Five-year effects of cognitive training in individuals with mild cognitive impairment

 Do you really think your doctor and hospital are competent enough to know about this AND implement this for stroke survivors?

Five-year effects of cognitive training in individuals with mild cognitive impairment

Sylvie Belleville, Marc Cuesta, Nathalie Bier, Catherine Brodeur, Serge Gauthier, Brigitte Gilbert, Sébastien Grenier, Marie-Christine Ouellet, Chantal Viscogliosi, Carol Hudon

First published: 06 September 2024

https://doi.org/10.1002/dad2.12626

Sections

PDF

Tools

Share

Abstract

INTRODUCTION

In a 5-year follow-up study, we investigated the enduring effects of cognitive training on older adults with mild cognitive impairment (MCI).

METHODS

A randomized controlled single-blind trial involved 145 older adults with MCI, assigned to cognitive training (MEMO+), an active control psychosocial intervention, or a no-contact condition. Five-year effects were measured on immediate and delayed memory recall, the Montreal Cognitive Assessment screening test (MoCA), self-reported strategy use, and daily living difficulties.

RESULTS

At follow-up, participants who received cognitive training showed a smaller decline in delayed memory and maintained MoCA scores, contrasting with greater declines in the control groups. Cognitive training participants outperformed controls in both delayed memory and MoCA scores at the 5-year time point. No significant group differences were observed in self-reported strategy use or difficulties in daily living.

DISCUSSION

Cognitive training provides long-term benefits by mitigating memory decline and slowing clinical symptom progression in older adults with MCI.

Highlights

• Cognitive training reduced the 5-year memory decline of persons with MCI.
• Cognitive training also reduced decline on the Montreal Cognitive Assessment (MoCA).
• No intervention effect was found on strategy use or activities of daily living.

1 INTRODUCTION

Alzheimer's disease (AD) has a long prodromal phase, offering a valuable opportunity to implement strategies aimed at slowing the progression of mild cognitive symptoms into dementia.^1-3 Among these strategies, cognitive training emerges as a promising approach to counter cognitive decline in individuals with mild cognitive impairment (MCI),^4-7 many of whom find themselves in the prodromal phase of AD. Cognitive training equips older adults with compensatory strategies that mitigate the impact of cognitive difficulties in their daily lives. Furthermore, it contributes to cognitive reserve, providing additional protection against dementia.^8-10

Studies have indicated that cognitive training can yield immediate cognitive benefits in individuals with MCI.^{5, 11-13} However, long-term effects of cognitive training in this population and its efficacy in mitigating the progression of cognitive symptoms remain largely unknown. In the context of normal aging, the ACTIVE trial¹⁴ stands out as one of the few studies that examined the long-term benefits of cognitive training, including follow-up assessments up to 10 years post-intervention.^{15, 16} Participants randomized to memory, reasoning, or processing speed training outperformed a no-contact control group in the targeted cognitive domains. Notably, those in the reasoning and processing speed groups maintained superior performance 5¹⁵ and 10 years¹⁶ post-training. Nevertheless, the ACTIVE trial exclusively involved healthy older adults, and to our knowledge, no study has assessed the long-term benefits of cognitive training on cognition in individuals with MCI beyond an 18-month follow-up.¹³ Demonstrating that cognitive training can reduce symptom progression holds significant potential, particularly in the absence of disease-modifying treatments. It could serve as an accessible tool to support cognition in older adults at risk of dementia.

Over the past 15 years, we have developed and validated the MEMO+ program (Méthode d'Entrainement pour une Mémoire Optimale, Training Method for Optimal Memory^{5, 17, 18}). This program teaches memory encoding strategies that utilize the remaining cognitive capacities of individuals with MCI, helping them in compensating for their everyday memory challenges. A prior randomized controlled trial involving 145 older adults with MCI demonstrated the program's short-term efficacy in improving episodic memory, showing enhanced delayed memory compared to a no-contact control group.⁵, while a psychosocial intervention (active control) did not. Participants also reported using more memory strategies in daily life, as measured by the Multifactorial Memory Questionnaire-Strategies (MMQ).¹⁹ Enhanced delayed memory and strategy use effects were still observed 6-months post-intervention. Furthermore, increased activation in frontal, temporal, and parietal brain regions was observed,¹⁸ suggesting enhanced recruitment of both specialized and alternative brain regions.

RESEARCH IN CONTEXT

1. Systematic review: There is a paucity of published data on the long-term effect of non-pharmacological interventions, such as cognitive training.

2. Interpretation: Following a 5-year follow-up, individuals with mild cognitive impairment who underwent cognitive training exhibited significantly less memory decline and outperformed the control groups on the Montreal Cognitive Assessment (MoCA). No intervention effects were observed on self-reported strategy use or difficulties in instrumental activities of daily living at the 5-year timepoint.

3. Future directions: Cognitive training shows promise for providing long-term benefits to older adults with mild cognitive impairment; however, larger studies are needed, and efforts should focus on identifying those who benefit and on developing approaches that facilitate effective transfer.

The main objective of the present study was to assess the long-term benefits of the MEMO+ cognitive training program. To accomplish this objective, we contacted participants from the initial MEMO+ study 5 years after training. We conducted assessments focusing on delayed memory, which was identified as the primary outcome sensitive to MEMO+ training in the initial study. Additionally, we investigated potential maintenance of self-reported difficulties in activities of daily living (ADL), of global cognition with the Montreal Cognitive Assessment (MoCA)²⁰ and of strategy use with the MMQ questionnaire. Given that the participants had MCI at study entry, we hypothesized that there would be a decline in delayed memory and MoCA scores at the 5-year follow-up, along with an increase in self-reported difficulties in ADL. However, we anticipated a significant Intervention × Time interaction, indicating that participants randomized to the MEMO+ program would exhibit less memory decline and fewer self-reported difficulties in ADL than those in the no-contact condition. Furthermore, we expected MEMO+ participants to continue reporting greater use of memory strategies on the MMQ than participants in the no-contact condition. Finally, based on the hypothesis that cognitive training has a protective effect, we anticipated that MEMO+ participants would better maintain their performance on the MoCA compared to participants in the no-contact condition.

More at link.