Cogstim: A Shared Decision-making Model to Support Older Adults’ Brain Health

Abstract

The lack of effective treatments for cognitive decline in older adults has led to an interest in the possibility that lifestyle interventions can help to prevent changes in mental functioning and reduce the risk for dementia. Multiple lifestyle factors have been related to risk for decline, and multicomponent intervention studies suggest that changing older adults’ behaviors can have a positive impact on their cognition. How to translate these findings into a practical model for clinical use with older adults, however, is not clear. In this Commentary, we propose a shared decision-making model to support clinicians’ efforts to promote brain health in older persons. The model organizes risk and protective factors into three broad groups based on their mechanism of action and provides older persons with basic information to allow them to make evidence- and preference-based choices in choosing goals for effective brain health programs. A final component includes basic instruction in behavior change strategies such as goal setting, self-monitoring, and problem-solving. The implementation of the model will support older persons’ efforts to develop a personally relevant and effective brain-healthy lifestyle that may help to reduce their risk for cognitive decline.

An online shared decision-making intervention for dementia prevention: A parallel group randomized pilot study

“…The intervention delivered as treatment as usual (TAU) was created to be a reasonable representation of what many older persons face in finding out about the importance of brain health and making lifestyle choices if they choose to try to improve it. A great deal of information is available online and in popular books, and authors have proposed a number of programs for brain health (16)(17)(18) The three mechanisms by which activities are hypothesized to affect brain health are drawn in part from Livingston et al (20), updated to add brain stimulation via neurohumoral effects as a mechanism (15). This organization simplifies and facilitates psychoeducational efforts and helps older adults understand how to make evidenceinformed choices about lifestyle changes.…”

“…They were used because of their brevity and strong evidence base. As the questionnaire was based on a previously reported model emphasizing cognitive activity, brain stimulation, and reducing inflammation referred to as the Cogstim model (15), this index is referred to here as the Cogstim Index.…”

“…Shared decision making has been related to greater patient satisfaction and better health outcomes (14). Elsewhere, we outlined a model for a dementia prevention intervention based on a shared decision model for brain health that integrates psychoeducation on risk and protective factors with coaching based in cognitive behavioral change techniques (15). The purpose of the current study was to evaluate the usefulness, acceptability, and efficacy of a model-based intervention deployed online with older adults.…”