Cognitive Interventions for Mild Cognitive Impairment

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Kelly Murphy, PhD

Neuropsychology & Cognitive Health, Baycrest Health Sciences Psychology Department, University of Toronto

Aging & Speech Communication:

5th_{Interdisciplinary International Research Conference}

October 6-9, 2013

Cognitive Interventions for

Mild Cognitive Impairment

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Objectives

•

Understand the difference between

normal aging, MCI, and dementia

•

Describe treatment approaches for

MCI

•

Describe how basic research

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What’s normal?

Salthouse (2004) Current Directions in Psychological Science

Chronological Age 10 20 30 40 50 60 70 80 90 Z-Sc or e -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 Synonym Vocabulary Pattern Comparison (Speed) Raven's (Reasoning) Recall (Memory) 84 50 16 P er cen til e of P op ula tion

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Normal aging, MCI, and dementia

Normal aging

MCI

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Differentiating MCI

Functional

Decline

Normal aging

Cognitive

Decline

MCI Dementia

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MCI: A definition

MCI is a set of symptoms characterized by a

decline in cognitive abilities, often involving

memory, that is greater than expected for

normal aging but not severe enough to

interfere with a person’s ability to manage

their daily activities.

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Progression of MCI to dementia

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Research

does not

support use of

cognitive enhancers

Tricco et al., CMAJ cmaj.130451; published ahead of print September 16, 2013,

doi:10.1503/cmaj.130451

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Cognitive Intervention

Research shows people with MCI can acquire

new information and apply that learning to

improve their performance on cognitive tasks.

FOR REVIEWS SEE:

Cotelli et al., Frontiers in Human Neurosci., 2012:6.

Simon et al., Neurosci Bio Behav Rev., 2012:36. Tsolaki et al., Neurodegenerative Dis., 2011:8.

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Cognitive Intervention

•

Improved memory performance on trained tasks

•

Evidence of neuroplasticity

•

Increased self-efficacy

•

Evidence of functional improvements

Cotelli et al., Frontiers in Human Neurosci., 2012:6. Simon et al., Neurosci Bio Behav Rev., 2012:36. Tsolaki et al., Neurodegenerative Dis., 2011:8.

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Lifestyle Intervention

Fratiglioni et al. (2004). Lancet Neurol, 3, 343-353.

Also see review by Ferland et al., Nutrition and Dementia in Journal of Current Clinical Care March/April 2011 Physical activity

Mental activity Social network

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Lifestyle Intervention

•

Emerging recognition of role in MCI intervention

Neville, et. al., 2013, Aging & Mental Health:17

•

improved management of cardiovascular risk

factors is associated with reduced dementia

prevalence

Matthews, et. al., 2013, Lancet doi.org/10.1016/S0140-6736(13)61570-6

•

higher educational attainment is associated with

better cognition and functioning in the oldest old.

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Learning the Ropes for MCI

™

Group intervention for people with MCI and their

family members (6 weekly + 2 follow-up sessions)



Cognitive and lifestyle intervention

Hour 1 Hour 2

Education/

Healthy lifestyle/ Resources

Memory Training (MCI)

Psychosocial Intervention (Family)

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Research Influences on Program

Content and Delivery

•

Memory Training

o

Targeting impaired & preserved memory

processes

•

Lifestyle factors

o

Leisure activities

•

Needs of Family Members

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People with aMCI are specifically less able to

make associations between items

Troyer, Murphy, Anderson, Craik, Moscovitch, Maione, & Gao. Neuropsychologia, 2012:50

0 0.2 0.4 0.6 0.8 1 1.2 1.4

Word-Word Face-Name Word-Word Face-Name

M em ory es tim at e Stimulus pairs

Item Recognition Associative Recognition Control aMCI

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Past experience influences cognitive

performance in MCI more so than in

matched controls (implicit memory)

Rowe, Troyer, Murphy, Hasher & Biss (in prep)

0 5 10 15 20 25 % Pri mi ng control aMCI

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Impact on Content & Delivery

Increased emphasis on

:

1. Semantic elaboration strategies

Identifying connections, meanings, and relationships

based on prior knowledge

2. Use of role play to solve practical

memory problems

Use past experiences to cue appropriate strategy

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Everyday Impact of Memory Change

Parikh, Troyer, Murphy, & Maione (in prep)

Themes Normal Aging MCI

Feelings & Views About Self • Frustrated • Disappointed • Reduced confidence • Self-acceptance • Frustrated • Disappointed • Reduced confidence • Self-acceptance

Social & Interpersonal Relationships • Memory partners • Increased empathy for peers • Increased reliance on others

• Social withdrawal & exclusion

Leisure Activities • Increased • Stopped or

decreased Behavioural

Compensation

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Research consistent with reduced

participation in leisure activities

•

Constricted life-space

James et al., Am J Geriatr Psychiatry, 2011:19

•

Fewer hours spent outside the home

Kaye et al., 2012; 27th_{annual ADI conference - abstract}

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Factors interacting with reduced

participation in leisure activities

•

Sensory loss – specifically hearing

•

Mood

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Impacts on Family

•

Frustration / Resentment

–being asked the same question,

–having to assist with something he/she should know how to

do (e.g., looking up movie times on internet).

