MEMO+: Efficacy, Durability and Effect of Cognitive Training and Psychosocial Intervention in Individuals With Mild Cognitive Impairment

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

Disclosures

J Am Geriatr Soc. 2018;66(4):655-663. 

In This Article

Abstract and Introduction

Abstract

Background/Objectives There is no consensus on the efficacy of cognitive training in persons with mild cognitive impairment (MCI) because of the paucity of well–designed randomized controlled trials. The objective was to assess the effect of memory training on the cognitive functioning of persons with MCI and its durability and to evaluate whether this effect generalizes to daily life and whether positive effects could be obtained from psychosocial intervention.

Design Single–blind randomized controlled trial.

Setting Research centers of the Institut Universitaire de Gériatrie de Montréal and Institut Universitaire en Santé Mentale de Québec.

Participants Older adults meeting criteria for amnestic MCI (N = 145).

Intervention Participants were randomized to cognitive training, a psychosocial intervention, or a no–contact control condition. Interventions were provided in small groups in eight 2–hour sessions.

Measurement Outcome measures were immediate and delayed composite performance memory scores, psychological health (depression, anxiety, well–being), and generalization effects of the intervention (strategy use in everyday life, difficulties in complex activities of daily living, memory complaints). Testing was administered before training and immediately, 3 months, and 6 months after training.

Results Participants in the cognitive training condition improved on the delayed composite memory score and on strategy use in everyday life. Improvement was maintained at the 3– and 6–month follow–up assessments. Participants in the psychosocial and no–contact conditions did not show any significant improvement.

Conclusion Cognitive training improves the memory of persons with amnestic MCI. The effect persists over a 6–month period, and learned strategies are used in everyday life. Cognitive training is a valid way to promote cognition in MCI.

Introduction

The term mild cognitive impairment (MCI) is broadly used to describe individuals in a prodromal stage of Alzheimer's disease (AD).[1] These individuals do not meet criteria for dementia but are mildly impaired in cognitive tasks, and many will progress to dementia.[2] There is considerable interest in identifying nonpharmacological interventions to slow progression. Cognitive training is increasingly being recognized as a promising and potentially crucial approach because there is evidence that being engaged in cognitively stimulating activities can protect against cognitive decline in older adults.[3] Furthermore, because their impairment is mild, persons with MCI are capable of learning and applying new strategies.

A few small–scale cognitive training studies have reported positive findings in persons with MCI, and a number of reviews have concluded that it is a potentially effective method for improving cognition and postponing cognitive decline,[4–10] but many studies rely on a waitlist rather than an active control as a condition of reference, do not provide information on long–term maintenance of cognitive improvements, do not report data on mood and quality of life, and lack information on whether the learned strategies transfer to real life. These issues limit our ability to conclude that cognitive training improves cognition in MCI and to recommend its use as a strategy to reduce cognitive decline.[8,11]

There has been recent interest in the potential of interventions that target noncognitive symptoms. Symptoms of anxiety and depression are frequent in individuals with MCI[12] and have been associated with risk of future decline.[13–15] One study indicated good feasibility and positive changes after use of a variant of cognitive–behavioral therapy.[16] Another study showed improved mood after participation in a multicomponent program that included relaxation techniques and stress management,[17] but both studies included elements of cognitive training in their program and were therefore unable to determine the isolated effect of the psychosocial component in their intervention.

Our goal was to determine the effect of cognitive training in persons with MCI in a randomized controlled study that included a psychosocial intervention as an active control condition and a no–contact control condition. This design has the advantage of isolating the effects of cognitive training while providing a meaningful active control condition that allows the contribution of each intervention to mood and well–being to be examined. Thus, a secondary objective was to measure whether a psychosocial intervention can improve the psychological health of individuals with MCI. The immediate and long–term effects of the training were assessed on proximal and distal outcome measures. Finally, we examined moderators of the effect of cognitive training.

The cognitive training used was the Méthode d'Entrainement pour Mémoire Optimale (MEMO) program.[18,19] The intervention focused on learning new strategies, because our goal was to optimize encoding and retrieval. Its content was based on the hypothesis that persons with MCI have difficulty actively encoding information in memory and that attentional control deficits exacerbate their memory deficits. Thus, the program provides participants with strategies that promote elaborative encoding[20–23] and attentional control capacities.

Participants randomized to the cognitive training condition were expected to have a greater increase in memory scores after training than the other groups and were expected to maintain their better performance over time. The training effect was expected to be larger for the delayed than for the immediate composite memory score based on prior work.[18] Participants in the psychosocial intervention group were expected to have better posttraining scores on anxiety, depression, and well–being measures than participants in the other groups. We expected generalization to everyday life for participants enrolled in cognitive training, as shown by a reduction in their level of complaint and an increase in their use of memory strategies in daily life.

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