Evaluating the sustainability of computer-based cognitive training program for older adults with cognitive decline managed in Hong Kong primary care setting.
HA Convention 2015
1. Department of Occupational Therapy, Queen Elizabeth Hospital
2. Department of Family Medicine and General Outpatient Clinic, Queen Elizabeth Hospital
Background (1) • Primary care
– Early detection of cognitive impairment, e.g. Mild cognitive impairment, dementia9.
From www.dementiatoday.com
Background (2) • Kowloon Central
Cluster (KCC) Enhancement of Public Primary Care Service (EPPS) – Occupational
Therapy Service in 2012
Background (3) • Referral for cognitive
assessment and training – Around 29% of total
new referrals in 2013 – Subjective/Objective
memory decline reported to GOPC doctors firstly
Cognitive 29%
Orthopaedic 23%
CTD 26%
Varicose Vein 14%
Others 8%
2013 New Case Statistic Review
Background (4) • Abstract in 2014 • Modified computer
based cognitive program by our centre – Positive effectiveness
indicated • Result was consistent
to previous research studies3,4,5
Objective • To evaluate the sustainability of
clients’ cognitive function who completed computer based cognitive training after 6 months.
Methodology (1) • Retrospective study
– 320 cases were retrieved between March 2013-April 2014 • Inclusion criteria
– Aged >= 65 y.o. – Self reported memory problem in daily life – CMMSE scores within 13-29 (13-22: suspected dementia; 23-29:
suspected mild cognitive impairment) – Completed 6-month cognitive assessment
• Treatment
– Modified computer-based cognitive training program – Cognitive areas covered attention, memory, logical reasoning, etc. – Weekly basis for 8 weeks
Methodology (2) • Control group vs. Intervention group
• Outcome measures
– Chinese Mini Mental State Examination (CMMSE)
– Everyday Memory Questionnaire (EMQ)
Demographic data (1) • 44 clients were selected. • Self-declared onset time
of memory decline – Ranged from 2 months to
8 years – Average 1.61 years.
73%
27%
Sex
FemaleMale
Demographic data (2)
4% 11%
44%
19%
15% 0% 7% Illness comorbidity
01234
05
101520
Illnesses
The intervention group (n=18)
The control group (n=26)
Mean age 80 years old 81 years old
Mean educational level 5 years 4 years
Result 19.73
5.88
18.42
5.77
0
5
10
15
20
25
CMMSE EMQ
Baseline Post 6 M
22.94
6.84
23.94
5.63
05
1015202530
CMMSE EMQ
Baseline Post 6 M
The intervention
group
The Control group
Mean Std. Deviation t Sig. (2-tailed)
The intervention group
CMMSE_baseline vs. CMMSE_6-month -1.000 2.108 -2.068 0.053
EMQ_baseline vs. EMQ_6-month 1.211 3.31 1.594 0.128 The control group
CMMSE_baseline vs. CMMSE_6-month 1.308 1.914 3.485 0.002
EMQ_baseline vs. EMQ_6-month 0.115 2.833 0.208 0.837
Conclusion • Our modified computer based
cognitive training shows promise in sustaining cognitive function for 6 months for older adults.
Implication • Early consultation and intervention in the
primary care setting – self-declared memory decline onset time up
to 8 years. • Public promotion
– Patients and caregivers – Misperception to cognitive impairment in
daily life awareness
Enhancement for service • Empowerment of clients and caregivers
– MCI/Dementia educational talk – Occupational lifestyle redesign program – MCI self management program
• Self management approach • Facilitated the generalization of cognitive skills in
daily practice
Knowledge
Lifestyles Skills
Develop new interest
Cognitive stimulating activities
Brain health knowledge
Body mind exercise
Increases both clients and caregivers’ self efficacy to the management of cognitive impairment
Reference (1) 1. Callahan, C.M., Hendrie, H.C. & Tierney (1995). Documentation and Evaluation of Cognitive
Impairment in Elderly Primary Care Patients. Ann Intern Med. 1995;122(6):422-429. 2. Cipriani G, Bianchetti A and Trabucchi M. (2006) Outcomes of a computer-based cognitive
rehabilitation program on a Alzheimer's disease patients compared with those on patients affected by mild cognitive impairment. Arch Gerontol Geriatr, 43: 327-335.
3. Deborah E. Barnes et al., Computer-based cognitive training for mild cognitive impairment: results from a pilot randomized, controlled trial. Alzheimer Dis Assoc Disord. 2009 Jul-Sep;23(3):205-10.
4. Department of Health (2006). Dementia Care Seminar cum Kick-off Ceremony for Dementia Care Campaign. Press release. Available at: http://www.dh.gov.hk/english/press/2006/061013.html
5. Faucounau V, Wu YH, Boulay M, et al. (2010) Cognitive intervention programmes on patients affected by mild cognitive impairment: a promising intervention tool for MCI? The Journal of Nutrition, Health & Aging, 14.1: 31-35.
6. Gates, N.J., Sachdev P.S., Singh, M.A.F. & Valenzuela, M. Cognitive and memory training in adults at risk of dementia: A Systematic Review. BMC Geriatrics 2011, 11:55 doi:10.1186/1471-2318-11-55.
7. Grace Y Lee, Calvin CK Yip, Edwin CS Yu, et al. (2013) Evaluation of a computer-assisted errorless learning-based memory training program for patients with early Alzheimer's disease in Hong Kong: a pilot study. Clinical Interventions in Aging, 8: 623-633.
Reference (2) 7. Hospital Authority. Hospital Authority Statistical Report 2011-2012. Available at:
http://www.ha.org.hk/upload/publication_15/471.pdf 8. Olazarán, J., Torrero, P, et.al. (2011). Mild cognitive impairment and dementia in primary care:
the value of medical history. Family Practice, 28 (4): 385-392. 9. Reisberg, B., Prichep, L. Mosconi, L., et al. (2008). The pre-mild cognitive impairment,
subjective cognitive impairment stage of Alzheimer’s disease. Alzhimer’s & Dementia, 4: 98-108.
10. Stott, J. and Spector, A. (2011). A review of the effectiveness of memory interventions in mild cognitive impairment (MCI). International Psychogeriatrics, 23:4, 526–538.
11. Talassi E, Guerreschi M, Feriani M, et al. (2007) Effectiveness of a cognitive rehabilitation program in mild dementia (MD) and mild cognitive impairment (MCI): a case control study. Arch Gerontol Geriatr, 44: 391-399.