•

Worry

–over likelihood of learning a new responsibility

–over what will happen if their loved one gets dementia

–how much help to provide

•

Sense of Loss

–For the way things used to be -Blieszner & Roberto, -Garand et al., Int.J. Geriatric PsychiatryThe Gerontologist, 2010:50 , 2005:20 -Savla et al., J. Gerontol. Series B: Psychol. Sci. & Soc. Sci, 2011:66

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Healthy Lifestyle

In MCI Increased emphasis on

leisure

activities



Identifying barriers to participation



Solutions to barriers

In family emphasis on self-care and

wellness

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Cognitive intervention

In MCI emphasis on

memory training



Practical (evidence based) strategies

to manage everyday situations

In family emphasis on

adapting to change



Mastering positive approaches to

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Intervention Control

Improved knowledge & application

of memory strategies

Troyer, Murphy, Anderson, Craik & Moscovitch. Neuropsych. Rehab., 2008:18

-1 -0.5 0 0.5 1 1.5 2 2.5 Z -s c ore c hange

Know Apply Know Apply

Immediate 3-month post

Intervention

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Commonly reported functional

memory problems:

Names of people, places, Misplacing things

Keeping track of schedule of commitments Forgetting to carry out an intended activity Numbers & passwords

Remembering what was said or decided upon

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How would you rate your current performance or ability in dealing with this problem?

1 2 3 4 5 6 7 8 9 10

Not able to do it

Can do it

extremely well

How satisfied are you with the way you currently handle this problem? 1 2 3 4 5 6 7 8 9 10 Not able to do it Can do it extremely well

Measure adapted from

Law et al., (1994). Canadian Occupational Performance Measure (2nd_{ed.). Toronto, ON: CAOT}

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Self-report of improved functional

memory skills in people with MCI

0 20 40 60 80 100 % Parti c ipants >+2 (clinically significant) Intervention +1 <0 0 20 40 60 80 100 % Parti c ipants >+2 (clinically significant) Control +1 <0 Performance Satisfaction

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How would you rate your current performance or ability in dealing with this problem?

1 2 3 4 5 6 7 8 9 10

Not able to do it

Can do it

extremely well

How satisfied are you with the way you currently handle this problem? 1 2 3 4 5 6 7 8 9 10 Not able to do it Can do it extremely well

Measure adapted from

Law et al., (1994). Canadian Occupational Performance Measure (2nd_{ed.). Toronto, ON: CAOT}

Problem:

I feel frustrated when my spouse

repeats questions I already answered.

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Improved ability managing challenges

related to living with a person with MCI

Performance Satisfaction 0 20 40 60 80 100 % Parti c ipants >+2 (clinically significant) Intervention +1 <0 0 20 40 60 80 100 % Parti c ipants >+2 (clinically significant) Control +1 <0

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Positive Lifestyle Change

Post-Program Participation

0 10 20 30 40 50 60 70 80 90 % of resp ondants MCI Family Yes No

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Types of Reported Lifestyle Changes

Exercise 28% Engagement 37% Diet 19% Stress Management 16% MCI Exercise 19% Engagement 29% Diet 14% Stress Management 38% Family

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Participant Feedback

MCI

•

increased confidence

•

better functional memory

•

95% recommend program

Family

•

decreased worry

•

improved skill at managing change

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MCI - Intervention Effectiveness

Immediate goals



• Improved healthy lifestyle behaviours

• Increased memory strategy knowledge and use / Improved

functional memory

• Improved ability to manage change

Long term goals

?

• Dementia onset is delayed (or prevented)

• Prevention of physical and mental health decline in close

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Acknowledgements

Andrea Maione Angelina Polsinelli Nicole D’Souza Diana Smith Preeyam Parikh Rita Vitorino Renee Biss Aurela Vangjeli Fuquiang Gao Nina Dopslaff Morris Goldenberg

Medical Research Endowment

Angela Troyer Nicole Anderson Morris Moscovitch Fergus Craik Gillian Rowe Lynn Hasher Janet Murchison Renee Climans Deirdre Dawson Corey Mackenzie Alzheimer Society C A N A D A THANK YOU

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Raising

Awareness

2012, Oxford University Press: New York