Determinants of Adherence to a “GRADIOR” Computer-Based Cognitive Training Program in People with Mild Cognitive Impairment (MCI) and Mild Dementia

Abstract

Background: Computer-based programs have been implemented from a psychosocial approach for the care of people with dementia (PwD). However, several factors may determine adherence of older PwD to this type of treatment. The aim of this paper was to identify the sociodemographic, cognitive, psychological, and physical-health determinants that helped predict adherence or not to a “GRADIOR” computerized cognitive training (CCT) program in people with mild cognitive impairment (MCI) and mild dementia. Method: This study was part of a randomized clinical trial (RCT) (ISRCTN: 15742788). However, this study will only focus on the experimental group (n = 43) included in the RCT. This group was divided into adherent people (compliance: ≥60% of the sessions and persistence in treatment up to 4 months) and non-adherent. The participants were 60–90 age and diagnosed with MCI and mild dementia. We selected from the evaluation protocol for the RCT, tests that evaluated cognitive aspects (memory and executive functioning), psychological and physical health. The CCT with GRADIOR consisted of attending 2–3 weekly sessions for 4 months with a duration of 30 min Data analysis: Phi and Biserial-point correlations, a multiple logical regression analysis was obtained to find the adherence model and U Mann–Whitney was used. Results: The adherence model was made up of the Digit Symbol and Arithmetic of Wechsler Adult Intelligence Scale (WAIS-III) and Lexical Verbal Fluency (LVF) -R tests. This model had 90% sensitivity, 50% specificity and 75% precision. The goodness-of-fit p-value of the model was 0.02. Conclusions: good executive functioning in attention, working memory (WM), phonological verbal fluency and cognitive flexibility predicted a greater probability that a person would be adherent.

Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives

“…Few studies have evaluated its usability and effectiveness in the rehabilitation field. Diaz Baquero et al performed an RCT study on 43 patients with MCI and mild dementia, highlighting good adherence to treatment, good acceptability, and potential efficacy of the device ( 8 ). Another RCT performed by the same authors on 89 people with MCI and dementia demonstrated the benefit of this training on several cognitive domains ( 48 ).…”

“…For dementia, there is some evidence that computer-based cognitive rehabilitation may be of help in improving different cognitive domains ( 57 ). In particular, the software “GRADIOR” looks promising in the CR field ( 8 , 48–50 ). Moreover, previous studies have applied computerized approaches using photos of the patient and his/her personal surroundings, with positive results ( 58 , 59 ).…”

“…Cognitive rehabilitation (CR) aims to improve residual neuropsychological capacities through specific strategies based on cognitive models. In particular, the innovative techniques mediated by personal computers (PC) use multimedia and computer resources, through hardware and software systems, to implement cognitive functioning, including attention, memory, problemsolving, language, and executive functions (5)(6)(7)(8). Computerized methods are based on repeated training of specific cognitive domains, through the execution of tasks involving specific skills.…”

“…The exercises are grouped according to the cognitive domain stimulated and adapt to the patient's abilities to avoid frustration due to too complex or too simple tasks (5). These devices could offer some therapeutic possibilities for the CR of various neurological diseases (4)(5)(6)(7)(8). It has been shown that innovative tools, such as PC-based treatments, could facilitate patient management in the rehabilitation process, allowing continuity of care at home through the telerehabilitation mode (9)(10)(11)(12)(13).…”

Adherence to a lifestyle intervention – just a question of self-efficacy? Analysis of the AgeWell.de-intervention against cognitive decline

“…A study focusing on a computer-based training program more deeply analysed determinants of adherence regarding MCI. They reported lower adherence to the program for participants with MCI, due to executive functioning in attention, working memory or cognitive flexibility [ 38 ]. Taken together, the results, nevertheless, underline the need for higher priority and other consideration of people with MCI to further maintain cognitive ability.…”