INS NYC 2024 Program

Poster	Poster Session 06 Program Schedule 02/15/2024 04:00 pm - 05:15 pm Room: Majestic Complex (Posters 61-120) Poster Session 06: Aging \| MCI \| Neurodegenerative Disease - PART 2 Final Abstract #91 Development and Feasibility of an Individualized Cognitive Augmentation Regimen for Elderly (iCARE) with mild to moderate dementia Aparna Kanmani S, National Institute of Mental Health and Neuroscience (NIMHANS), BENGALURU, India Prof. Keshav Kumar J, National Institute of Mental Health and Neuroscience (NIMHANS), BENGALURU, India Category: Neurodegenerative Disorders Keyword 1: cognitive rehabilitation Keyword 2: dementia - Alzheimer's disease Objective: The increasing evidence for experience-dependent neuroplasticity in older adults, especially in degenerative conditions like dementia, has provided hope in battling cognitive decline. Cognitive Training (CT) – A set of neuroscience-based controlled tasks designed to tweak neural circuitry that mediate cognition and promote brain plasticity - has proven efficacious in improving cognitive functions (Vinogradov et al., 2011). Most studies, however, lack consensus on the mechanism and agreed model of CT for the elderly. Inconsistent effectiveness and huge dropout rates are observed in the existing programs in India due to lack of awareness, accessibility, caregiver support, mobility, resources, geriatric health concerns, etc. There is a need for theoretically-driven and culture-specific models of CT for mild to moderate dementia in India which may help delay or slow overall deterioration. Thus, the study aimed to develop and assess the feasibility of a cognitive neuroscience-informed caregiver-driven training module called the Individualized Cognitive Augmentation Regimen for Elderly (iCARE). The design uses a unique method of empowering the caregivers to serve as co-therapists in delivering the intervention in their ecological setting. Participants and Methods: The study had two phases: Development Phase- This included a) extensive literature review, b) item generation, c) expert rating (by five clinical/neuropsychologists), d) field trial (n=3), and e) feedback and modification. The module is designed as a flip book targeting primarily eight cognitive domains. The program involves caregivers (family or professional) as trainers who provide the intervention to the patient on receiving supervision from a neuropsychologist. Pilot Phase - A quasi-experimental research design was used to recruit patients diagnosed with mild-moderate dementia from a clinical setting and screened using the Clinical Dementia Rating Scale (CDR= 1 or 2). The eligible individuals (n=15) were allocated (1:1) to Treatment as usual group (TAU) or Intervention group (iCARE+TAU). They were assessed at three time points, (baseline, post-intervention, and 1-month follow-up) and received a 5-week treatment (intervention or TAU). Along with neuropsychological variables, secondary variables such as cognitive symptoms, quality of life, activities of daily living, behavioral and psychological symptoms, and caregiver health were also measured using rating scales. The feasibility and the fidelity of the training were also assessed. Results: Promising results were observed from the pilot study that indicated positive changes in task-related performance, neuropsychological variables, secondary outcome measures, and generalizability to functional abilities. The neuropsychological profiles of patients post-iCARE demonstrated improvement in attention, working memory, fluency, verbal recognition, logical memory, and visual memory. Patients also showed better quality of life, independence in daily activities, and reduced symptom severity compared to the TAU group. Further, this was corroborated by caregivers’ subjective reports of increased confidence in patients, improved error detection and self-correction, better communication, self-initiation, and enhanced insight. The caregiver-driven model was found most viable for younger caregivers and those with increased family support. Conclusions: The iCARE program serves as a means to support families in learning a better quality home-based management of dementia. The method of using interactive flipbooks and the caregivers as active co-therapists in delivering the intervention is recommended for collectivistic societies like India to address cognitive decline in dementia.

Poster

02/15/2024
04:00 pm - 05:15 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 06: Aging | MCI | Neurodegenerative Disease - PART 2

Final Abstract #91

Development and Feasibility of an Individualized Cognitive Augmentation Regimen for Elderly (iCARE) with mild to moderate dementia

Aparna Kanmani S, National Institute of Mental Health and Neuroscience (NIMHANS), BENGALURU, India
Prof. Keshav Kumar J, National Institute of Mental Health and Neuroscience (NIMHANS), BENGALURU, India

Category: Neurodegenerative Disorders

Keyword 1: cognitive rehabilitation
Keyword 2: dementia - Alzheimer's disease

Objective:

The increasing evidence for experience-dependent neuroplasticity in older adults, especially in degenerative conditions like dementia, has provided hope in battling cognitive decline. Cognitive Training (CT) – A set of neuroscience-based controlled tasks designed to tweak neural circuitry that mediate cognition and promote brain plasticity - has proven efficacious in improving cognitive functions (Vinogradov et al., 2011). Most studies, however, lack consensus on the mechanism and agreed model of CT for the elderly. Inconsistent effectiveness and huge dropout rates are observed in the existing programs in India due to lack of awareness, accessibility, caregiver support, mobility, resources, geriatric health concerns, etc. There is a need for theoretically-driven and culture-specific models of CT for mild to moderate dementia in India which may help delay or slow overall deterioration. Thus, the study aimed to develop and assess the feasibility of a cognitive neuroscience-informed caregiver-driven training module called the Individualized Cognitive Augmentation Regimen for Elderly (iCARE). The design uses a unique method of empowering the caregivers to serve as co-therapists in delivering the intervention in their ecological setting.

Participants and Methods:

The study had two phases:

Development Phase- This included a) extensive literature review, b) item generation, c) expert rating (by five clinical/neuropsychologists), d) field trial (n=3), and e) feedback and modification. The module is designed as a flip book targeting primarily eight cognitive domains. The program involves caregivers (family or professional) as trainers who provide the intervention to the patient on receiving supervision from a neuropsychologist.
Pilot Phase - A quasi-experimental research design was used to recruit patients diagnosed with mild-moderate dementia from a clinical setting and screened using the Clinical Dementia Rating Scale (CDR= 1 or 2). The eligible individuals (n=15) were allocated (1:1) to Treatment as usual group (TAU) or Intervention group (iCARE+TAU). They were assessed at three time points, (baseline, post-intervention, and 1-month follow-up) and received a 5-week treatment (intervention or TAU). Along with neuropsychological variables, secondary variables such as cognitive symptoms, quality of life, activities of daily living, behavioral and psychological symptoms, and caregiver health were also measured using rating scales. The feasibility and the fidelity of the training were also assessed.

Results:

Promising results were observed from the pilot study that indicated positive changes in task-related performance, neuropsychological variables, secondary outcome measures, and generalizability to functional abilities. The neuropsychological profiles of patients post-iCARE demonstrated improvement in attention, working memory, fluency, verbal recognition, logical memory, and visual memory. Patients also showed better quality of life, independence in daily activities, and reduced symptom severity compared to the TAU group. Further, this was corroborated by caregivers’ subjective reports of increased confidence in patients, improved error detection and self-correction, better communication, self-initiation, and enhanced insight. The caregiver-driven model was found most viable for younger caregivers and those with increased family support.

Conclusions:

The iCARE program serves as a means to support families in learning a better quality home-based management of dementia. The method of using interactive flipbooks and the caregivers as active co-therapists in delivering the intervention is recommended for collectivistic societies like India to address cognitive decline in dementia.