The memory support system for mild cognitive impairment: randomized trial of a cognitive rehabilitation intervention

Greenaway, Melanie C.; Duncan, Noah; Smith, Glenn E.

doi:10.1002/gps.3838

Cited by 162 publications

(181 citation statements)

References 27 publications

(24 reference statements)

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“…One study focused on improving memory through compensatory cognitive training (Greenaway et al 2012). Greenaway et al (2012) emphasized training in calendars and notebooks 2 hours/week for 6 weeks, including setting appointments, adding “to do” items, and journaling.…”

Section: Results: Efficacy Of Crts For MCImentioning

confidence: 99%

Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

et al. 2013

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Objective To evaluate the efficacy of cognitive rehabilitation therapies (CRTs) for mild cognitive impairment (MCI). Our review revealed a need for evidence-based treatments for MCI and a lack of a theoretical rehabilitation model to guide the development and evaluation of these interventions. We have thus proposed a theoretical rehabilitation model of MCI that yields key intervention targets - cognitive compromise, functional compromise, neuropsychiatric symptoms, and modifiable risk and protective factors known to be associated with MCI and dementia. Our model additionally defines specific cognitive rehabilitation approaches that may directly or indirectly target key outcomes - restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic techniques. Methods Fourteen randomized controlled trials met inclusion criteria and were reviewed. Results Studies markedly varied in terms of intervention approaches and selected outcome measures and were frequently hampered by design limitations. The bulk of the evidence suggested that CRTs can change targeted behaviors in individuals with MCI and that CRTs are associated with improvements in objective cognitive performance, but the pattern of effects on specific cognitive domains was inconsistent across studies. Other important outcomes (i.e., daily functioning, quality of life, neuropsychiatric symptom severity) were infrequently assessed across studies. Few studies evaluated long-term outcomes or the impact of CRTs on conversion rates from MCI to dementia or normal cognition. Conclusions Overall, results from trials are promising but inconclusive. Additional well-designed and adequately powered trials are warranted and required before CRTs for MCI can be considered evidence based.

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Section: Results: Efficacy Of Crts For MCImentioning

confidence: 99%

Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

et al. 2013

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“…Targeted cognitive rehabilitation may be beneficial across the spectrum of memory dysfunction, 29 especially in mild impairment. 30 Pharmacologically, cholinesterase inhibitors are approved for use in the treatment of Alzheimer disease and Parkinson disease dementias, and memantine is approved for the later stages of Alzheimer disease. 31,32 SEMANTIC MEMORY Semantic memory refers to an individual's acquired knowledge about things in the world, their relationships, and their uses, including facts and concepts as well as words and their meanings.…”

Section: Y28mentioning

confidence: 99%

Memory Dysfunction

Matthews¹

2015

CONTINUUM: Lifelong Learning in Neurology

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“…The authors reported a "medium effect size" for improvement of independence in daily activities including medication management, improved social activities, decreased anxiety, and improved mood. A follow-up study reported similar results extending out to 6 months follow-up and also reported a benefit in caregiver burden (compared with the nonintervention arm of the trial) [62].…”

Section: Memory Support Systemmentioning

confidence: 68%

Treatment of Mild Cognitive Impairment

Kelley

2015

Curr Treat Options Neurol

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It is increasingly evident that early identification of cognitive impairment in older adults presents opportunities for interventions that aim to mitigate the impact of cognitive symptoms on daily function and that attempt to delay (or ultimately prevent) progression from mild cognitive impairment (MCI) to dementia. To date, no intervention has proven protective in ultimately preventing conversion to dementia. However, several lifestyle, dietary, and pharmacologic interventions have suggested symptomatic benefit for those having MCI. A number of diet and lifestyle recommendations have been associated with decreased risk of dementia both in cognitively intact older adults and in those having mild cognitive impairment. Thus, these recommendations may be appropriate for both people presenting with subjective cognitive concerns and for those having objective evidence of memory problems. It remains less certain whether adopting these lifestyle habits in later life confers the benefits seen in epidemiological cohorts (where people have likely practiced them for many years). Discussion of starting on a cholinesterase inhibitor is appropriate for those having MCI, particularly those in whom the MCI is thought to have a vascular etiology or to represent the prodromal stage of a neurodegenerative disease. Recent meta-analyses exploring the use of cholinesterase inhibitors in patients having MCI have concluded that there is no evidence to support this practice. Although meta-analytic techniques seemingly strengthen the confidence in a recommendation via the incorporation of a large number of subjects analyzed, the technique is not capable of overcoming any inherent weaknesses of the individual studies included in the analysis. It is arguable whether studies in MCI may have employed endpoints poorly adapted to investigating effect of cholinesterase inhibitors. Most studies have used cognitive screening examinations, all of which stretch their detection ability to identify subjects with MCI, let alone discriminate subtle differences between them. Some have used conversion from MCI to dementia as an endpoint, which may not be the best measure for a symptomatic treatment. Further, once conversion to dementia has occurred, a cholinesterase inhibitor would be started in most (if not all) clinical settings, a reality not well reflected in most study designs. Additionally, several large studies have not permitted subject stratification by APOE carrier status, another important defect in assessing outcome. In clinical practice, our center typically does recommend cholinesterase inhibitors for patients having MCI. Despite the modest effect size, many patients do wish to start on treatment. It appears that this is a generally accepted practice and experience, as most clinical trials for prodromal Alzheimer's disease specify that participants should be taking a cholinesterase inhibitor.

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The memory support system for mild cognitive impairment: randomized trial of a cognitive rehabilitation intervention

Cited by 162 publications

References 27 publications

Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

Memory Dysfunction

Treatment of Mild Cognitive Impairment

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