Shandera‐Ochsner, Anne L.

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.

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.

AbstractBackgroundThe syndrome of mild cognitive impairment (MCI) is classified into different subtypes– amnestic MCI (aMCI) and non‐amnestic MCI based on cognitive domains impacted, while different underlying disease etiologies cause the impairments. The Memory Support System (MSS), a memory‐support tool which utilizes a calendar/planner, has been shown to have positive impact on daily functioning in MCI (Chandler et al., 2017). We have previously shown that cognitive impairment severity and personality traits are associated with MSS learning (De Wit et al., 2021; Khayoun et al., 2021). In this study, we hypothesized that 1) participants with single domain aMCI (SD‐aMCI) will have higher MSS learning scores than multi‐domain aMCI (MD‐aMCI), and 2) participants with suspected Alzheimer’s disease (AD) etiology will have lower MSS learning scores than other etiologies.MethodParticipants (mean age = 75.2) underwent daily MSS training between 2017 and 2021 as part of the 10‐day Mayo Clinic HABIT program. The MSS learning success score (LSS) was determined by how far participants progressed in three learning phases of increasing difficulty: Acquisition (0‐2 points), Application (3‐4 points), and Adaptation (5‐6 points; Greenway et al., 2008). Ordinal logistic regression analysis was used to predict MSS learning scores between SD‐aMCI (n = 142) versus MD‐aMCI (n = 119), and AD etiology (n = 213) versus other neurodegenerative etiologies (n = 57). Dementia Rating Scale‐2 scores (Jurica, 2001) were included to control for cognitive severity.ResultCompared to participants with SD‐aMCI, those with MD‐aMCI had 54.1% lower odds of having higher LSS at training end (p = .004), after controlling for cognitive impairment severity. AD versus other etiology’s impact on LSS was nonsignificant.ConclusionParticipants with MD‐aMCI showed poorer MSS learning efficiency than participants with SD‐aMCI. Etiology did not impact MSS learning. Results suggest having more than just memory impairment (e.g., additional language or executive dysfunction) reduces MSS learning, regardless of overall impairment level. Additional MSS training may be needed to facilitate learning for these individuals.

AbstractBackgroundBehavioral interventions are often recommended for persons with mild cognitive impairment (MCI). The Healthy Action to Benefit Independence & Thinking® Program (HABIT) has been shown to benefit activities of daily living (ADL) and self‐efficacy in patients at 6‐ and 12‐months post intervention. However, to date, the findings have been limited by comparison to a relatively small, untreated control group. This study attempted to explore HABIT ADL outcomes compared to a large, presumably untreated Alzheimer's Disease Neuroimaging Initiative (ADNI) MCI cohort.MethodA total of 767 participants with MCI were selected from the ADNI database, whereas 478 participants with MCI were recruited from the HABIT IRB approved research registry. Functional outcomes were assessed with informant‐based measures ‐ Functional Activities Questionnaire (FAQ) and Everyday Cognition scale (ECOG) memory and total scores – at both 6‐month‐ and 12‐month‐follow‐ups. After near‐neighbor propensity score matching with a caliper of 0.2, 288 participants from each group were matched for the FAQ, and 333 were matched for the ECOG scores. Latent growth curve models were used to test the hypothesis that the HABIT program might delay functional decline in patients with MCI.ResultAfter matching HABIT group continued to show higher initial scores on FAQ (b=.849, p=.013), and ECOG memory (b=.200, p=.004) and total scores (b=1.115, p<.001) compared to the ADNI group. Although an increase in scores was observed in both groups for each functional outcome, the slopes were steeper for the HABIT group for FAQ (b=1.194, p<.001), ECOG memory (b=.073, p=.019) and ECOG total (b=.383, p=.007).ConclusionContrary to our hypothesis, in this non‐randomized study, partners of HABIT participants with MCI reported more rapid functional decline compared to those in an imaging study. This discrepancy could be due to the HABIT group’s higher baseline impairment level even after matching. Furthermore, patients with perceived more rapid decline may be more likely to seek interventions relative to those who elect to participate in a non‐interventional imaging study. In addition, the intervention sessions could prime the partners to be more scrupulous and aware when rating functional assessments. Additional randomized research may help add clarity to these findings.

