Behavioral Interventions to Prevent or Delay Dementia: Protocol for a Randomized Comparative Effectiveness Study.

BACKGROUND: Currently, people at risk for dementia and their caregivers are confronted with confusing choices about what behavioral interventions are most effective. OBJECTIVE: The objective of this study is to determine which empirically supported behavioral interventions most impact the outcomes highly valued by patients with mild cognitive impairment and their partners. METHODS: This protocol describes a comparative effectiveness trial targeting 300 participants with mild cognitive impairment and their study partners. The trial is being conducted at the Mayo Clinic campuses in Arizona, Florida, Minnesota, and the University of Washington in Seattle. The study examines the contribution of five behavioral interventions (yoga, memory compensation training, computerized cognitive training, support groups, and wellness education) on primary outcomes of participant and partner quality of life and self-efficacy. In this unique 10-day multicomponent intervention, groups of couples were randomized to have one of the five interventions withheld while receiving the other four. Although the longitudinal follow-up is still under way, enrollment results are available and reported. RESULTS: In total, 272 couples have been enrolled in the trial and follow-up visits continue. Outcomes will be assessed at the end-of-intervention and 6-, 12-, and 18-month follow-ups. We anticipate reporting on our primary and secondary outcomes across time points in the next 2 years. CONCLUSIONS: This paper describes the protocol for a randomized comparative effectiveness study of behavioral interventions to prevent or delay dementia. We describe of the rationale, design, power analysis, and analysis plan. Also because enrollment is complete and we are in follow-up phases of the study, we have included enrollment data from the trial. TRIAL REGISTRATION:  ClinicalTrials.gov NCT02265757; http://clinicaltrials.gov/ctsshow/ NCT02265757 (Archived by WebCite at http://www.webcitation.org/6ueRfwSYv).

The effect of internet-based cognitive rehabilitation in persons with memory impairments after severe traumatic brain injury.

PRIMARY OBJECTIVE: The current study examined whether cognitive rehabilitation delivered over the Internet was associated with improvements in functioning. RESEARCH DESIGN: A total of 14 individuals with medically documented traumatic brain injury completed this study. Participants completed 30 sessions of an active calendar acquisition intervention and 30 sessions of a control diary intervention in a cross-over study design for a total of 60 online sessions. All sessions were completed using an instant messaging system via the Internet. Measures of cognitive functioning, ratings of memory and mood and frequency of use of common memory and cognitive compensation techniques were gathered from participants and family members. MAIN OUTCOMES AND RESULTS: There were no significant differences between the active and control conditions on the primary outcome measure of memory functioning. However, significant improvements in use of compensatory strategies as well as family reports of improved memory and mood were observed following completion of all sessions. Individuals with less use of compensatory strategies at baseline were significantly less likely to complete the study. CONCLUSIONS: These results suggest that the Internet may be an effective delivering mechanism for compensatory cognitive rehabilitation, particularly among individuals who are already utilizing some basic compensatory strategies.

Internet-based cognitive rehabilitation in individuals with acquired brain injury: a pilot feasibility study.

PRIMARY OBJECTIVE: The goal of the current study was to assess the feasibility of an Internet-based cognitive rehabilitation program for individuals with acquired brain injuries and memory impairment. METHODS: Participants were 10 individuals with a history of an acquired brain injury and documented memory impairment. All participants received training in how to use a secure IM system. They were then scheduled to log into the system weekly to participate in online cognitive rehabilitation therapy sessions over the Internet. Treatment focused on training to use a calendar system aimed at improving accuracy and efficiency in home and work tasks. Participants underwent assessment of cognitive function, psychological status, level of functioning and use of compensation techniques both pre- and post-treatment. RESULTS: All participants were able to learn to use the IM system. Only two of the 10 participants missed any planned sessions, despite severe memory impairments. CONCLUSIONS: Individuals with a history of an acquired brain injury with concomitant memory impairment appear to be able to learn how to successfully use an Internet-based cognitive rehabilitation program. Future research will assess whether participation in this Internet based cognitive rehabilitation program results in improved daily functioning.

A behavioral rehabilitation intervention for amnestic mild cognitive impairment.

Individuals with amnestic mild cognitive impairment (MCI) currently have few treatment options for combating their memory loss. The Memory Support System (MSS) is a calendar and organization system with accompanying 6-week curriculum designed for individuals with progressive memory impairment. Ability to learn the MSS and its utility were assessed in 20 participants. Participants were significantly more likely to successfully use the calendar system after training. Ninety-five percent were compliant with the MSS at training completion, and 89% continued to be compliant at follow-up. Outcome measures revealed a medium effect size for improvement in functional ability. Subjects further reported improved independence, self-confidence, and mood. This initial examination of the MSS suggests that with appropriate training, individuals with amnestic MCI can and will use a memory notebook system to help compensate for memory loss. These results are encouraging that the MSS may help with the symptoms of memory decline in MCI.