Behavioral Interventions May Improve Life for People With Mild Cognitive Impairment

By Lorraine L. Janeczko

NEW YORK (New York) - Behavioral interventions may be helpful for people with mild cognitive impairment (MCI), new research suggests.

"After MCI diagnosis, behavioral interventions can benefit mood and improve functioning," lead author Dr. Melanie J. Chandler of Mayo Clinic in Jacksonville, Florida, told Reuters Health by email. "I hope these results encourage more physicians to refer to behavioral intervention programs such as the Mayo Clinic HABIT (Healthy Action to Benefit Independence and Thinking), or to provide education and recommend physical exercise, including yoga."

"Even though there is no cure for dementia, non-medicine interventions are available to recommend to patients diagnosed with MCI," she added. "While yoga benefitted daily functioning at one year and wellness education benefitted mood, this does not mean that the other behavioral interventions are not worthwhile. . . Multicomponent programs like the HABIT program likely are the best bet for impacting multiple outcomes."

The findings were published in JAMA Network Open, online May 17.

Dr. Chandler and her colleagues used the HABIT program model to compare the effects of combinations of five behavioral interventions on outcomes important to patients with MCI.

The 272 participants, who averaged 75 years of age and met the National Institute on Aging-Alzheimer’s Association criteria for MCI, were enrolled in the study over a two-year period at four academic medical outpatient centers.

During the 50-hour, two-week program, they were randomized to one of five groups, with each group having one intervention withheld: 56 received no yoga, 54 no computerized cognitive training (CCT), 52 no wellness education, 53 no support and 57 no memory-support system. At six and 12 months, participants and their partners received one-day booster sessions.

At 12 months, the greatest effect size for quality of life, 0.34, was found for the comparison of no CCT and no wellness education (favoring the latter), though this difference was not statistically significant after adjusting for multiple testing (P=0.15).

In secondary analyses, however, wellness education had a significantly greater effect on mood than CCT (effect size, 0.53; P=0.01); and yoga had a greater effect on memory-related activities of daily living than support groups (effect size, 0.43; P=0.04).

Dr. Paul Newhouse, director of the Center for Cognitive Medicine at Vanderbilt University School of Medicine in Nashville, Tennessee, told Reuters Health by email, "The study was remarkable for the willingness of patients to participate and the ability of patients to maintain attendance."

Dr. Newhouse, who was not involved in the study, noted that these findings are important and may encourage providers to incorporate lifestyle interventions into their clinical practice.

"It will be challenging to get these kinds of interventions reimbursed by insurance at this point, but such efforts are warranted," he said.

"This is an important proof-of-concept pilot study in an area that will need increasing study over the next decade," he noted. "The ultimate approach may be to combine these types of lifestyle interventions and/or computerized cognitive training with novel pharmacologic approaches to enhance cognitive function."

Dr. Gwenn S. Smith, who heads the Division of Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, said, "The greater impact of wellness education and yoga on mood along with the possible negative impact of cognitive training is somewhat surprising. This observation reinforces the importance of the multimodality approach."

"Effective treatments for MCI are in development and there is great interest in developing behavioral interventions that can improve cognition, including memory and executive function," Dr. Smith, who also was not involved in the study, told Reuters Health by email. "An evidence base for selecting the optimal components of the intervention is needed, which is why the study is so important."

"Major strengths of the study," she noted, "are its multimodality intervention approach and that such programs can be easily implemented and should be acceptable to many older individuals."

SOURCE: https://bit.ly/2InIB0C and https://bit.ly/2WeJCwK

JAMA Netw Open 2019.

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