A Qualitative Study of the Cognitive Rehabilitation Program GRADIOR for People with Cognitive Impairment: Outcomes of the Focus Group Methodology

Harmonizing Cognitive and Psychosocial Needs in Cognitive Training: Lessons Learned from Piano Training in Persons Living with Mild Cognitive Impairment

OBJECTIVES

This qualitative study explored the potential of piano training as a holistic intervention to enhance both cognitive and emotional well-being. The study aims to detail the experiences of older adults living with mild cognitive impairment (MCI) in a piano training program and recommend strategies to boost engagement.

METHODS

Fourteen individuals (seven older adults with MCI and their family members) participated in individual semi-structured interviews before and after a 12-week group-based piano training program. These interviews were recorded, transcribed, open-coded, and analyzed by conventional content analysis.

RESULTS

Participants with MCI reported improvements in mood, cognitive function, and social interaction. The learning process elicited mixed emotions, with both enjoyment and frustration occurring during the learning phases. Skill mastery and positive social interactions were crucial for sustained engagement throughout the program, although group settings sometimes led to negative self-comparisons.

CONCLUSIONS

Findings highlighted the need to address both cognitive and emotional needs in interventions for MCI. Neglecting these aspects can exacerbate feelings of low self-esteem and other negative emotions.

CLINICAL IMPLICATIONS

Recommendations for cognitive training programs include positive reinforcement, personalized support, mental preparation for challenges, and rapport building to enhance participant motivation and adherence.

Perspectives of persons with mild cognitive impairment, caregivers and healthcare professionals on computer-assisted cognitive training: A multi-perspective qualitative study

OBJECTIVE

To explore the perspectives and perceptions of persons with mild cognitive impairment (MCI), their caregivers, and healthcare professionals on computerized cognitive training (CCT).

MATERIAL AND METHODS

Utilizing phenomenological research methods, 12 MCI patients, 11 caregivers, and 15 healthcare professionals were recruited. Data were collected through four focus group interviews and six semi-structured in-depth interviews conducted between March 2023 and June 2023. Colaizzi's analysis method was used to analyze the transcribed interviews.

RESULTS

The study identified three main themes: (1) perception of CCT treatment, (2) emotional experiences with CCT, and (3) coping strategies. These themes highlighted various barriers and facilitators to CCT acceptance and implementation.

CONCLUSIONS

Emphasizing the popularization of CCT for MCI treatment is crucial. The study underscores the importance of addressing patients' emotional needs, providing psychological and social support, and offering personalized, multidomain non-pharmacological guidance to maximize CCT's effectiveness.

Compensatory Strategy Intervention: What Older Patients Want and Why

OBJECTIVE

Compensatory strategies can improve performance of instrumental activities of daily living in people with cognitive impairment. This study investigated patient interest in compensatory strategy interventions and preference for various intervention formats.

METHODS

Semi-structured qualitative interviews with 38 older adults with cognitive impairment queried motivation to improve strategy use and interest in intervention formats/delivery methods. Two coders used thematic analysis to determine rates of interest in each intervention type and explore patient-reported barriers and facilitators to motivation and intervention models.

RESULTS

Most of the samples reported motivation to enhance compensatory strategy use. Degree of motivation was driven by current experiences with strategy use, perceived benefit of potential changes, intrinsic desire to improve life and self, and current perceived need. The vast majority were interested in hour-long, multi-session, instructor-led interventions. Just over half of the sample was interested in a self-directed virtual program, and just under half was interested in involving family/friends. Facilitators and barriers to interest in intervention formats and delivery methods varied based on participants' previous experiences, preferred learning style, content, and time commitment of the intervention, and perceived current need for intervention. One-fifth of the sample expressed no interest in any intervention type, though they expressed openness to assistance in the future as needed.

CONCLUSIONS

Older adults with cognitive impairment are generally motivated to enhance their compensatory strategy use. Clinicians/researchers designing compensatory strategy interventions should consider instructor-led formats, present individualized benefits of interventions, and demonstrate the benefits of both preventative and remedial intervention to optimize patient engagement.

