Participant Outcomes of a Pilot Telehealth Compensatory Cognitive Training Program

Katie Stypulkowski, University of Colorado, Colorado Springs, Colorado Springs, United States
Elizabeth Anquillare, University of Colorado, Colorado Springs, Colorado Springs, United States
Rachel Thayer, University of Colorado, Colorado Springs, Colorado Springs, United States


Among older adults (OA), mild cognitive impairment (MCI) poses risk for greater cognitive decline and may represent the early stages of a dementia process. Cognitive training has been widely researched as an intervention to improve or stabilize cognition, though non-cognitive outcomes are often omitted. Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) is a compensatory cognitive training (CCT) program providing cognitive strategies to improve cognitive performance and daily functioning. This study examined the impacts of completing CCT among OA with MCI and hypothesized that participants’ ratings of cognitive strategy use, quality of life, daily functioning, mood, and self-efficacy would increase, while reports of cognitive failures and daily cognitive problems would decrease.

Participants and Methods:

OA age 55+ with documented MCI (n=28) and an optional care partner (CP; n=18) were recruited for video-chat delivery of a 6-week, motivationally-enhanced CCT program adapted from CogSMART. Prior to and following program completion, participants reported on quality of life, cognitive self-efficacy, daily cognitive failures, cognitive strategy use, daily functioning, mood, and a control measure assessing motor symptoms. Paired t-tests compared participant pre- and post-measures, and Cohen’s d effect sizes were calculated.


Participants reported more cognitive failures (t=-2.32, p=.03, 95% CI [-24.75, -1.42]), and higher use of cognitive strategies (t=-2.82, p = .01, 95% CI [-11.77, -1.79]) following the intervention. Small effects were seen reflecting higher functional independence (d=0.21), less depression (d=0.29), more anxiety (d=0.38), fewer motor symptoms (d=0.31), and more cognitive failures (d=0.47) after completing CCT. Increased cognitive strategy use showed a medium effect (d=0.59). Post-hoc analysis comparing CP involvement revealed a statistically significant interaction (F(1, 19)=5.10, p=.036; partial eta squared=0.21), wherein participants who completed CCT without CP involvement increased their cognitive strategy use by a greater degree than those who included a CP.


OA with MCI reported higher cognitive strategy use after completing a CCT program, supporting proof of concept. However, they also reported more cognitive failures, which may reflect greater self-monitoring. Small to medium effects were seen on self-ratings of functioning, mood, awareness of cognitive errors, and increased use of cognitive strategies. Changes on a control measure appeared to be driven by reductions in daytime fatigue. Participants who completed the program independently showed a greater increase in their cognitive strategy use than participants who included a CP, perhaps suggesting that those who had CP support could depend on their assistance, whereas those who participated independently may have been more motivated to implement the strategies for themselves. This study is limited by its small and relatively homogeneous sample, which, along with lack of control group, limits statistical power. Overall, proof of concept was supported using this CCT program among OA with MCI through medium effects on increased cognitive strategy use, along with small improvements in daily functioning and depression. The possibility for an increase in anxiety and self-monitoring represents a potential risk of program completion.

Category: Cognitive Intervention/Rehabilitation

Keyword 1: mild cognitive impairment
Keyword 2: cognitive rehabilitation