Intraindividual variability in post-stroke cognition and its relationship with activities of daily living and social functioning: an ecological momentary assessment approach.

INTRODUCTION: Ecological momentary assessment (EMA) is a methodological approach to studying intraindividual variation over time. This study aimed to use EMA to determine the variability of cognition in individuals with chronic stroke, identify the latent classes of cognitive variability, and examine any differences in daily activities, social functioning, and neuropsychological performance between these latent classes. METHODS: Participants (N = 202) with mild-to-moderate stroke and over 3-month post-stroke completed a study protocol, including smartphone-based EMA and two lab visits. Participants responded to five EMA surveys daily for 14 days to assess cognition. They completed patient-reported measures and neuropsychological assessments during lab visits. Using latent class analysis, we derived four indicators to quantify cognitive variability and identified latent classes among participants. We used ANOVA and Chi-square to test differences between these latent classes in daily activities, social functioning, and neuropsychological performance. RESULTS: The latent class analysis converged on a three-class model. The moderate and high variability classes demonstrated significantly greater problems in daily activities and social functioning than the low class. They had significantly higher proportions of participants with problems in daily activities and social functioning than the low class. Neuropsychological performance was not statistically different between the three classes, although a trend approaching statistically significant difference was observed in working memory and executive function domains. DISCUSSION: EMA could capture intraindividual cognitive variability in stroke survivors. It offers a new approach to understanding the impact and mechanism of post-stroke cognitive problems in daily life and identifying individuals benefiting from self-regulation interventions.

"I'm more aware now": perspectives from people with mild cognitive impairment (MCI), supporters and counsellors about the MAXCOG cognitive rehabilitation intervention.

Objectives: Cognitive Rehabilitation interventions have the potential to improve quality of life for people with MCI. We recently developed, trialled, and evaluated the use of the MAXCOG (Maximising Cognition) intervention-a very brief (four-session) face-to-face program focussing on individualised goals to improve function in daily life. Although the program assisted people reach their practical goals, we could not demonstrate broader changes to quality of life, mood, or carer burden. The aim of this study was to explore qualitatively the experiences of clients, supporters, and counsellors who participated.Method: Fifteen clients, fourteen supporters, and three counsellors were interviewed using the Most Significant Change technique. Subsequently, thirty-five narrative accounts were transcribed and subjected to thematic analysis following Braun and Clarke's (2006) model.Results: Key themes identified changes at two levels: specific changes (Putting strategies in place; and Doing it differently) and meta changes (More aware now; Facing up to life; and on top of anxiety and stress). Participants also mentioned supports and hindrances.Conclusion: The analysis provided a new perspective on the experiences of participants, supporters, and counsellors with the MAXCOG intervention, including identification of psychological changes that were not apparent from the quantitative analyses.

Family-Centered Care During Constraint-Induced Therapy After Chronic Stroke: A Feasibility Study.

PURPOSE: This feasibility study evaluated a theory-based intervention (CARE-CITE) designed to engage carepartners (CPs) in supporting stroke survivor upper extremity rehabilitation. DESIGN: The study was a one-group design with pre- and posttest and 1 month follow-up (N = 7 dyads). METHODS: Feasibility was determined by participant retention, CP and stroke survivor intervention adherence, and CP acceptability of the intervention (exit interview). Measures of CP depressive symptoms, fatigue, and family conflict around stroke recovery and stroke survivor upper extremity function are reported. Data were analyzed using descriptive statistics. FINDINGS: All participants completed the study and adhered to the intervention, and CPs found CARE-CITE helpful. Descriptively, better scores were observed for CP's mental health, family conflict, stroke survivor confidence, and upper extremity tasks performed. CONCLUSION: These results provide initial evidence that CARE-CITE is feasible after chronic stroke and that CPs and stroke survivors may benefit from family-centered care. CLINICAL RELEVANCE: Improving CP skills in supporting rehabilitation activities may improve stroke survivor upper extremity function.

Effectiveness of the maximising cognition (MAXCOG) information resource for clients with mild cognitive impairment and their families.