Background: In Alzheimer’s disease and related disorders (ADRD) research, common outcome measures include cognitive and functional impairment, as well as persons with mild cognitive impairment (pwMCI) and care partner self-reported mood and quality of life. Studies commonly analyze these measures separately, which potentially leads to issues of multiple comparisons and/or multicollinearity among measures while ignoring the latent constructs they may be measuring. Objective: This study sought to examine the latent factor structure of a battery of 12-13 measures of domains mentioned above, used in a multicomponent behavioral intervention (The HABIT® program) for pwMCI and their partners. Methods: Exploratory factor analysis (EFA) involved 214 pwMCI-partner pairs. Subsequent Confirmatory factor analyses (CFA) used 730 pairs in both pre- and post-intervention conditions. Results: EFA generated a three-factor model. Factors could be characterized as partner adjustment (29.9%), pwMCI adjustment (18.1%), and pwMCI impairment (12.8%). The subsequent CFA confirmed our findings, and the goodness-of-fit for this model was adequate in both the pre- (CFI = 0.937; RMSEA = 0.057, p = 0.089) and post-intervention (CFI = 0.942; RMSEA = 0.051, p = 0.430) groups. Conclusion: Results demonstrated a stable factor structure across cohorts and intervention conditions suggesting that three broad factors may provide a straightforward and meaningful model to assess intervention outcome, at least during the MCI phase of ADRD.

There is currently limited and mixed evidence for the cognitive benefits of Computerized Cognitive Training (CCT) and yoga in persons with Mild Cognitive Impairment (pwMCI). The objective of this study was to investigate the benefit of computerized cognitive training (CCT) vs. physical (yoga) intervention on cognitive abilities. Participants in this study were part of the larger Mayo Clinic’s Healthy Action to Benefit Independence and Thinking (HABIT) program comparative effectiveness trial. The HABIT program is designed for pwMCI and their care partner and consists of five behavioral interventions: CCT, Memory Support System-Calendar (MSS-Calendar), wellness education, support groups, and yoga. The subtractive study design randomly withheld one of the interventions for a total of five study arms. Longitudinal mixed-effects regression models were used to investigate the hypothesis that CCT and yoga has a greater positive impact on psychomotor and basic attention abilities at 12 months post-intervention as compared to the other HABIT interventions. Findings showed CCT had a positive impact compared to yoga on the Cogstate psychomotor/attention composite at 12 months post-intervention (ES = 0.54; unadjusted p value = 0.007, adjusted p value = 0.021). The impact of yoga or combining CCT with yoga did not show statistically significant improvement. Continued CCT practice at home showed further benefit on psychomotor/attention at 12 months post-intervention. There was no significant benefit of CCT or yoga on Cogstate learning/working memory composite.

AbstractBackgroundOne nonpharmacological intervention for persons with amnestic Mild Cognitive Impairment (MCI) is development of a compensatory memory notebook/planner system. De Wit et al. (2019) showed that global cognitive status is the primary predictor of learning success with training on a memory notebook system and that learning success predicts ongoing adherence to the tool. The purpose of our work is to validate their analysis in a new sample and evaluate whether or not patient or partner personality traits predict learning success over and above that explained by cognitive status.MethodTraining in the Memory Support System (MSS) is one component of the multi‐disciplinary behavioral intervention program called Healthy Action to Benefit Independence and Thinking (HABIT) offered at Mayo Clinic. 183 patient and partner dyads completed the HABIT program and enrolled in our IRB approved ongoing research registry to allow use of their clinical data for research purposes. Personality traits were measured with the self‐report Ten Item Personality Inventory (TIPI) based on the five‐factor model of personality (Agreeableness, Conscientiousness, Emotional Stability, Openness, and Extraversion) completed by both the patient and the partner. For our analyses, we fit logistic regression models to predict full MSS mastery at the end of the two‐week program and dichotomized TIPI into “high” or “low” for each trait based on its median (low was the reference group).ResultConsistent with De Wit et al. (2019), global cognitive status again was the only significant predictor of MSS learning mastery when considering age, education, baseline depression score and baseline global cognitive status (Table 2). When adding patient personality traits, only openness significantly added to the model with higher openness predicting learning success (Table 3). Adding both patient and partner personality traits resulted in a significant interaction between patient and partner openness (Table 4). The direction of this interaction indicates that learning success is highest when either the partner or patient is high in openness (but not both).ConclusionHigh openness to experience in the patient with MCI or their partner (but not both) significantly improves learning success for a cognitive rehabilitation memory support tool in patients with MCI.