Applying a Person-Centered Approach to Enhance Cognitive Training in Senior Living Community Residents With Mild Cognitive Impairment
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Cognitive Studies, Cognitive Studies |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 60 - Any |
| Updated: | 1/30/2019 |
| Start Date: | October 1, 2017 |
| End Date: | March 2019 |
Computerized cognitive interventions (CCIs) have been increasingly widely implemented among
older adults with mild cognitive impairment (MCI). However, the efficacy of CCIs in
maintaining or improving older adults' cognitive and functional health has been modest and
highly variable. Older individuals' attitudes toward technology use may help explain some of
the variability in CCI effects. The goal of this R21 is to generate proof-of-concept for an
intervention that may improve attitudes toward computers among those with MCI, in turn
improving engagement with and efficacy of a subsequent CCI. Person-centered care—that is,
integrating individuals' preferences throughout the process of intervention--has improved
intervention engagement among older persons, including those with MCI. A recent intervention
predicated on this person-centered approach is called "personalized engagement program"
(PEP). PEP involves a database of individualized computer-led leisure activities. The
investigators' recent pilot data in senior living facilities suggest that PEP promotes
psychological well-being among older persons with MCI, and may shift computers from
dauntingly complex or personally irrelevant devices to familiar, enjoyable technology. These
results are consistent with a number of theories indicating that exposure to pleasurable
experiences with an object or task improves several dimensions of attitudes, including
affective and cognitive components, as well as behavior and motivation. Grounded in both this
pilot data and the theory around it, the investigators seek to take the next step in an arc
of research ultimately intended to improve the efficacy of CCIs. A small randomized
controlled trial (RCT) is proposed to assess whether an initial period of PEP, followed by a
standard CCI, improves a) attitudes toward computers, b) engagement with the CCI, and c)
cognitive outcomes, compared to an attention control period followed by CCI. Our design
involving stratified random assignment of 50 assisted living residents with MCI from 4 senior
living facilities to these two groups. The initial phase involves 4 weeks of either attention
control or PEP, a "dose" suggested by prior work on attitude change and computers, followed
by 6 weeks of CCI for both groups (a period our prior work indicates is sufficient for change
in key cognitive domains among this population). This application is the first of which we
are aware striving to augment CCIs, which are now ubiquitous, by addressing an attitudinal or
affective element of the person, which are often ignored in the cognitive intervention
literature. The adjuvant of PEP also answers increasing calls for "personalized" or
"person-centered" behavioral interventions with older persons.
older adults with mild cognitive impairment (MCI). However, the efficacy of CCIs in
maintaining or improving older adults' cognitive and functional health has been modest and
highly variable. Older individuals' attitudes toward technology use may help explain some of
the variability in CCI effects. The goal of this R21 is to generate proof-of-concept for an
intervention that may improve attitudes toward computers among those with MCI, in turn
improving engagement with and efficacy of a subsequent CCI. Person-centered care—that is,
integrating individuals' preferences throughout the process of intervention--has improved
intervention engagement among older persons, including those with MCI. A recent intervention
predicated on this person-centered approach is called "personalized engagement program"
(PEP). PEP involves a database of individualized computer-led leisure activities. The
investigators' recent pilot data in senior living facilities suggest that PEP promotes
psychological well-being among older persons with MCI, and may shift computers from
dauntingly complex or personally irrelevant devices to familiar, enjoyable technology. These
results are consistent with a number of theories indicating that exposure to pleasurable
experiences with an object or task improves several dimensions of attitudes, including
affective and cognitive components, as well as behavior and motivation. Grounded in both this
pilot data and the theory around it, the investigators seek to take the next step in an arc
of research ultimately intended to improve the efficacy of CCIs. A small randomized
controlled trial (RCT) is proposed to assess whether an initial period of PEP, followed by a
standard CCI, improves a) attitudes toward computers, b) engagement with the CCI, and c)
cognitive outcomes, compared to an attention control period followed by CCI. Our design
involving stratified random assignment of 50 assisted living residents with MCI from 4 senior
living facilities to these two groups. The initial phase involves 4 weeks of either attention
control or PEP, a "dose" suggested by prior work on attitude change and computers, followed
by 6 weeks of CCI for both groups (a period our prior work indicates is sufficient for change
in key cognitive domains among this population). This application is the first of which we
are aware striving to augment CCIs, which are now ubiquitous, by addressing an attitudinal or
affective element of the person, which are often ignored in the cognitive intervention
literature. The adjuvant of PEP also answers increasing calls for "personalized" or
"person-centered" behavioral interventions with older persons.
Inclusion Criteria:
- 18 ≤ MoCA ≤ 26
- RAVLT Delayed Recall Total Score ≤ 6 (or 1.5 SD below age-corrected norms)
- mild or no active depressive symptoms
- intact or mild deficits in IADL functioning
- if on AD medication (i.e., Memantine or cholinesterase inhibitors), antidepressant, or
anxiolytics, no changes of doses in the 3 months prior to recruitment;
- age ≥60 years
- English-speaking
- adequate visual and hearing acuity for testing
- intact decision making capacity.
Exclusion Criteria:
- current enrollment in another cognitive improvement study;
- uncontrollable major depression: or other psychopathology identified by staff or
medical records;
- having active legal guardian (indicating impaired capacity for decision making);
- medical history of AD or other types of dementia
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