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

• Photos of the training (Pending)

Corner of computer based cognitive training

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.