Usability and user experience impressions of older adults with cognitive impairment and people with schizophrenia towards GRADIOR, a cognitive rehabilitation program: A cross-sectional study

OBJECTIVE

The aim of this study was to evaluate and compare the impressions of older adults with mild dementia/MCI (mild cognitive impairment) and people with schizophrenia towards the usability of GRADIOR (version 4.5) and their user experience (UX) with this computerized cognitive rehabilitation program.

METHODS

The impressions towards the usability of GRADIOR and the UX of 41 older adults with mild dementia/MCI and 41 people with schizophrenia were obtained using the User Experience Questionnaire.

RESULTS

Older adults with dementia/MCI had more positive impressions than people with schizophrenia. Both agreed that its quality was lower in Dependability.

CONCLUSION

GRADIOR meets users' needs and preferences but needs improvements to ensure they feel more in control when interacting with it. For people with schizophrenia, other aspects of usability and UX need improvement. Usability and UX evaluation allow the verification of technological acceptability and functionality, and to identifying specific improvements for each user group.

Tailoring Semantic Interventions for Older Adults: Task-Focused and Person-Centered Approaches

In this narrative review, we explore the latest evidence on semantic interventions for older adults, including both prevention and rehabilitation/remediation efforts, discussing them particularly in the context of dementia. Cognitive interventions vary in their level of structure, encompassing standardized (task-focused tasks) and unstandardized tasks (person-centered tasks). These interventions also differ in their target: rehabilitation or prevention. Addressing semantic knowledge/semantic memory/semantics is important, primarily because its efficiency impacts other cognitive domains. Semantic tasks are commonly included in preventive and rehabilitation programs, typically as standardized tasks with pre-defined semantic referents. On the other hand, person-centered approaches introduce personally relevant semantics, allowing patients to share thoughts and experiences with expressive language. Although these approaches offer benefits beyond cognitive improvement, their lack of structure may pose challenges. Our question club (CQ) program blends structured activities with personally relevant semantics, aiming to harness the advantages of both methods. Additionally, in this narrative review, we discuss future challenges and directions in the field of semantic interventions.

What are effective vaccine distribution approaches for equity-deserving and high-risk populations during COVID-19? Exploring best practices and recommendations in Canada: protocol for a mixed-methods multiple case codesign study

INTRODUCTION

The WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities.

METHODS AND ANALYSIS

Multiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations.

ETHICS AND DISSEMINATION

This study is approved by the University of Toronto's Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations.

Digital storytelling intervention to enhance social connections and participation for people with mild cognitive impairment: a research protocol

Introduction

Interventions utilizing the principles of digital storytelling can improve cognitive ability by cultivating positive emotions and framing a new way to enhance social participation among people with mild cognitive impairment. However, existing research has understudied group-based storytelling, focusing instead on building individual stories and connections with family and friends. In response to this research gap, this paper proposes co-designing a digital storytelling intervention for people with Mild Cognitive Impairment (MCI) to enhance their social participation and build meaningful connections.

Methods

We will conduct two co-design workshops with people with MCI (n = 12), their caregivers (n = 4-12), and therapists (n = 5) in Beijing, China, to facilitate the co-development of the digital storytelling application. During the first workshop, we will utilize card sorting and voting to define potential facilitators of social participation, identifying the abilities people with MCI want to improve through storytelling. During the second workshop, we will build on these findings to facilitate people with MCI and their caregivers to visualize the interfaces. After reflexive thematic analysis of the co-design workshops, we will develop a digital storytelling application and test its usability and efficacy among people with MCI and therapists, respectively. A single-blinded field test will be conducted with 20 community-dwelling adults with MCI (Age: 65+). The testing will consist of an intervention group of 10 participants who use the co-designed digital storytelling intervention and a control group of 10 participants who will not use the co-designed intervention on the waiting list. The intervention period will extend over 7 weeks, with individual intervention sessions lasting 30 min. We will evaluate its efficacy in terms of social participation, social connectedness, self-efficacy, subjective sense of happiness, and user experience of people with MCI.

Discussion

This study will examine an innovative digital storytelling intervention to enhance social participation among people with MCI. This study is expected to advance the concept of community-centric social groups in social health service contexts by integrating technological solutions with the self-identified needs and lived experiences of people with MCI, increasing the motivation of people with MCI to cultivate social participation.

