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Self-efficacy for cognitive remediation in Alzheimer's disease
Oral Sessions: O2-01: Social-Behavioral and Care Research and Practice: Cognitive Training and Physical Exercise Interventions approach, taking into account the educational and health experiences of diverse people can help to identify early and accurate markers of cognitive decline and dementia.
ORAL SESSIONS: O2-01 SOCIAL-BEHAVIORAL AND CARE RESEARCH AND PRACTICE: COGNITIVE TRAINING AND PHYSICAL EXERCISE INTERVENTIONS O2-01-01
KNOWLEDGE-TRANSFER FOLLOWING COGNITIVE INTERVENTION FOR AMNESTIC MILD COGNITIVE IMPAIRMENT
Glynda Kinsella1, David Ames2, Elsdon Storey3, Ben Ong1, Kerryn Pike1, Elizabeth Mullaly4, Elizabeth Rand4, Linda Clare5, Michael Saling6, Samuel Parsons1, 1La Trobe University, Melbourne, Australia; 2National Ageing Research Institute Melbourne, Parkville, Australia; 3Monash University, Melbourne, Australia; 4Caulfield Hospital, Melbourne, Australia; 5Bangor University, Bangor, United Kingdom; 6University of Melbourne, Melbourne, Australia. Background: Many people with amnestic mild cognitive impairment (aMCI) seek guidance about how best to manage everyday memory challenges. Building upon positive pilot study results, we investigated response to a six-week cognitive-behavioural intervention for aMCI. The program (the LaTCH Memory Group Program) focuses on providing knowledge about memory strategies and how to use such strategies in everyday activities. It is based on the expectation that people experiencing memory difficulties need assistance in learning and implementing effective compensatory strategies in everyday situations. This offers an alternative approach to ‘brain training’ or practice on memory tasks. Methods: In a randomised controlled trial, 220 older adults, either diagnosed with aMCI or agematched healthy older adults (HOA), were randomly allocated to early or late intervention. Over three years, we trained allied health professionals to deliver the intervention which was provided through 40 memory groups at locations throughout Melbourne and regional centres in Victoria, Australia. Results: Following intervention, both HOA and aMCI groups (i) improved knowledge about memory strategies and when to use them (d ¼ 0.50); (ii) improved contentment and self-efficacy about memory ability (d ¼ 1.22); (iii) improved self-report of everyday memory ability, (d ¼ 0.54), e.g. remembering to return a missed telephone call; (iv) improved achievement of personal memory goals, (d ¼ 0.28), e.g., learning people’s names in a yoga class. Nevertheless, these significant changes were not reflected in performance on neuropsychological tests of memory. A further benefit was that family members, accompanying relatives with aMCI, significantly improved their memory strategy knowledge (d ¼ 1.23). Conclusions: The ability of participants (HOA and aMCI) to achieve self-determined memory-based goals after intervention was the most critical outcome of the study as it opens up opportunity for people to engage in more life activities and more socialising, adding to the cycle of improving mental health. Reasons for the discrepancy between improved memory strategy knowledge, personal memory goal achievement and lack of change on neuropsychological test performance will be discussed.
O2-01-02
SELF-EFFICACY FOR COGNITIVE REMEDIATION IN ALZHEIMER’S DISEASE
Jimmy Choi1, Joanna Fiszdon2, 1Columbia University, New York, New York, United States; 2Yale University School of Medicine, West Haven, Connecticut, United States. Background: Cognitive remediation (CR) for Alzheimer’s disease (AD) is becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. Patients with dementing pathology, however, may have difficulty adhering to these cognitive treatments due to denial of memory deficits, lack of motivation and apathy, or a sense of hopelessness which may be primarily due to illness or secondary to geriatric depression. For
P235
this reason, remediation techniques which incorporate motivational strategies to enhance treatment engagement and self efficacy may provide greater benefits than standard remediation training. Methods: Sixtynine outpatients diagnosed with mild to moderate Alzheimer’s disease were randomly assigned to 3 months of (1) computer-based memory training (MT), or (2) Cognitive Vitality Training (CVT), the same memory training but contextualized in a milieu specifically designed to increase adherence to treatment by reducing the sense of hopelessness, enhancing motivation, and empowering patients to be actively involved in treatment. Assessments of cognitive function, quality of life, neuropsychiatric symptoms, activities of daily living, treatment adherence, motivation, and perceptions of self efficacy were conducted at intake, 2, 4, and 6 months. Results: Patients in CVT showed greater resistance to memory decline compared to MT at 6 months. Patients and caregivers in CVT both reported better quality of life and less overall depressive symptoms throughout the intervention. Interestingly, perceptions of self-efficacy for treatment predicted cognitive outcome, even after variance attributable to group assignment, baseline memory ability, overall dementia symptoms, and depressive symptoms were accounted for. Conclusions: This suggest that while patients recently diagnosed with AD (and their caregivers) experience a tremendous loss of control in their lives, therapies which strive to re-introduce elements of control and self-efficacy through intrinsic motivation may offer psychological as well as neuropsychological benefits. Applying these findings to a more preventive approach in the prodromal stages of dementia (mild cognitive impairment) will also be discussed. O2-01-03
TRAINING THE BRAIN: CAN COGNITIVE TRAINING ALTER THE GLOBAL EFFECTS OF ALZHEIMER’S DISEASE?
