The Association between Functional Status and Adherence to Compensatory Strategy Training in Individuals with Mild Cognitive Impairment

Kaitlyn Tobin, Georgia State University, Atlanta, United States
Felicia Goldstein, Emory University School of Medicine, Atlanta, United States
Liselotte De Wit, Emory University School of Medicine, Atlanta, United States
Kayci Vickers, Emory University School of Medicine, Atlanta, United States


Evidence suggests compensatory strategy training is a useful behavioral intervention for improving everyday function in older adults with Mild Cognitive Impairment (MCI). Few studies have examined factors, such as baseline functional and cognitive status, that promote or hinder adherence to behavioral interventions in MCI. Thus, the current study sought to evaluate the relationship between baseline functional and cognitive status and adherence to compensatory training.

Participants and Methods:

One hundred and sixteen participants diagnosed with MCI (Mage=74.13 years, SDAge=7.09 years) and their care partners (Mage=66.43 years, SDAge=14.16 years) were enrolled in Emory’s Cognitive Empowerment Program and completed a 12-week compensatory training group (CEP-CT) focused on learning attention, memory, and executive function strategies adapted from Ecologically Oriented Neurorehabilitation for people with MCI. Participants were 54.3% male, primarily White (83.6% White; 13.8% Black; 2.6% Hispanic), and college-educated (M=16.18, SD=2.54). Informant-report measures were completed by a care partner to assess for functional status (Functional Activities Questionnaire; FAQ) and cognitive status (Everyday Cognition Scale; ECog-I). Participants also completed self-report measures of cognitive status (Everyday Cognition Scale; ECog-P) and objective cognitive measures (Montreal Cognitive Assessment [MoCA]; Hopkins Verbal Learning Test [HVLT]; Trail Making Test A & B [TMT]). The outcome assessed was CEP-CT adherence (i.e., proportion of sessions attended; M=.82, SD=.16).


Bivariate Pearson correlations revealed significant associations between CEP-CT adherence and functional and cognitive status, such that better attendance was associated with fewer functional and cognitive difficulties as rated by an informant (FAQ: r=-.18, p=0.05; ECog-I: r=-.21, p=0.03). Item-level exploratory analyses were conducted to understand which FAQ items were most related to participant attendance. These analyses suggested greater independence in shopping alone (r=-.20, p=0.03), safely using the kitchen (r=-.22, p=0.02), and traveling outside the neighborhood (r=-.21, p=0.02) were associated with better class attendance. A significant association was observed between member and care partner attendance (r= .51, p<.01), suggesting participants were more likely to attend if their care partners attended with them. Objective cognitive performance and self-rated cognitive status were not related to rates of CEP-CT adherence.


Results demonstrate participants with MCI who were rated as having fewer functional and cognitive difficulties by a care partner were more likely to attend CEP-CT sessions. Given that care partner attendance in class was associated with increased attendance for the person with MCI, engagement in training may suggest care partners are more likely to encourage attendance with participants perceived to have fewer deficits, as they may experience more perceptible benefits from CEP-CT. These individuals may also have fewer logistical barriers (such as transportation). These results clearly suggest care partner support is a key element of engagement in CEP-CT, even among individuals who are early in their disease process. Future research should identify additional predictors of benefit from cognitive interventions and the role of care partner support in compensatory strategy training.

Category: MCI (Mild Cognitive Impairment)

Keyword 1: mild cognitive impairment
Keyword 2: memory training