Ethics and dissemination

Swinburne University of Technology's Human Research Ethics Committee gave ethics approval for this research (Approval Number: 20226525-11105; Date: 26/09/2022). Our findings shall be reported in peer-reviewed journal articles and at relevant conferences.

"It's Another Feather in My Hat"-Exploring Factors Influencing the Adoption of Apps With People Living With Dementia

INTRODUCTION

With the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing adoption of mobile applications for people living with dementia.

METHODS

The recruitment of participants was facilitated through a dementia advocacy group of people living with dementia. A focus group design was applied to elicit discussion and to explore divergent views on the topic. The data was analysed using thematic analysis.

FINDINGS

The 15 individuals who participated in this study comprised of seven women and eight men within the age range of 60-90 years. This study reports key findings pertaining to the views and experiences of using mobile apps. Data analysis revealed the following four distinct themes; (Theme 1: Living with dementia)-"That's the difficulty there even with apps or anything else." (Theme 2: Motivation)- "It makes me feel good. I feel a little with it [laughs], that its not all gone in there" (Theme 3: Fears and Concerns)- "Can somebody else get into your personal memories?" (Theme 4- Support)- "So it's important that we have that support". Together these themes encapsulate the most influential aspects, as highlighted by the participants influencing the acceptance and adoption of apps.

CONCLUSION

This paper explores the barriers and facilitators to app acceptance and adoption. This includes the importance of "feel good moments" and positive experiences, challenges associated with living with dementia, the importance of ongoing support, and security of the user's information. This study adds to what is already known by capturing the views and experiences of people living with dementia in relation to the factors influencing the adoption of apps.

Perceptions of Older People with Cognitive Impairment, Caregivers, and Professionals about ehcoBUTLER (Tablet Health Care Platform): A Qualitative Focus Group Study

EhcoBUTLER is a tablet platform mainly aimed at the elderly with mild cognitive impairment (MCI) to promote their well-being and health. The main objective of this study was to explore the perceptions and feedback level of the ehcoBUTLER potential users and stakeholders to improve its development. Through this exploration, the secondary objective was to contribute to the development of software/apps that promote their integral health. Focus groups were conducted (13 elderly with MCI, 13 with dementia, 12 caregivers, 11 professionals). The content and feedback level were analyzed. Participants liked the appearance of ehcoBUTLER, would like to use it, and were mainly interested in the emotional, healthy lifestyle, cognitive, and ergonomic tools. It is necessary to have prior training, more intuitive/customizable apps, low-price/free, offline/USB content, and add other activities/features. EhcoBUTLER is well-oriented to meet the needs and preferences of potential users. However, improvements in its usability, accessibility, and sustainability are needed. The participants' perspectives provided a comprehensive view to improve ehcoBUTLER, so that in the future, it can benefit the elderly to be active agents in their health; support caregivers in their role and to have a respite; and professionals to have a multi-intervention platform. The present findings can contribute to the development of tablet software/apps that promote the integral well-being of this population.

Cognitive Stimulation Program Presented Through New Technologies in a Group of People with Moderate Cognitive Impairment

BACKGROUND

Cognitive stimulation is one of the non-pharmacological therapies recommended for intervention in dementia, consisting of activities involving different cognitive domains and involving brain activation. New technologies can be very useful in this field, favoring intervention tasks.

OBJECTIVE

The objective of this work is to test the effectiveness of a cognitive stimulation intervention mediated with new technologies on a group of people with moderate dementia.

METHODS

This is a quantitative, quasi-experimental study with a control and treatment group, with three measurement times (pre, post, and follow-up months after the end of the intervention). Ninety-eight subjects with moderate dementia were randomly assigned to the treatment group (N = 50) and the control group (N = 48). The treatment group received 16 intervention sessions including attention, executive function, and memory tasks, which were presented using new technologies and the activity was conducted in a group setting. Control group remained on a waiting list. The evaluators did not know which group each subject belonged to. All participants were assessed with a battery of neuropsychological tests.

RESULTS

The results show an improvement in post-intervention outcomes in the treatment group compared to the control group on cognitive variables. No differences were found in mood depression. These results fade overtime after a few months without intervention.