OBJECTIVE: To evaluate a new information resource developed for clients with mild cognitive impairment (MCI) or early dementia and their family supporters. METHODS: A controlled group trial was undertaken comparing 40 clients and family supporters who received 'service as usual' followed by 40 clients and family supporters who received 'service as usual' plus the new information resource. Telephone interviews comprising open questions, ratings and a quality-of-life questionnaire were undertaken two to four weeks after the client's final feedback session. RESULTS: The two groups (equivalent on sex, age and cognition) showed a similar pattern of responses regarding handout use and evaluation. However, family supporters in the group who received and read the new resource were better able to describe their use of cognitive management strategies. CONCLUSION: Some family supporters appeared to benefit from using the new resource but people with MCI may require further face-to-face support to learn new strategies.

'Most significant change' and the maximising cognition (MAXCOG) intervention: The views of clients, supporters and counsellors.

OBJECTIVES: To explore the views of clients, supporters and counsellors about their experiences of the maximising cognition (MAXCOG) intervention. METHODS: The most significant change (MSC) method of analysis was used. Twenty-three narrative accounts of the MAXCOG intervention and the 'MSC' that occurred were obtained. A panel, including experts from Alzheimer's Australia, the MAXCOG research team and clinicians from memory clinics, conducted a workshop to discuss and categorise the accounts. RESULTS: Two subcategories of stories were identified: (i) An 'acceptance group' that focused on adjustment issues; and (ii) A 'goal achievement' group with a focus on goals and improvement in ability and confidence. These subcategories mapped closely to the original goals outlined for the MAXCOG intervention. CONCLUSION: The MAXCOG intervention was successful in assisting people to work towards goals and adjust psychologically to difficulties.

MAXCOG-Maximizing Cognition: A Randomized Controlled Trial of the Efficacy of Goal-Oriented Cognitive Rehabilitation for People with Mild Cognitive Impairment and Early Alzheimer Disease.

OBJECTIVES: To review the efficacy of a home-based four-session individualized face-to-face cognitive rehabilitation (MAXCOG) intervention for clients with mild cognitive impairment (MCI) or early dementia and their close supporters. DESIGN: Randomized controlled trial comparing the intervention group (MAXCOG) with treatment as usual (control). PARTICIPANTS: A total of 55 client-supporter dyads were enrolled in the study and 40 completed; 25 client-supporter dyads completed MAXCOG and 15 completed treatment as usual. Both MAXCOG and control groups included more MCI cases than dementia (22 versus 3 and 12 versus 3, respectively). INTERVENTION: Four weekly individual sessions of MAXCOG consisting of personalized interventions to address individually relevant goals, supported by the provision of the MAXCOG information resource. MEASURES: The primary outcomes were goal performance and satisfaction, assessed using the Canadian Occupational Performance Measure (COPM). Questionnaires assessing mood, illness adjustment, quality of life, and carer burden were also administered. RESULTS: The intervention group displayed significantly higher performance and satisfaction with primary goals on the COPM post-intervention than the control group, using a per-protocol analysis. CONCLUSIONS: The MAXCOG intervention is effective in improving goal performance and satisfaction in clients with MCI and early dementia.

Adjustment, depression, and anxiety in mild cognitive impairment and early dementia: a systematic review of psychological intervention studies.

BACKGROUND: Many people with mild cognitive impairment (MCI) or early dementia suffer from concomitant depression and anxiety disorders, which in some cases, may be related difficulties adjusting to their diagnosis and associated cognitive problems. Successful adjustment and alleviation of depression and anxiety symptoms in these people is of critical importance for quality of life and may also help prevent, or delay, further cognitive decline. A variety of psychosocial intervention approaches has been trialed with this group. METHOD: The literature was systematically searched for community-based intervention studies that aim to improve depression, anxiety, or adjustment. Studies were included or excluded using a priori criteria. Once included, the quality of studies was evaluated using pre-set criteria. RESULTS: Seventeen of 925 studies identified through literature databases and manual searches met the inclusion criteria. Of these, 16 were considered to be of at least "adequate quality." These included seven randomized controlled trials and eight pre-post studies. A diverse range of psychotherapeutic approaches, formats (individual or group), outcome measures, inclusion criteria, and cultural contexts were apparent, making comparisons between studies challenging. CONCLUSIONS: Several studies have demonstrated positive findings in the treatment of depression in older adults with early dementia using problem solving and modified cognitive behavior therapy (CBT) approaches. Amongst the large range of approaches trialed to improve adjustment and quality of life for patients with MCI and early dementia, some approaches, such as modified CBT, have shown promise. There is a need for replication studies using more rigorous methodology before clear clinical recommendations can be made.