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Abstract

Objective:

To determine the feasibility of recruitment and retention of healthy older adults and the effectiveness of an intervention designed to manage age-related executive changes.

Design:

A pilot randomized controlled trial.

Setting:

Research centre and participants’ homes.

Participants:

Nineteen healthy, community dwelling older adults with complaints of cognitive difficulties and everyday problems, but no evidence of mild cognitive impairment, dementia or depression on objective testing.

Interventions:

Seventeen hours of group and individual training. Participants in the experimental arm received education about self-management, successful aging and an occupation-based meta-cognitive strategy-training program. Participants in the control arm received education about brain health and participated in cognitively stimulating exercises.

Main measures:

Changes on untrained, everyday life goals were identified using the Canadian Occupational Performance Measure. Generalization of benefits was measured using the Stanford Chronic Disease Questionnaire, general self-efficacy and changes in executive function (Delis-Kaplan Executive Function System Tower Test, Word Fluency and Trail-Making Test).

Results:

20% (19/96) of healthy older adults approached were eligible, consented and were enrolled in the study, 90% (17/19) were retained to three-month follow-up. Participants in the experimental arm reported significantly more improvement on untrained goals (11/22 compared with 9/46, χ²=4.92, p<0.05), maintenance of physical activity (p<0.05) and better preparation for doctors’ visits (p<0.05) relative to the control group. There were no significant between group differences on objective measures of executive function.

Conclusions:

These data support the feasibility of a larger trial where a sample of 72 (36 participants in each arm) would be required to confirm or refute these findings.

Keywords

Aging cognitive impairment controlled clinical trial rehabilitation interventions strategy-training

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References

Herman

Mirelman

Giladi

. Executive control deficits as a prodrome to falls in healthy older adults: A prospective study linking thinking, walking, and falling. J Gerontol A: Biol 2010; 65A: 1086–1092.

Anstey

Wood

Lord

. Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev 2005; 25: 45–46.

Royall

Lauterbach

Kaufer

. The cognitive correlates of functional status: A review from the committee on research of the American Psychiatric Association. J Neuropsych Clin N 2007; 19: 249–265.

Buckner

. Memory and executive function in aging and AD: Multiple factors that cause decline and reserve factors that compensate. Neuron 2004; 44: 195–208.

Levine

Stuss

Winocur

. Cognitive rehabilitation in the elderly: Effects on strategic behavior in relation to goal management. J Inter Neuropsych Soc 2007; 13: 143–152.

Willis Sherry

Tennstedt Sharon

Ball

. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA-J Am Med Assoc 2006; 296: 2805–2814.

Zelinsky

. Far transfer in cognitive training of older adults. Restor Neurol Neurosci 2009; 27: 455–471.

Polatajko

Mandich

. Enabling occupation in children: The Cognitive Orientation to daily Occupational Performance (CO-OP) approach. Ottawa: CAOT Pub, 2004.

Dawson

Gaya

Hunt

. Using the cognitive orientation to occupational performance (CO-OP) with adults with executive dysfunction following traumatic brain injury. Can J Occ Ther 2009; 76: 115–127.

10.

Skidmore

Holm

Whyte

. A case report examining the feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation. Neuropsych Rehab 2011; 21: 208–223.

11.

Dawson

Troyer

. Applying CO-OP to older adults with age-related executive dysfunction. In: Meaningful occupation: Enabling an ocean of possibilities. CAOT Conference Guide, Halifax, Canada, Poster S7, p.51.

12.

Broadbent

Cooper

Fitgerald

. The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychy 1982; 21: 1–16.

13.

Haringsma

Engels

Beekman

ATF

. The criterion validity of the center for epidemiological studies depression scale (CES-D) in a sample of self-referred elders with depressive symptomatology. Int J Ger Psych 2004; 19: 558–563.

14.

Brandt

Spencer

Folstein

. The telephone interview for cognitive status. Cogn Behav Neurol 1988; 1: 111–117.

15.

Nasreddine

Phillips

Bédirian

. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695–699.

16.

Wechsler

. Wechsler adult intelligence scale – revised manual. New York: Psychological Corporation, 1981.

17.

Wechsler

. WMS-III administration and scoring manual. San Antonio, TX: The Psychological Corporation, 1997.

18.

Heaton

Chelune

Talley

. Wisconsin card sorting test manual. Odessa: Psychological Assessment Resources Inc., 2003.

19.

Levine

Schweizer

O’Connor

. Rehabilitation of executive functioning in patients with frontal lobe brain damage with goal management training. Front Hum Neurosci 2011; 5: 1–9.

20.

Carswell

McColl

Baptiste

. The Canadian Occupational Performance Measure: A research and clinical literature review. Can J Occ Ther 2004; 71: 210–222.

21.

Stanford Patient Education Research Center. Chronic disease self-management program questionnaire code book. 2007.

22.

Sherer

Adams

. Construct validation of the self-efficacy scale. Psychol Rep 1983; 53: 899–902.

23.

Delis

Kplan

Kramer

. Delis-Kaplan Executive Function System. Examiner’s manual. San Antonio, Texas: The Psychological Corporation, Harcourt Assessment Company, 2001.

24.

Moher

Hopewell

Schulz

. CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 2010; 63: e1–e37.

25.

Richardson

JTE

. Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev 2011; 6: 135–147.

26.

Merriam

Caffarella

Baumgartner

. Learning in adulthood: A comprehensive guide. 3rd edn. San Francisco, California: Jossey-Bass, 2007.

27.

Schwartz

. Applications of response shift theory and methods to participation measurement: A brief history of a young field. Arch Phys Med Rehabil 2010; 91: S38–43.

28.

Wallen

Ziviani

. Canadian Occupational Performance Measure: Impact of blinded parent-proxy ratings. Can J Occ Ther 2012; 79: 7–14.

An occupation-based strategy training approach to managing age-related executive changes: a pilot randomized controlled trial