CONCLUSION

This type of intervention is useful to maintain cognitive functioning using new technologies and in a group setting, which favors the intervention. The improvements of the intervention disappear at follow-up, which would indicate the need to maintain the intervention over time.

Determinants of Adherence to a "GRADIOR" Computer-Based Cognitive Training Program in People with Mild Cognitive Impairment (MCI) and Mild Dementia

BACKGROUND

Computer-based programs have been implemented from a psychosocial approach for the care of people with dementia (PwD). However, several factors may determine adherence of older PwD to this type of treatment. The aim of this paper was to identify the sociodemographic, cognitive, psychological, and physical-health determinants that helped predict adherence or not to a "GRADIOR" computerized cognitive training (CCT) program in people with mild cognitive impairment (MCI) and mild dementia.

METHOD

This study was part of a randomized clinical trial (RCT) (ISRCTN: 15742788). However, this study will only focus on the experimental group (n = 43) included in the RCT. This group was divided into adherent people (compliance: ≥60% of the sessions and persistence in treatment up to 4 months) and non-adherent. The participants were 60-90 age and diagnosed with MCI and mild dementia. We selected from the evaluation protocol for the RCT, tests that evaluated cognitive aspects (memory and executive functioning), psychological and physical health. The CCT with GRADIOR consisted of attending 2-3 weekly sessions for 4 months with a duration of 30 min Data analysis: Phi and Biserial-point correlations, a multiple logical regression analysis was obtained to find the adherence model and U Mann-Whitney was used.

RESULTS

The adherence model was made up of the Digit Symbol and Arithmetic of Wechsler Adult Intelligence Scale (WAIS-III) and Lexical Verbal Fluency (LVF) -R tests. This model had 90% sensitivity, 50% specificity and 75% precision. The goodness-of-fit p-value of the model was 0.02.

CONCLUSIONS

good executive functioning in attention, working memory (WM), phonological verbal fluency and cognitive flexibility predicted a greater probability that a person would be adherent.

The Effectiveness of GRADIOR: A Neuropsychological Rehabilitation Program for People with Mild Cognitive Impairment and Mild Dementia. Results of a Randomized Controlled Trial After 4 and 12 Months of Treatment

BACKGROUND

Computer-based cognitive training programs have been developed with promising results on the maintenance/improvement of cognitive performance in people with dementia.

OBJECTIVE

The objective was to evaluate the effectiveness of the cognitive rehabilitation program "GRADIOR" in people with mild cognitive impairment and mild dementia.

METHOD

This study was a single-blind multicenter randomized clinical trial. Participants were recruited from hospitals/day centers. The experimental group (EG) and control group (CG) received computer-based cognitive training (CCT) and routine daily care, respectively. Outcome measures at T0: baseline, T1: at 4 months, T2: at 12 months were compared within and between-groups.

RESULTS

Significant differences or important effect sizes were detected at the intragroup and intergroup level for most variables, observing a trend of improvement and/or maintenance at 4 months by Visual Reasoning of Cambridge Cognitive Examination (CAMCOG), Digit and Arithmetic of WAIS-III, Semantic Verbal Fluency, Mini-Mental State Exam (MMSE), Trail Making Test (TMT)-A-Mistakes and at 12 months by Visual Reasoning of CAMCOG, Digit Symbol of WAIS-III, TMT-B-mistakes, Visual Memory of Rivermead Behavioural Memory Test, Lexical Verbal Fluency-P, Yesavage's Geriatric Depression Scale (GDS), TMT-A-time scales whose objective was to evaluate some executive functions and/or the memory. The CG presented a worsening trend for most of the measures towards 12 months. There was also a significant interaction between "time and group" for MMSE (F = 8.971; p = 0.03; η 2 = 0.019) and the GDS (F = 3.414; p = 0.04; η 2 = 0.041), as well as small effect sizes for TMT-A-time (F = 1.641; p = 0.21; η 2 = 0.021) and TMT-A-mistakes (F = 0.908; p = 0.41; η 2 = 0.019).

CONCLUSION

CCT with GRADIOR has been proved to benefit cognitive functions (ISRCTN:15742788).