Behavioral strategies offer unique benefits in mild cognitive impairment

Takeaway

• A set of 5 behavioral strategies (various cognitive exercises or compensatory memory interventions) showed differing effectiveness when it came to outcomes that were important to older adults with mild cognitive impairment (MCI).

Why this matters

• Number of geriatric individuals living with MCI, a prodromal phase of dementia, is rising.

Key results

• For QoL, benefit appeared greatest for wellness education over computerized cognitive training (effect size, 0.34; 95% CI, 0.05-0.64).
• For mood, benefit appeared greatest for wellness education over computerized cognitive training (effect size, 0.53; 95% CI, 0.21-0.86).
• For memory-related activities of daily living, benefit appeared greatest for yoga over support groups (effect size, 0.43; 95% CI, 0.13-0.72).
• For self-efficacy, benefit did not differ across 5 strategies.

Expert comment

• In an invited commentary, Kelsey T. Laird, PhD, and Helen Lavretsky, MD, MS, write that the new findings, “… support the notion that different MCI-related outcomes can be optimized by specific combinations of behavioral interventions. In particular, yoga and wellness education may be most effective for improving mADLs and mood, outcomes ranked among the most important by patients with MCI and their caregivers. This study offers a new understanding of the comparative efficacy of behavioral interventions for MCI that is easily translatable into real-world clinical practice and sets the stage for future comparative effectiveness studies aiming to prevent cognitive decline and improve QoL in older adults.”

Study design

• Multisite cluster-randomized trial among 272 patients with MCI and their partners from US academic medical outpatient centers.
• 5 behavioral strategies incorporated into 50-hour group sessions conducted during 2 weeks:
  • Yoga,
  • Computerized cognitive training,
  • Wellness education,
  • Therapist-led support groups, and
  • Memory support system.
• In each study group, 1 intervention withheld.
• Booster sessions at 6, 12 months.
• Main outcome: QoL at 12 months.
• Funding: Patient-Centered Outcomes Research Institute.

Limitations

• Insufficient power.
• Interventions tailored for trial.