Cognitive Interventions for Mild Cognitive Impairment

Transcription

1 Cognitive Interventions for Mild Cognitive Impairment Kelly Murphy, PhD Neuropsychology & Cognitive Health, Baycrest Health Sciences Psychology Department, University of Toronto Aging & Speech Communication: 5 th Interdisciplinary International Research Conference October 6-9, 2013

2 Objectives Understand the difference between normal aging, MCI, and dementia Describe treatment approaches for MCI Describe how basic research influences effective intervention

3 Z-Score What s normal? Synonym Vocabulary Pattern Comparison (Speed) Raven's (Reasoning) Recall (Memory) Percentile of Population Chronological Age Salthouse (2004) Current Directions in Psychological Science

4 Normal aging, MCI, and dementia Normal aging MCI Dementia

5 Differentiating MCI Functional Decline Normal aging MCI Cognitive Decline Dementia

6 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.

7 Progression of MCI to dementia Petersen et al. (2001). Archives of Neurology: 58

8 How do we treat MCI? Research does not support use of cognitive enhancers Tricco et al., CMAJ cmaj ; published ahead of print September 16, 2013, doi: /cmaj

9 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.

10 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.

11 Lifestyle Intervention Social network Physical activity Mental activity Fratiglioni et al. (2004). Lancet Neurol, 3, Also see review by Ferland et al., Nutrition and Dementia in Journal of Current Clinical Care March/April 2011

12 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/ /s (13) higher educational attainment is associated with better cognition and functioning in the oldest old. Christensen, et. al., 2013, Lancet doi.org/ /s (13)

13 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 Memory Training (MCI) Education/ Healthy lifestyle/ Resources Psychosocial Intervention (Family)

14 Research Influences on Program Content and Delivery Memory Training o Targeting impaired & preserved memory processes Lifestyle factors o Leisure activities Needs of Family Members

15 Memory estimate People with amci are specifically less able to make associations between items Item Recognition Associative Recognition Control amci Word-Word Face-Name Word-Word Face-Name Stimulus pairs Troyer, Murphy, Anderson, Craik, Moscovitch, Maione, & Gao. Neuropsychologia, 2012:50

16 E M B L E M L I V E R H F X V V L O T T E R Y

17 % Priming Past experience influences cognitive performance in MCI more so than in matched controls (implicit memory) control amci Rowe, Troyer, Murphy, Hasher & Biss (in prep)

18 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 application

19 Everyday Impact of Memory Change 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 Increased Increased Parikh, Troyer, Murphy, & Maione (in prep)

20 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; 27 th annual ADI conference - abstract

21 Factors interacting with reduced participation in leisure activities Sensory loss specifically hearing Mood

22 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, The Gerontologist, 2010:50 -Garand et al., Int.J. Geriatric Psychiatry, 2005:20 -Savla et al., J. Gerontol. Series B: Psychol. Sci. & Soc. Sci, 2011:66

23 Healthy Lifestyle In MCI Increased emphasis on leisure activities Identifying barriers to participation Solutions to barriers In family emphasis on self-care and wellness Stress management

24 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 everyday challenges

25 Z-score change Improved knowledge & application of memory strategies 2.5 Immediate 3-month post 2 Intervention 1.5 Control Know Apply Know Apply Intervention Control Troyer, Murphy, Anderson, Craik & Moscovitch. Neuropsych. Rehab., 2008:18

26 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 Also see Ahmed et al., Alzheimer s Disease & Ass. Dis., 2008:22

27 Problem: I frequently misplace my cell phone How would you rate your current performance or ability in dealing with this problem? Not able to do it Can do it extremely well How satisfied are you with the way you currently handle this problem? Not able to do it Can do it extremely well Measure adapted from Law et al., (1994). Canadian Occupational Performance Measure (2 nd ed.). Toronto, ON: CAOT

28 % Participants % Participants Self-report of improved functional memory skills in people with MCI 100 Intervention 100 Control >+2 (clinically significant) +1 <0 >+2 (clinically significant) +1 <0 Performance Satisfaction

29 Problem: I feel frustrated when my spouse repeats questions I already answered. How would you rate your current performance or ability in dealing with this problem? Not able to do it Can do it extremely well How satisfied are you with the way you currently handle this problem? Not able to do it Can do it extremely well Measure adapted from Law et al., (1994). Canadian Occupational Performance Measure (2 nd ed.). Toronto, ON: CAOT

30 % Participants % Participants Improved ability managing challenges related to living with a person with MCI Intervention Control >+2 (clinically significant) +1 <0 0 >+2 (clinically significant) +1 <0 Performance Satisfaction

31 % of respondants Positive Lifestyle Change Post-Program Participation Yes No MCI Family

32 Types of Reported Lifestyle Changes Stress Management 16% MCI Exercise 28% Stress Management 38% Family Exercise 19% Diet 19% Engagement 29% Engagement 37% Diet 14%

33 Participant Feedback MCI increased confidence better functional memory 95% recommend program Family decreased worry improved skill at managing change 97% recommend program

34 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 family

35 Acknowledgements Angela Troyer Nicole Anderson Morris Moscovitch Fergus Craik Gillian Rowe Lynn Hasher Janet Murchison Renee Climans Deirdre Dawson Corey Mackenzie Andrea Maione Angelina Polsinelli Nicole D Souza Diana Smith Preeyam Parikh Rita Vitorino Renee Biss Aurela Vangjeli Fuquiang Gao Nina Dopslaff Alzheimer Society C A N A D A Morris Goldenberg Medical Research Endowment THANK YOU

36 Raising Awareness 2012, Oxford University Press: New York