Locke, Dona E.C.

Background Mild cognitive impairment (MCI) represents a critical window for both pharmacological therapies and non-pharmacological interventions to delay cognitive decline. Objective To evaluate whether combining pharmacotherapy with multicomponent behavioral interventions enhances outcomes relative to behavioral interventions alone. Methods The sample included people with MCI (pwMCI) of any etiology who completed the HABIT Healthy Action to Benefit Independence & Thinking ® program. Baseline pharmacotherapy (acetylcholinesterase inhibitor and/or glutamate regulators) use was dichotomized (yes/no). Multivariate linear mixed-effects models examined changes from baseline in care partner-reported everyday functional skills, quality of life, self-efficacy, anxiety, depression, and HABIT compliance at post-intervention, 6 months, and 12 months, adjusting for baseline cognitive impairment severity and relevant demographic covariates. Results Among 1074 pwMCI, 413 (38.5%) were receiving pharmacotherapy at baseline. Pharmacotherapy use was more prevalent among White than non-White participants (39.4% versus 23.3%, p = 0.01). At baseline, pharmacotherapy users had more severe cognitive impairment and lower utilization of rehabilitation strategies (all p < 0.05). Both groups demonstrated significant improvements across all outcomes at post-intervention. During follow-up (mean score change compared to baseline), pharmacotherapy users showed greater increases in HABIT compliance at 6 months (3.2 versus 2.0) and 12 months (2.1 versus 1.4). In contrast, by 12 months, pharmacotherapy users experienced greater worsening of everyday functional skills related to memory (−2.1 versus −1.3) and executive function (−5.8 versus-3.7). Conclusions pwMCI undergoing pharmacotherapy entered the HABIT program with more advanced cognitive impairment. The pharmacotherapy was not associated with greater intervention-related benefit or attenuation of long-term cognitive decline.

Abstract INTRODUCTION Multicomponent non‐pharmacological interventions, such as the HABIT Healthy Action to Benefit Independence & Thinking® program, have shown promise for improving emotional well‐being, functioning, and self‐efficacy in both people with mild cognitive impairment (pwMCI) and their care partners. However, limited research has examined whether outcomes differ based on type of care partner who co‐enrolls with the pwMCI. METHODS We analyzed data from 875 pwMCI−care partner dyads who completed the HABIT program. Multivariate linear mixed‐effects regression models evaluated changes from baseline in outcomes by care partner type (spouse vs. non‐spouse) at post‐intervention, 6‐months, and 12‐ months. RESULTS At post‐intervention, pwMCI with spousal care partners demonstrated significant improvements across all outcomes from baseline, whereas those with non‐spousal partners improved in five out of seven outcomes. Across subsequent follow‐ups, pwMCI with spousal care partners showed sustained mean reductions in anxiety (post‐intervention: −2.0; 12‐month: −0.9) and increased compliance (post‐intervention: 5.7; 12‐month: 0.9). Everyday functioning in memory (post‐intervention: −0.9; 12‐months: 1.8) and executive functioning (post‐intervention: −0.7; 12‐months: 4.8) improved at post‐intervention but declined thereafter. Spousal care partners reported reduced anxiety (−1.2) and depression (−1.3) at post‐intervention, but by 12‐months they experienced increased burden, anxiety, and depression relative to baseline. Non‐spousal pwMCI–care partner dyads did not show significant change at 6 or 12‐months. DISCUSSION The HABIT intervention may have more favorable outcomes for pwMCI and care partners in spousal compared to non‐spousal dyads. These findings highlight the potential impact of care partner characteristics on both immediate and long‐term response to behavioral interventions for MCI. Highlights At post‐intervention, people with mild cognitive impairment (pwMCI) with spousal care partners showed significant improvements across all outcomes, while those with non‐spousal partners improved in five of seven outcomes. Gains attenuated over time for both spousal and non‐spousal dyads Spousal care partners reported reduced anxiety and depression at post‐intervention, but by 12 months they experienced increased burden, anxiety, and depression relative to baseline. Non‐spousal pwMCI–care partner dyads did not show significant change at 6 or 12 months.

