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Review
. 2022 Jan;19(1):117-131.
doi: 10.1007/s13311-022-01225-8. Epub 2022 Apr 12.

Behavioral Interventions in Mild Cognitive Impairment (MCI): Lessons from a Multicomponent Program

Shellie-Anne Levy  1 , Glenn Smith  2 , Liselotte De Wit  2 , Brittany DeFeis  2 , Gelan Ying  2 , Priscilla Amofa  2 , Dona Locke  3 , Anne Shandera-Ochsner  4 , Courtney McAlister  4 , Vaishali Phatak  5 , Melanie Chandler  6
Affiliations
Review

Behavioral Interventions in Mild Cognitive Impairment (MCI): Lessons from a Multicomponent Program

Shellie-Anne Levy et al. Neurotherapeutics. 2022 Jan.

Abstract

Comparative effectiveness of behavioral interventions to mitigate the impacts of degeneration-based cognitive decline is not well understood. To better address this gap, we summarize the studies from the Healthy Action to Benefit Independence & Thinking (HABIT®) program, developed for persons with mild cognitive impairment (pwMCI) and their partners. HABIT® includes memory compensation training, computerized cognitive training (CCT), yoga, patient and partner support groups, and wellness education. Studies cited include (i) a survey of clinical program completers to establish outcome priorities; (ii) a five-arm, multi-site cluster randomized, comparative effectiveness trial; (iii) and a three-arm ancillary study. PwMCI quality of life (QoL) was considered a high-priority outcome. Across datasets, findings suggest that quality of life was most affected in groups where wellness education was included and CCT withheld. Wellness education also had greater impact on mood than CCT. Yoga had a greater impact on memory-dependent functional status than support groups. Yoga was associated with better functional status and improved caregiver burden relative to wellness education. CCT had the greatest impact on cognition compared to yoga. Taken together, comparisons of groups of program components suggest that knowledge-based interventions like wellness education benefit patient well-being (e.g., QoL and mood). Skill-based interventions like yoga and memory compensation training aid the maintenance of functional status. Notably, better adherence produced better outcomes. Future personalized intervention approaches for pwMCI may include different combinations of behavioral strategies selected to optimize outcomes prioritized by patient values and preferences.

Trial registration: ClinicalTrials.gov NCT02265757.

Keywords: Behavioral interventions; Comparative effectiveness; HABIT®; Mild cognitive impairment.

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Conflict of interest statement

The Mayo Clinic and the University of Florida offer the HABIT® program as a clinical service, billing for and collecting revenues from this program. While several of the authors are salaried employees of one of these organizations, none of the study authors or PIs receives direct, financial benefit from this service. Furthermore, none of the authors holds equity in or benefit financially from the vendors of the products used in the HABIT program.

Figures

Fig. 1
Fig. 1
Conceptual model of multisystem memory decline in Alzheimer’s disease
Fig. 2
Fig. 2
Post-intervention confirmatory factor analysis model. Reproduced with permission
Fig. 3
Fig. 3
Effect sizes on impacts related to pwMCI adjustment. a Quality of life (QOL), b mood, and c self-efficacy by study arm. Effect sizes were estimated from linear mixed effects regression models where a 1-unit increase in the effect size corresponds to 1 standard deviation (SD) improvement in patient outcome. BL = baseline; EOT = end of treatment. Baseline SDs were 5.59 (QOL), 8.11 (mood), 14.0 (self-efficacy)
Fig. 4
Fig. 4
Effect sizes by study arm on patient impairment. Effect sizes on were estimated from linear mixed effects regression models, in which a 1-unit increase in the effect size corresponds to a 1 standard deviation (SD) improvement in outcome. a FAQ and b CDR-SOB. Abbreviations: EOT, end of treatment; CCT, computerized cognitive training; MSS, memory support system. Error bars represent 95% confidence intervals for the effect sizes
Fig. 5
Fig. 5
a Impact of CCT and yoga on psychomotor/visual attention outcome; b Impact of CCT and yoga on learning/working memory outcome
See this image and copyright information in PMC

References

    1. Smith G, Petersen R, Parisi J, Ivnik R, Kokmen E, Tangalos E, et al. Definition, course and outcome of mild cognitive impairment. Aging Neuropsychol Cogn. 1996;3:141–147. doi: 10.1080/13825589608256619. - DOI
    1. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–308. doi: 10.1001/archneur.56.3.303. - DOI - PubMed
    1. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7(3):270–279. doi: 10.1016/j.jalz.2011.03.008. - DOI - PMC - PubMed
    1. As A. Alzheimer’s disease facts and figures. Alzheimer’s dement. 2017;13:325–373. doi: 10.1016/j.jalz.2017.02.001. - DOI
    1. Alexander GC, Knopman DS, Emerson SS, Ovbiagele B, Kryscio RJ, Perlmutter JS, et al. Revisiting FDA Approval of Aducanumab. N Engl J Med. 2021;385(9):769–771. doi: 10.1056/NEJMp2110468. - DOI - PMC - PubMed

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