Sherrie Hanna

A behavioral rehabilitation intervention for amnestic mild cognitive impairment.

Individuals with amnestic mild cognitive impairment (MCI) currently have few treatment options for combating their memory loss. The Memory Support System (MSS) is a calendar and organization system with accompanying 6-week curriculum designed for individuals with progressive memory impairment. Ability to learn the MSS and its utility were assessed in 20 participants. Participants were significantly more likely to successfully use the calendar system after training. Ninety-five percent were compliant with the MSS at training completion, and 89% continued to be compliant at follow-up. Outcome measures revealed a medium effect size for improvement in functional ability. Subjects further reported improved independence, self-confidence, and mood. This initial examination of the MSS suggests that with appropriate training, individuals with amnestic MCI can and will use a memory notebook system to help compensate for memory loss. These results are encouraging that the MSS may help with the symptoms of memory decline in MCI.

The effect of internet-based cognitive rehabilitation in persons with memory impairments after severe traumatic brain injury

Primary objective: The current study examined whether cognitive rehabilitation delivered over the Internet was associated with improvements in functioning. Research design: A total of 14 individuals with medically documented traumatic brain injury completed this study. Participants completed 30 sessions of an active calendar acquisition intervention and 30 sessions of a control diary intervention in a cross-over study design for a total of 60 online sessions. All sessions were completed using an instant messaging system via the Internet. Measures of cognitive functioning, ratings of memory and mood and frequency of use of common memory and cognitive compensation techniques were gathered from participants and family members. Main outcomes and results: There were no significant differences between the active and control conditions on the primary outcome measure of memory functioning. However, significant improvements in use of compensatory strategies as well as family reports of improved memory and mood were observed following completion of all sessions. Individuals with less use of compensatory strategies at baseline were significantly less likely to complete the study. Conclusions: These results suggest that the Internet may be an effective delivering mechanism for compensatory cognitive rehabilitation, particularly among individuals who are already utilizing some basic compensatory strategies.

Dissociable executive functions in behavioral variant frontotemporal and Alzheimer dementias

Objective: The objective of this study was to determine which aspects of executive functions are most affected in behavioral variant frontotemporal dementia (bvFTD) and best differentiate this syndrome from Alzheimer disease (AD). Methods: We compared executive functions in 22 patients diagnosed with bvFTD, 26 with AD, and 31 neurologically healthy controls using a conceptually driven and comprehensive battery of executive function tests, the NIH EXAMINER battery (http://examiner.ucsf.edu). Results: The bvFTD and the AD patients were similarly impaired compared with controls on tests of working memory, category fluency, and attention, but the patients with bvFTD showed significantly more severe impairments than the patients with AD on tests of letter fluency, antisaccade accuracy, social decision-making, and social behavior. Discriminant function analysis with jackknifed cross-validation classified the bvFTD and AD patient groups with 73% accuracy. Conclusions: Executive function assessment can support bvFTD diagnosis when measures are carefully selected to emphasize frontally specific functions.

Predicting Functional Ability in Mild Cognitive Impairment with the Dementia Rating Scale-2

BACKGROUND We examined the utility of cognitive evaluation to predict instrumental activities of daily living (IADLs) and decisional ability in Mild Cognitive Impairment (MCI). METHODS Sixty-seven individuals with single-domain amnestic MCI were administered the Dementia Rating Scale-2 (DRS-2) as well as the Everyday Cognition assessment form to assess functional ability. RESULTS The DRS-2 Total Scores and Initiation/Perseveration and Memory subscales were found to be predictive of IADLs, with Total Scores accounting for 19% of the variance in IADL performance on average. In addition, the DRS-2 Initiation/Perseveration and Total Scores were predictive of ability to understand information, and the DRS-2 Conceptualization helped predict ability to communicate with others, both key variables in decision-making ability. CONCLUSIONS These findings suggest that performance on the DRS-2, and specific subscales related to executive function and memory, is significantly related to IADLs in individuals with MCI. These cognitive measures are also associated with decision-making-related abilities in MCI.

Priority of Treatment Outcomes for Caregivers and Patients with Mild Cognitive Impairment: Preliminary Analyses

IntroductionThe patient-centered movement advocates for greater attention to the outcomes that matter most to patients and their families. In neurodegenerative disease, determination of patient and caregiver priorities has received scant attention in part because dementia patients are deemed unreliable reporters. However, people with mild cognitive impairment (MCI) likely retain capacity to report their preferences.MethodsIn two separate MCI cohorts, we conducted preliminary analyses of patient and caregiver priorities among seven patient and five caregiver outcomes of the HABIT® Healthy Action to Benefit Independence & Thinking program (Mayo Clinic, Rochester, MN, USA).ResultsVia interview and paper-and-pencil reporting both patient and caregiver respondents’ ranked patient and caregiver quality of life and patient self-efficacy as highest priorities, ranking them ahead of patient and caregiver mood, patient functional status, patient distressing behaviors and caregiver burden. Patients and caregivers tended to value the outcomes for their loved ones higher than their own outcomes.ConclusionCaregivers appeared to be reasonable, but not perfect, proxies for patient reports. Additional research with larger cohorts and a more comprehensive range of outcomes is needed.

Computer versus Compensatory Calendar Training in Individuals with Mild Cognitive Impairment: Functional Impact in a Pilot Study

This pilot study examined the functional impact of computerized versus compensatory calendar training in cognitive rehabilitation participants with mild cognitive impairment (MCI). Fifty-seven participants with amnestic MCI completed randomly assigned calendar or computer training. A standard care control group was used for comparison. Measures of adherence, memory-based activities of daily living (mADLs), and self-efficacy were completed. The calendar training group demonstrated significant improvement in mADLs compared to controls, while the computer training group did not. Calendar training may be more effective in improving mADLs than computerized intervention. However, this study highlights how behavioral trials with fewer than 30–50 participants per arm are likely underpowered, resulting in seemingly null findings.

P4-187: Compensating for memory loss in amnestic mild cognitive impairment

2) Have you been able to utilize the information provided in your day-today living? 3) Would you call the Memory Disorder Clinic for additional information? 4) Are you interested in additional programs at the clinic?. The scoring system we used was 5 strongly agree through 1 strongly disagree with the above statements. During this period 528 received the full evaluation and counseling. We mailed 80 surveys and received 60 responses. Results: On question one through 4 the mean (STD deviation) scores were 4.0( /-0.89), 3.7( /-1.0), 4.0( /-1.1 and 4.1 ( /-1.0.). We made 353 referrals for respite, 97 referrals for adult day care, 292 referrals to support groups, 102 referrals to assisted living facilities, 74 referrals to skilled nursing facilities and 96 referrals for other related social services. Conclusions: From this survey it is clear that physician and geriatric counseling sessions are highly valued by the caregiver. The families receive important information and referrals. Third party payers such as Medicare should reimburse for this service.