Abstract Background Individuals with mild cognitive impairment (MCI) experience challenges in maintaining independence in their instrumental activities of daily living (IADLs). The memory support system (MSS) is a paper‐based planner intervention to train individuals with MCI to complete personal goals and IADLs independently. As more individuals use electronic calendar systems, the MSS will need to adapt. This project aimed to develop and test an electronic prototype of the MSS (eMSS). Method Drawing on the MSS, an eMSS prototype intended for phone/tablet use was developed in Axure, allowing participants to interact with the planner and its sections (calendar, notes, to do list). The prototype was evaluated with MSS trainers and individuals with MCI and their partners using a computer or tablet over a virtual platform. Participants were asked to go through fictional ‘planning’ scenarios which were assessed using cognitive task analysis (CTA). The scenarios were designed to evaluate overall ease of use, and specifics such as navigation between pages/sections and developing schedules and task lists. During sessions, participants were encouraged to 'think aloud,' providing insight into their eMSS experience. Result To date, CTA has been conducted with 6 MSS trainers, and 2 patient/partner dyads that completed the MSS training program. Early results provide insight on strengths, challenges and opportunities to optimize the eMSS. Participants could identify and use key features (e.g., menus) and found the symbols and language consistent. However, participants didn’t notice some features (e.g., interactive arrows to navigate across dates) and requested more ‘cueing’ or ‘interactive prompts.’ Participants would prefer to see all information entered on individual pages (which is possible with the MSS) to support better situation awareness. Conclusion To respond to the everyday planning needs of individuals with MCI in a digital age, an eMSS was developed, drawing on a clinically trialed hardcopy version (MSS). Positive feedback from MSS trainers and patients with MCI and their partners suggests promise for the overall design. Improvements for the next iteration include designing cues to help users know actions have been completed or when to attend to important information, as well as providing more fulsome information on pages to support awareness of daily tasks.

Background: Mild cognitive impairment (MCI) is a precursor to dementia, with a prevalence of over 15% among community dwellers, with significant economic and social implications. Despite preserved autonomy in daily living, individuals with MCI face challenges in handling everyday technology and memory-related tasks, necessitating digital interventions, such as digital planning-based technologies to support cognitive functioning. Objective: The aim of this study is to identify and summarize available research literature on available digital planning-based technologies to support memory-related functioning in older adults with MCI. Specifically, this study seeks to (1) document the types and functions of these technologies, (2) report their effectiveness, and (3) identify gaps in the current evidence. Methods: A comprehensive literature search of four databases (Medline, Embase, APA PsycINFO, and CINAHL) was conducted in accordance with Arksey and O’Malley’s scoping review methodological framework from inception to February 6, 2024, without restrictions. Inclusion criteria focused on peer-reviewed studies involving adults aged 50 or older with diagnosed cognitive impairment, specifically using digital planning-based technologies for memory support. Results: From 1854 sources, 8 studies were included. Five categories of digital planning-based technologies were identified: (1) reminders and alarms, (2) electronic calendars, (3) digital memory notebooks, (4) digital visual mapping, and (5) smart-home integration. Several studies reported improved task performance, memory recall, and executive function, with digital memory notebooks and visual mapping software showing greatest impact on functional independence. While interventions were generally well-received, usability challenges and low adherence were common, often linked to technological familiarity and motivation. Conclusions: Digital planning-based technologies show promise in supporting memory-related functioning in older adults with MCI. While studies report positive outcomes, more research is needed to refine these tools, evaluate long-term effects, and ensure integration into daily life. Expanding the evidence base will be key to improving accessibility and effectiveness for this population.

AbstractINTRODUCTIONWe previously demonstrated that single‐domain amnestic mild cognitive impairment (SDAm‐MCI) detected through longitudinal neuropsychological testing in our research cohort is less severe than in clinically incident symptomatic individuals. This study aims to replicate and expand this work using a National Alzheimer's Coordinating Center dataset.METHODSParticipants were classified into two groups: those enrolled with normal cognition (Normal Enrollees) and those enrolled with SDAm‐MCI (Amnestic Enrollees). Groups were compared at the time of diagnosis and on rates of cognitive decline post‐diagnosis.RESULTSAt SDAm‐MCI diagnosis, Normal Enrollees were 17% to 39% less impaired on memory tasks, after which the slope of change over time steepened compared to their pre‐symptomatic change and was steeper than in Amnestic Enrollees.DISCUSSIONIncident MCI detected through longitudinal neuropsychological testing is initially milder but may progress more steeply than in clinically established MCI. Sensitive assessment of cognitive decline is essential for capturing early changes that are more likely to be amenable to therapeutic treatment.Highlights Longitudinal cognitive evaluation detects symptomatic Alzheimer's disease earlier than mental status exams. At the time of diagnosis, converters were less impaired compared to initially symptomatic patients. Converters’ cognition declined more steeply than initially symptomatic patients. Sensitive cognitive tests are essential to capture early changes, given new disease‐modifying therapies.