Non-pharmacologic Interventions for MCI
With the disappointing results coming from studies of pharmacologic treatment of mild cognitive impairment, non-pharmacologic interventions have received greater attention. The following reviews give some insight into current issues in this area of research.
ABSTRACT
Cognitive Rehabilitation of Memory for Mild Cognitive Impairment: A Methodological Review and Model for FutureResearch (2014)
Several recent reviews have suggested that cognitive rehabilitation may hold promise in the treatment of memory deficits experienced by patients with mild cognitive impairment. In contrast to the previous reviews that mainly focused on outcome, the current review examines key methodological challenges that are critical for designing and interpretingresearch studies and translating results into clinical practice. Using methodological details from 36 studies, we first examine diagnostic variability and how the use of cutoffs may bias samples toward more severely impaired patients. Second, the strengths and limitations of several common rehabilitative techniques are discussed. Half of the reviewed studies used a multi-technique approach that precludes the causal attribution between any specific technique and subsequent improvement. Third, there is a clear need to examine the dose-response relationship since this information was strikingly absent from most studies. Fourth, outcome measures varied widely and frequently depended on neuropsychological tests with little theoretical justification or ecological relevance. Fifth, we discuss how the variability in each of these other four areas complicates efforts to examine training generalization. Overall, future studies should place greater emphasis on ecologically relevant treatment approaches and outcome measures and we propose a hierarchical model that may aid in this pursuit. [Hampstead, B. M., Gillis, M. M. & Stringer, A. Y. (2014). Journal of the International Neuropsychological Society, 20(2): 135-151.]
FURTHER READING
PODCAST
In this podcast, Dr Helen Lavretsky summarizes the highlights of the following 3 studies that appear in the November 2011 issue of the American Journal of Geriatric Psychiatry.
1. Yeh YC, Tsang HY, Lin PY, et al. Subtypes of mild cognitive impairment among the elderly with major depressive disorder in remission. Am J Geriatr Psychiatry. 2011;19:923-931.
2. Hanfelt JJ, Wuu J, Sollinger AB, et al. An exploration of subgroups of mild cognitive impairment based on cognitive, neuropsychiatric and functional features: analysis of data from the national Alzheimer's coordinating center. Am J Geriatr Psychiatry. 2011 Nov;19:940-950.
3. Duara R, Loewenstein DA, Greig MT, et al. Pre-MCI and MCI: Neuropsychological, Clinical, and Imaging Features and Progression Rates. Am J Geriatr Psychiatry. 2011 Nov;19:951-960.
ABSTRACT
Cognitive Rehabilitation of Memory for Mild Cognitive Impairment: A Methodological Review and Model for FutureResearch (2014)
Several recent reviews have suggested that cognitive rehabilitation may hold promise in the treatment of memory deficits experienced by patients with mild cognitive impairment. In contrast to the previous reviews that mainly focused on outcome, the current review examines key methodological challenges that are critical for designing and interpretingresearch studies and translating results into clinical practice. Using methodological details from 36 studies, we first examine diagnostic variability and how the use of cutoffs may bias samples toward more severely impaired patients. Second, the strengths and limitations of several common rehabilitative techniques are discussed. Half of the reviewed studies used a multi-technique approach that precludes the causal attribution between any specific technique and subsequent improvement. Third, there is a clear need to examine the dose-response relationship since this information was strikingly absent from most studies. Fourth, outcome measures varied widely and frequently depended on neuropsychological tests with little theoretical justification or ecological relevance. Fifth, we discuss how the variability in each of these other four areas complicates efforts to examine training generalization. Overall, future studies should place greater emphasis on ecologically relevant treatment approaches and outcome measures and we propose a hierarchical model that may aid in this pursuit. [Hampstead, B. M., Gillis, M. M. & Stringer, A. Y. (2014). Journal of the International Neuropsychological Society, 20(2): 135-151.]
FURTHER READING
- Cognitive intervention for persons with mild cognitive impairment: A meta-analysis. [Li, et al. (2011). Ageing ResearchReviews, 10(2): 285-296.]
- Nonpharmacological therapies for behavioral and cognitive symptoms of mild cognitive impairment. [Hahn & Andel (2011). J Aging Health, 23(8): 1223-45.]
- Efficacy of cognitive rehabilitation therapies for mild cognitive impairment (MCI) in older adults: working toward a theoretical model and evidence-based interventions. [Huckans, et al. (2013). Neuropsychology Review, 23(1): 63-80.]
PODCAST
- Appropriate Diagnosis of Mild Cognitive Impairment—Just What Is “Normal”? By Helen Lavretsky, MD, MS
In this podcast, Dr Helen Lavretsky summarizes the highlights of the following 3 studies that appear in the November 2011 issue of the American Journal of Geriatric Psychiatry.
1. Yeh YC, Tsang HY, Lin PY, et al. Subtypes of mild cognitive impairment among the elderly with major depressive disorder in remission. Am J Geriatr Psychiatry. 2011;19:923-931.
2. Hanfelt JJ, Wuu J, Sollinger AB, et al. An exploration of subgroups of mild cognitive impairment based on cognitive, neuropsychiatric and functional features: analysis of data from the national Alzheimer's coordinating center. Am J Geriatr Psychiatry. 2011 Nov;19:940-950.
3. Duara R, Loewenstein DA, Greig MT, et al. Pre-MCI and MCI: Neuropsychological, Clinical, and Imaging Features and Progression Rates. Am J Geriatr Psychiatry. 2011 Nov;19:951-960.
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