McAlister, Courtney

AbstractBackgroundHearing loss occurs commonly with age and is more prevalent among adults with Mild Cognitive Impairment (MCI) or Alzheimer’s Disease and related dementias (ADRD) than among older adults with typical cognitive abilities. Over‐the‐counter (OTC) hearing aids are a recently approved, lower‐cost method of hearing treatment which can be accessed directly by patients. However, there are almost no data which can guide whether to recommend this treatment for adults with MCI or ADRD. OTC aids also have technology constraints that may limit their benefit for wearers with ADRD, who have specific communication and rehabilitation needs.MethodParticipants in this randomized clinical trial will be recruited at the time of diagnosis of either MCI or early ADRD. The trial design embeds a brief hearing assessment within the structure of a memory assessment at Geriatrics and Neurology clinics, in both urban (Madison, WI) and rural (La Crosse, WI) settings. Trial participants will be randomized to receive either OTC aids or communication strategies tailored for adults with cognitive decline. To maximize access for patients (including patients from rural or underserved areas), treatment will be delivered via telehealth. Outcomes will be measured at baseline and after one month of use of the OTC hearing aids or communication strategies. The primary outcome is subjective assessment of dyadic communication by the listener’s primary communication partner. Additional outcomes include hearing‐related quality of life and a novel assessment of communication ability using structured conversation analysis.ResultThis presentation will describe the trial design, expertise and roles of the multidisciplinary study team, mechanism of treatment delivery via telehealth, and planned outcome measurements.ConclusionResults of this trial will provide important evidence to guide treatment recommendations in community‐dwelling older adults with MCI or early ADRD. This project will also establish feasibility of conducting hearing assessment as part of a memory assessment.

AbstractBackgroundPartners of persons with mild cognitive impairment (pwMCI) show increased rates of depression and other mental health problems compared to the general population. While dyadic behavioral interventions such as cognitive rehabilitation have shown beneficial effects in reducing caregiver burden, research to date lacks consistent outcome measures and rarely focuses on distressed partners. Therefore, this study explored the longitudinal effect of the Healthy Action to Benefit Independence & Thinking® (HABIT) program on partners with relatively low initial adjustment level. We hypothesized that the HABIT program would improve partner adjustment in those who were distressed.MethodData from 322 pwMCI and partners were utilized from the HABIT IRB research registry. Among them, 240 completed HABIT while 82 served as an untreated control group. Consistent with our previous exploratory factor analysis, a composite partner adjustment score was calculated using the Center for Epidemiologic Studies Depression scale (CES‐D), the REACH Anxiety Inventory Form, and the Quality of Life scale for adults with Alzheimer’s Disease (QOL‐AD). We included partners with an adjustment score below the median of each group to focus on partners with low levels of baseline adjustment. Latent growth curve models were conducted at baseline, 3‐month, 6‐month, and 1‐year follow‐ups to investigate the trajectories of partner adjustment level.ResultIn the low adjustment subsample, no between group difference was found at baseline. An overall improvement in partner adjustment scores was observed only in the treatment group (b = 5.00, p<.001). The slope of change was larger (b = 3.75, p = .016) in the treatment group, indicating a faster improvement in adjustment level in HABIT partners with marginally lower baseline and higher follow‐up scores. This difference in the improvement rates was most evident at the 3‐month follow‐up (t(1, 94) = ‐2.63, p = .010) and gradually reduced in subsequent visits.ConclusionIn partners of those with MCI who have low levels of emotional adjustment, behavioral interventions like HABIT can be beneficial in accelerating improvement in their overall adjustment level and facilitate adaptation to their loved ones’ MCI symptoms compared to untreated controls. Techniques taught in dyadic interventions may serve as protective factors for mental health problems in primary caregivers of pwMCI.

Objectives This study evaluated the efficacy of a multidomain brain health intervention on health behavior change and sought to understand whether health literacy or brain health knowledge predicted engagement with the intervention. Methods One-hundred thirty midlife and older adults were assigned to one of three intervention conditions: brain fitness (B-Fit) utilizing education and goal setting, education-only, or waitlist. Questionnaires were completed at baseline and post-intervention. Results Both B-Fit and education-only conditions reported improvements in health behaviors over time. Although effect size for the education-only condition was moderate, only the B-Fit condition differed significantly in health behaviors from the waitlist post-intervention. Lower baseline brain health knowledge predicted improvements in health behaviors for education-only condition. Discussion The multidomain brain health intervention was successful in helping participants change their behaviors, but it was not more effective than the education-only condition. For those with lower brain health knowledge, an education-only intervention may be sufficient to encourage behavior change.

Abstract Objective The night out task (NOT) was developed as a naturalistic, open-ended, multitasking measure that requires individuals to complete eight subtasks comparable to those encountered during real-world functioning (e.g., pack travel bag, prepare tea). We examined psychometric properties and administration feasibility of this direct observation measure within a clinic-like setting using a tablet-based coding application. Method A sample of 148 community-dwelling older adults (82% cognitively healthy; 18% mild cognitive impairment) and 57 younger adults completed the NOT along with other neurocognitive tests and questionnaires. Results Inter-rater reliability across NOT primary (i.e., time, accuracy, efficiency) and process-related (e.g., error-types, self-corrections) variables was mostly excellent. NOT primary measures showed expected patterns of convergent and discriminant validity with measures of cognition, demographics, and well-being. External validity was established by the NOT ability to distinguish between age and diagnostic (cognitively healthy vs. mild cognitive impairment) groups. Demonstrating incremental validity, the NOT primary variables (execution time in particular) were predictive of self-reported functional abilities and completion quality of in-home everyday tasks over and earlier variables such as demographics, cognition, and mobility. Conclusions These findings suggest that the NOT and its app interface, which allows for continuous logging of observations, are a feasible in-clinic measure to assess cognitive capacities important for real-world functioning. With further validation, the NOT may allow for earlier detection of functional difficulties. Understanding errors and strategies used during NOT performance could also have implications for individualized interventions.