A multi-modal intervention to enhance cognitive compensation strategies and promote brain health activities

Background: Neuropathological changes associated with Alzheimer's disease (AD) start decades before diagnosis. Subjective cognitive concerns (SCC) and subtle changes in functional abilities also begin very early. Older adults with difficulties in everyday executive and memory abilities are at risk for eventually losing independence in instrumental activities of daily living (IADLs) and progressing towards mild cognitive impairment or AD. Thus, there is a critical window of opportunity for intervention to delay further loss of function. This unique multidimensional intervention builds on compensatory training with other populations to directly target the functional abilities most likely to maintain independent living. Methods: Targeted compensatory training includes 1) a calendar system to support planning and memory, 2) goal planning and task‐lists to increase sense of purpose and accomplish goals, 3) an organization system to maximize daily efficiency. This multidimensional intervention program also targets engagement in healthy lifestyle activities (physical/cognitive exercise, emotional wellbeing) to promote brain health. This project tests the feasibility and efficacy of a 10‐week intervention designed to enhance compensation skills to directly support everyday activities among independent cognitively normal older adults with SCC. A primary goal is to provide evidence that the intervention results in changes in target behaviors. Secondary goals are to obtain preliminary evidence of the program's impact on everyday function. A randomized wait‐list control (WLC) group design will be employed. Results: Initial recruitment is as follows: 50 individuals attended information sessions about the program or received information over the phone, 30 were not interested due mostly to travel complications or schedule conflict, and 20 were randomized with 10 individuals to each the immediate and WLC group. Results from previous pilot data (n=30) provide preliminary evidence that this intervention can result in enhanced compensation skills and more frequent engagement in cognitively stimulating activities and changes can be maintained at three month follow up. Conclusions: Pilot data for this intervention indicates a well‐accepted, novel intervention to support everyday function. Initial recruitment data highlights recruitment complications, most notably travel difficulties for older adults. Thus, this intervention will be provided more directly in the community in which older adults live to enhance recruitment.