate of 80.9 cases per 1000 person-years. Older age (HR 2.82, 95% CI 1.26-6.28) and being single (HR 2.15, 95% CI 1.11-4.19) were risk factors for developing MCI in the multivariable regression model. A total of 660 participants were included in the sensitivity analysis, with an MCI incidence of 114.4 cases per 1000 person-years. Older age and being single remained to be risk factors for MCI among older adults with multimorbidity. There may be a high incidence of MCI among Chinese older adults with multimorbidity in primary care in Hong Kong. Future larger studies need to confirm the prevalence and incidence of MCI among primary care Chinese patients.