William Tippett, Mireille Rizkalla, University of Northern British Columbia, Prince George, British Columbia, Canada. Background: There is a growing need for novel behavioural interventions such as cognitive training that can benefit clinically vulnerable populations, such as people living with Alzheimer’s disease (AD). Specifically, the potential for neural plasticity, which is the ability of the brain to adapt to changes at a cellular and molecular level, may still be present after trauma or neurodegeneration, particularly in the early stages of a disease. Consequently, there is great interest in the potential for neurologically compromised individuals, such as AD patients, to adapt to new challenges through neural plasticity and altered brain chemistry. Cognitive training (CT) for AD patients is a relatively new area of research however; recent evidence suggests that techniques such as CT may be effective way in stabilising and even enhancing cognition in mild AD1, perhaps through neuronal plasticity. Methods: Six participants diagnosed with probable or possible AD participated in a 14-week program consisting of twice-weekly on-site sessions of 2 hours each. Training tasks included: a visuomotor activity (Pac-man game playing), visuoconstructive procedures (e.g. Block design, 3-D puzzle construction), and a navigation task (finding on-site location using a map). Each participant also completed twice-weekly in-home sessions of 1 hour each, consisting primarily of visuospatial tasks (e.g. mazes and similar paper and pencil tasks).Neuropsychological testing occurred at 2 time points: baseline (pre-training) and follow-up (post-training). Completion of our neuropsychological test battery required approximately 100 min. This battery was selected to index all major cognitive domains, and to have a sufficient range of difficulty, i.e. floor and ceiling effects. The Neuropsychiatric Inventory2 and the Disability Assessment for Dementia3 were also scored to assess functional behaviour and activities of daily living (ADLs). Results: Participants demonstrated improvement upon post-training neuropsychological evaluation, compared to pre-training. Importantly, for some patients the pre-training to post-training improvement in scores was from the impaired range to within normal limits. In addition, patients also demonstrated significant positive changes on a number of the training procedures. Conclusions: Providing regular and challenging cognitive training tasks for AD patients can lead to positive improvements in cognitive and functional performances.
ORAL SESSIONS: O2-01 SOCIAL-BEHAVIORAL AND CARE RESEARCH AND PRACTICE: COGNITIVE TRAINING AND PHYSICAL EXERCISE INTERVENTIONS O2-01-01
KNOWLEDGE-TRANSFER FOLLOWING COGNITIVE INTERVENTION FOR AMNESTIC MILD COGNITIVE IMPAIRMENT
Glynda Kinsella1, David Ames2, Elsdon Storey3, Ben Ong1, Kerryn Pike1, Elizabeth Mullaly4, Elizabeth Rand4, Linda Clare5, Michael Saling6, Samuel Parsons1, 1La Trobe University, Melbourne, Australia; 2National Ageing Research Institute Melbourne, Parkville, Australia; 3Monash University, Melbourne, Australia; 4Caulfield Hospital, Melbourne, Australia; 5Bangor University, Bangor, United Kingdom; 6University of Melbourne, Melbourne, Australia. Background: Many people with amnestic mild cognitive impairment (aMCI) seek guidance about how best to manage everyday memory challenges. Building upon positive pilot study results, we investigated response to a six-week cognitive-behavioural intervention for aMCI. The program (the LaTCH Memory Group Program) focuses on providing knowledge about memory strategies and how to use such strategies in everyday activities. It is based on the expectation that people experiencing memory difficulties need assistance in learning and implementing effective compensatory strategies in everyday situations. This offers an alternative approach to ‘brain training’ or practice on memory tasks. Methods: In a randomised controlled trial, 220 older adults, either diagnosed with aMCI or agematched healthy older adults (HOA), were randomly allocated to early or late intervention. Over three years, we trained allied health professionals to deliver the intervention which was provided through 40 memory groups at locations throughout Melbourne and regional centres in Victoria, Australia. Results: Following intervention, both HOA and aMCI groups (i) improved knowledge about memory strategies and when to use them (d ¼ 0.50); (ii) improved contentment and self-efficacy about memory ability (d ¼ 1.22); (iii) improved self-report of everyday memory ability, (d ¼ 0.54), e.g. remembering to return a missed telephone call; (iv) improved achievement of personal memory goals, (d ¼ 0.28), e.g., learning people’s names in a yoga class. Nevertheless, these significant changes were not reflected in performance on neuropsychological tests of memory. A further benefit was that family members, accompanying relatives with aMCI, significantly improved their memory strategy knowledge (d ¼ 1.23). Conclusions: The ability of participants (HOA and aMCI) to achieve self-determined memory-based goals after intervention was the most critical outcome of the study as it opens up opportunity for people to engage in more life activities and more socialising, adding to the cycle of improving mental health. Reasons for the discrepancy between improved memory strategy knowledge, personal memory goal achievement and lack of change on neuropsychological test performance will be discussed.
