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Behavioral Interventions in Mild Cognitive Impairment (MCI): Lessons from a Multicomponent Program

Neurotherapeutics volume 19, pages 117–131 (2022)Cite this article

Abstract

Comparative effectiveness of behavioral interventions to mitigate the impacts of degeneration-based cognitive decline is not well understood. To better address this gap, we summarize the studies from the Healthy Action to Benefit Independence & Thinking (HABIT®) program, developed for persons with mild cognitive impairment (pwMCI) and their partners. HABIT® includes memory compensation training, computerized cognitive training (CCT), yoga, patient and partner support groups, and wellness education. Studies cited include (i) a survey of clinical program completers to establish outcome priorities; (ii) a five-arm, multi-site cluster randomized, comparative effectiveness trial; (iii) and a three-arm ancillary study. PwMCI quality of life (QoL) was considered a high-priority outcome. Across datasets, findings suggest that quality of life was most affected in groups where wellness education was included and CCT withheld. Wellness education also had greater impact on mood than CCT. Yoga had a greater impact on memory-dependent functional status than support groups. Yoga was associated with better functional status and improved caregiver burden relative to wellness education. CCT had the greatest impact on cognition compared to yoga. Taken together, comparisons of groups of program components suggest that knowledge-based interventions like wellness education benefit patient well-being (e.g., QoL and mood). Skill-based interventions like yoga and memory compensation training aid the maintenance of functional status. Notably, better adherence produced better outcomes. Future personalized intervention approaches for pwMCI may include different combinations of behavioral strategies selected to optimize outcomes prioritized by patient values and preferences.

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Acknowledgements

Research reported in this manuscript was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Award (CER-1306-01897). The statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee. Trial Registration: ClinicalTrials.gov Identifier, NCT02265757, and peace of mind studies.

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Authors and Affiliations

  1. Department of Clinical and Health Psychology, University of Florida, Gainesville, PO Box 100165, Florida, FL, 32653, USA

    Shellie-Anne Levy, Glenn Smith, Liselotte De Wit, Brittany DeFeis, Gelan Ying & Priscilla Amofa

  2. Division of Neuropsychology, Mayo Clinic, Scottsdale, AZ, USA

    Dona Locke

  3. Department of Psychiatry and Psychology, Mayo Clinic Health System, La Crosse, WI, USA

    Anne Shandera-Ochsner & Courtney McAlister

  4. Department of Neurological Sciences, University of Nebraska Medical Center Omaha, Nebraska, USA

    Vaishali Phatak

  5. Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA

    Melanie Chandler

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  1. Shellie-Anne Levy
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Correspondence to Shellie-Anne Levy.

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Conflict of Interest

The Mayo Clinic and the University of Florida offer the HABIT® program as a clinical service, billing for and collecting revenues from this program. While several of the authors are salaried employees of one of these organizations, none of the study authors or PIs receives direct, financial benefit from this service. Furthermore, none of the authors holds equity in or benefit financially from the vendors of the products used in the HABIT program.

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Levy, SA., Smith, G., De Wit, L. et al. Behavioral Interventions in Mild Cognitive Impairment (MCI): Lessons from a Multicomponent Program. Neurotherapeutics 19, 117–131 (2022). https://doi.org/10.1007/s13311-022-01225-8

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Keywords

  • Behavioral interventions
  • Mild cognitive impairment
  • HABIT®
  • Comparative effectiveness