Wellness education and yoga appeared to offer the most effective interventions for people with mild cognitive impairment, a cluster comparative effectiveness trial found.
A year after they were delivered, five behavioral interventions showed no significant between-group differences on overall quality of life, the study’s primary endpoint.
But wellness education and yoga showed benefits in secondary endpoints: wellness education boosted mood, and yoga improved memory-related activities of daily living, according to Melanie Chandler, PhD, of the Mayo Clinic in Jacksonville, Florida, and colleagues.
Computerized cognitive training had the least effect on these outcomes, they wrote in JAMA Network Open.
“This study was a preliminary look at comparative effectiveness of different types of interventions for mild cognitive impairment,” Chandler said.
“Most research to date in this area has focused on the cognitive performance outcome itself or functional ability,” she told MedPage Today. But the first part of this Patient-Centered Outcomes Research Institute (PCORI) study asked a sample of patients with mild cognitive impairment and their partners to rank which outcomes were most important in an intervention trial. “The top four responses, from a possible 13 choices, were quality of life, mood, self-efficacy, and memory-related activities of daily living,” she said.
Approximately 15% to 20% of people age 65 or older have mild cognitive impairment and about 32% of these people develop Alzheimer’s dementia within 5 years. Patients and family members “may receive many suggestions of what to do to help with memory loss, like writing down more notes, doing computer games or paper and pencil games, or eating a certain diet,” Chandler said. “They want to do things to help their situation, but are unsure what they should and should not invest their time doing.”
In this trial, Chandler and co-authors looked at comparative differences between five behavioral interventions in a novel study design: they withheld one of them from patients in randomized fashion while providing the other four.
The study used core components of the Mayo Clinic’s HABIT (Healthy Action to Benefit Independence and Thinking) program. HABIT is a 10-day program for patients with mild cognitive impairment and their partners that offers five group interventions:
- Memory support, which teaches memory compensation skills, including a calendar system and written notes
- Cognitive exercise, which uses computerized and other cognitive training
- Yoga, to teach chair-based physical exercise and relaxation
- Wellness education, which shares scientific evidence about nutrition, sleep, and emotional health
- Support groups, led by trained therapists with separate groups for patients and partners
Study participants were randomized to one of five groups. In each group, one of the interventions was randomly selected to be withheld. The remaining four interventions were delivered for 40 hours over 2 weeks to patients and care partners, with 1-day booster sessions 6 and 12 months after the intervention.
The researchers enrolled 272 patients from four academic medical outpatient centers who met the National Institute on Aging-Alzheimer’s Association criteria for mild cognitive impairment from September 2014 through August 2016. Their average age was 75 and 58.8% were men.
For the primary endpoint of quality of life at 12 months, there were no significant pair-wise differences among the interventions. The greatest effect size for quality of life was between the group without computerized cognitive training and the group without wellness education at 0.34 (95% CI 0.05-0.64, P=0.15).
Among secondary outcomes, wellness education had a greater effect on mood than computerized cognitive training (effect size 0.53, 95% CI 0.21-0.86, P=0.01). Yoga also showed a greater effect on memory-related activities of daily living than support groups (effect size 0.43, 95% CI 0.13-0.72, P=0.04).
Yoga and wellness education had been ranked as the two least important components by prior HABIT participants, “raising questions as to whether patients recognize the potential value of these interventions,” noted Kelsey Laird, PhD, and Helen Lavretsky, MD, MS, both of the University of California, Los Angeles, in an accompanying editorial.
“Chandler et al also note that while they accurately predicted a minimal effect of cognitive training on the outcomes of interest, the relatively superior effect of wellness education on mood was unexpected,” they continued. “However, this result is consistent with previous research demonstrating significant mood benefits of health education and no significant difference in the effect of cognitive training vs health education on mood in older adults with mild cognitive impairment.”
The trial had several limitations — most importantly, that it was underpowered, the authors noted. “Our study had a novel statistical design, and our initial statistical power assessment was unrealistic,” they wrote. “However, the results still provide preliminary answers regarding comparative effectiveness.”
The study also relied on subjectively-reported data and did not include biomarkers to measure mood and stress, or objective assessments of participants’ ability to perform memory-related activities of daily living. The trial population was not diverse and was highly educated, limiting its ability to apply to other people. In addition, the study’s endpoints were determined from patients participating in HABIT; preferences could change over the trajectory of cognitive impairment.
This research was funded through Patient-Centered Outcomes Research Institute (PCORI).
Researchers reported relationships with PCORI, the National Institutes of Health and the State of Arizona.
Editorialists reported relationships with Allergan/Forest Laboratories, the National Institutes of Health, PCORI, the Alzheimer’s Research and Prevention Foundation, the Oxford University Press, and Johns Hopkins University Press.
Source: MedicalNewsToday.com