O2-01-02
SELF-EFFICACY FOR COGNITIVE REMEDIATION IN ALZHEIMER’S DISEASE
Jimmy Choi1, Joanna Fiszdon2, 1Columbia University, New York, New York, United States; 2Yale University School of Medicine, West Haven, Connecticut, United States. Background: Cognitive remediation (CR) for Alzheimer’s disease (AD) is becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. Patients with dementing pathology, however, may have difficulty adhering to these cognitive treatments due to denial of memory deficits, lack of motivation and apathy, or a sense of hopelessness which may be primarily due to illness or secondary to geriatric depression. For
P235
this reason, remediation techniques which incorporate motivational strategies to enhance treatment engagement and self efficacy may provide greater benefits than standard remediation training. Methods: Sixtynine outpatients diagnosed with mild to moderate Alzheimer’s disease were randomly assigned to 3 months of (1) computer-based memory training (MT), or (2) Cognitive Vitality Training (CVT), the same memory training but contextualized in a milieu specifically designed to increase adherence to treatment by reducing the sense of hopelessness, enhancing motivation, and empowering patients to be actively involved in treatment. Assessments of cognitive function, quality of life, neuropsychiatric symptoms, activities of daily living, treatment adherence, motivation, and perceptions of self efficacy were conducted at intake, 2, 4, and 6 months. Results: Patients in CVT showed greater resistance to memory decline compared to MT at 6 months. Patients and caregivers in CVT both reported better quality of life and less overall depressive symptoms throughout the intervention. Interestingly, perceptions of self-efficacy for treatment predicted cognitive outcome, even after variance attributable to group assignment, baseline memory ability, overall dementia symptoms, and depressive symptoms were accounted for. Conclusions: This suggest that while patients recently diagnosed with AD (and their caregivers) experience a tremendous loss of control in their lives, therapies which strive to re-introduce elements of control and self-efficacy through intrinsic motivation may offer psychological as well as neuropsychological benefits. Applying these findings to a more preventive approach in the prodromal stages of dementia (mild cognitive impairment) will also be discussed. O2-01-03
TRAINING THE BRAIN: CAN COGNITIVE TRAINING ALTER THE GLOBAL EFFECTS OF ALZHEIMER’S DISEASE?
William Tippett, Mireille Rizkalla, University of Northern British Columbia, Prince George, British Columbia, Canada. Background: There is a growing need for novel behavioural interventions such as cognitive training that can benefit clinically vulnerable populations, such as people living with Alzheimer’s disease (AD). Specifically, the potential for neural plasticity, which is the ability of the brain to adapt to changes at a cellular and molecular level, may still be present after trauma or neurodegeneration, particularly in the early stages of a disease. Consequently, there is great interest in the potential for neurologically compromised individuals, such as AD patients, to adapt to new challenges through neural plasticity and altered brain chemistry. Cognitive training (CT) for AD patients is a relatively new area of research however; recent evidence suggests that techniques such as CT may be effective way in stabilising and even enhancing cognition in mild AD1, perhaps through neuronal plasticity. Methods: Six participants diagnosed with probable or possible AD participated in a 14-week program consisting of twice-weekly on-site sessions of 2 hours each. Training tasks included: a visuomotor activity (Pac-man game playing), visuoconstructive procedures (e.g. Block design, 3-D puzzle construction), and a navigation task (finding on-site location using a map). Each participant also completed twice-weekly in-home sessions of 1 hour each, consisting primarily of visuospatial tasks (e.g. mazes and similar paper and pencil tasks).Neuropsychological testing occurred at 2 time points: baseline (pre-training) and follow-up (post-training). Completion of our neuropsychological test battery required approximately 100 min. This battery was selected to index all major cognitive domains, and to have a sufficient range of difficulty, i.e. floor and ceiling effects. The Neuropsychiatric Inventory2 and the Disability Assessment for Dementia3 were also scored to assess functional behaviour and activities of daily living (ADLs). Results: Participants demonstrated improvement upon post-training neuropsychological evaluation, compared to pre-training. Importantly, for some patients the pre-training to post-training improvement in scores was from the impaired range to within normal limits. In addition, patients also demonstrated significant positive changes on a number of the training procedures. Conclusions: Providing regular and challenging cognitive training tasks for AD patients can lead to positive improvements in cognitive and functional performances.