Shared decision making (SDM) occurs when patients and clinicians consider patients' values and preferences while discussing medical evidence to inform healthcare decisions. SDM enables patients with mild cognitive impairment (MCI) to express values and preferences when making current healthcare decisions and presents a unique opportunity to inform future decision making in the case of further cognitive decline. However, clinicians often fail to facilitate SDM with patients with MCI. This review describes research pertaining to value solicitation, weighing of the medical evidence, and medical decision making for individuals with MCI, explores the role of caregivers, identifies barriers to and facilitators of SDM in MCI, and suggests strategies to optimize SDM for persons with MCI in neurology clinical practice. Further research is needed to identify more strategies for decision support for individuals affected by cognitive impairment.

2020) Functional ability is associated with higher adherence to behavioral interventions in mild cognitive impairment, The Clinical Neuropsychologist, 34:5, 937-955, ABSTRACT Objective: Behavioral interventions during early memory decline hold promise in delaying the development of dementia. In the present study, participants in a multimodal behavioral intervention study were assessed for post-intervention adherence and predictors of adherence. Methods: Participants (N ¼ 272, mean age ¼ 75.04 ± 7.54) diagnosed with amnestic Mild Cognitive Impairment (aMCI) were assigned to intervention groups receiving four out of five behavioral intervention components, including yoga, memory compensation training, computerized cognitive training, support groups, and/or wellness education. Length of the intervention was 10 days, 4 h per day, with post-intervention follow-up at 6, 12, and 18 months. Results: Two-hundred and thirty-seven participants completed the 6-month post-intervention follow-up measures, 228 participants completed the 12-month measures, and 218 participants completed the 18-month measures. Participants fully adhered to a mean of 2 out of the 4 taught intervention components. Eightynine percent of participants were at least partially adherent to one or more taught intervention components at 6-, 12-, and 18-month post-intervention follow-up. Physical activity was the most adhered to intervention while group support was the least adhered to intervention across all three follow-up time-points. Higher educational level, higher baseline depressive symptoms, higher baseline global cognitive functioning, and better baseline and concurrent functional abilities were associated post-intervention adherence. Conclusion: Changes in functional abilities are associated with disease progression among persons with aMCI. In the present study, individuals with aMCI who have higher education, higher depressive symptoms, and better baseline functioning abilities are ARTICLE HISTORY more likely to adhere to behavioral intervention components over time. Post-intervention adherence also associates with concurrent daily function.

No abstract

No abstract

No abstract

Objective Little is known regarding the values that patients with mild cognitive impairment (MCI) incorporate into healthcare decision-making or how culture may affect such values. Even if values overlap across cultures, cultural groups may emphasize the importance of specific values differently since values emanate, at least in part, from cultural and life-long learning. The aim of this study was to explore and compare values that older adults of different ethnicities and cognitive statuses incorporate in their medical decisions. Participants and Method Four focus groups were established by identifying older adults as, a) Hispanic or non-Hispanic, and with b) normal cognition or MCI. Participants were recruited from the 1Florida Alzheimer’s Disease Research Center. Focus groups were audio-recorded and transcribed using a professional transcription service. Results There were a total of 23 participants (Age: M = 70.9, SD = 6.4). MCI groups had briefer discussions (Time M = 44 minutes) than the normal cognition groups (Time M = 62 minutes). Qualitative analysis of discussions was used to explore the values identified across the focus groups. The MCI groups valued spirituality, doctor recommendations, and family involvement when facing medical decisions. Normal cognition groups valued the necessity of proactive involvement as healthcare consumers and the relationship between the quality of patient-clinician interaction and their health care related decisions. Cultural themes involving perceptions of gender and generational differences emerged from the Hispanic normal cognition group. Conclusions This study identified many determinants influencing the medical decision-making process of diverse older adults: including past experiences, family involvement, healthcare barriers, and cultural background. These results have the potential to impact patient-clinician discussions, decisions made by surrogates, and the development of decision aids with a broader range of relevant patient values.

No abstract

No abstract