Comparative Effectiveness of Behavioral Interventions on Quality of Life for Older Adults With Mild Cognitive Impairment: A Randomized Clinical Trial
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Importance: Recommendations to engage in behavioral strategies to combat clinically significant cognitive and behavioral symptoms are routinely given to persons with mild cognitive impairment (MCI). The comparative effectiveness of these behavioral interventions is not well understood. Objective: To compare the incremental effects of combinations of 5 behavioral interventions on outcomes of highest importance to patients with MCI. Design, Setting, and Participants: In this multisite, cluster randomized, multicomponent comparative effectiveness trial, 272 patients from 4 academic medical outpatient centers (Mayo Clinic, Rochester, Minnesota; Mayo Clinic, Scottsdale, Arizona; Mayo Clinic, Jacksonville, Florida; and University of Washington, Seattle) were recruited from September 1, 2014, to August 31, 2016, with last follow-up March 31, 2019. All participants met the National Institute on Aging-Alzheimer's Association criteria for MCI. Interventions: The intervention program was modeled on the Mayo Clinic Healthy Action to Benefit Independence and Thinking (HABIT) program, a 50-hour group intervention conducted during 2 weeks, including memory compensation training, computerized cognitive training, yoga, patient and partner support groups, and wellness education. In our study, 1 of 5 interventions was randomly selected to be withheld for each intervention group. Participants and their partners had 1-day booster sessions at 6 and 12 months after intervention. Main Outcomes and Measures: Quality-of-life measurement of participants with MCI at 12 months was the primary outcome, selected based on the preference rankings of previous program participants. Mood, self-efficacy, and memory-based activities of daily living were also highly ranked. Results: A total of 272 participants (mean [SD] age, 75 [8] years; 160 [58.8%] male and 112 [41.2%] female) were enrolled in this study, with 56 randomized to the no yoga group, 54 to no computerized cognitive training, 52 to no wellness, 53 to no support, and 57 to no memory support system. The greatest effect size for quality of life was between the no computerized cognitive training and no wellness education groups at 0.34 (95% CI, 0.05-0.64). In secondary analyses, wellness education had a greater effect on mood than computerized cognitive training (effect size, 0.53; 95% CI, 0.21-0.86), and yoga had a greater effect on memory-related activities of daily living than support groups (effect size, 0.43; 95% CI, 0.13-0.72). Conclusions and Relevance: These results provide further support for behavioral interventions for persons with MCI. Different outcomes were optimized by different combinations of interventions. These findings provide an initial exploration of the effect of behavioral interventions on patient-advocated outcomes in persons with MCI. Trial Registration: ClinicalTrials.gov identifier: NCT02265757.
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With regard to mood, well-being and quality of life, no therapeutic effects in MCI patients, neither at short-term (3 months) nor at long-term (24 months) follow-up, were detected in most studies, including four randomized controlled trials and one randomized non-controlled trial.
“With regard to mood, well-being and quality of life no therapeutic effects in MCI patients, neither at short-term (3 months) nor at long-term (24 months) follow-up, were detected in most studies, including four randomized controlled trials [48–51, 54, 59, 60] and one randomized non-controlled trial [52, 53].”
From Psychotherapeutic interventions in individuals at risk for Alzheimer’s dementia: a systematic review (2022) · cites this paper as [53]
The Results (Outcome Measures; page not supplied) found no statistically significant differences between interventions in quality of life at 12 months, supporting that part of the claim. But the same section reports a significant mood difference at 12 months, and Methods (Outcome Measures; page not supplied) lists follow-up only through 12 months, not 24 months. This trial also had no untreated control group, so it cannot establish an absence of therapeutic effects overall. (LLM, conf=0.89)
Experimental — accuracy not yet measuredA total of 10 research groups described psychoeducational interventions in individuals with MCI in addition to cognitive rehabilitation, cognitive training, mindfulness-based stress reduction, behavioral activation, or enriched by a recovery model approach.
“A total of 10 research groups described psychoeducational interventions in addition to cognitive rehabilitation [38, 50], cognitive training [52, 53, 59, 60, 65], mindfulness-based stress reduction (MBSR) [46, 47, 57, 58], behavioral activation [44, 45, 48, 49, 51, 54], or enriched by a recovery model approach [67]”
From Psychotherapeutic interventions in individuals at risk for Alzheimer’s dementia: a systematic review (2022) · cites this paper as [53]
Long-term follow-up assessments (6 or more months post-intervention) were described in 14 publications.
“Long-term follow-up assessments (6 or more months post-intervention) were described in 14 publications [37, 39, 43, 48, 49, 51–53, 59, 60, 62, 63, 68, 69].”
From Psychotherapeutic interventions in individuals at risk for Alzheimer’s dementia: a systematic review (2022) · cites this paper as [53]
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References 33 · Cited by 75
Research works printed but not linked: 1
- [26]Smith G, Fields J, Castro M, Yutsis M, Locke D, Greenaway M Understanding efficacy of a multi-component intervention for mild cognitive impairment. Paper presented at: 11th International Conference on Alzheimer’s and Parkinson’s Disease; March 8, 2013; Florence, Italy.
- Authors
- Chandler, M. J., Locke, D. E., Crook, J. E., Fields, J. A., Ball, C. T., Phatak, V. S., Dean, P. M., Morris, M., & Smith, G. E.
- Affiliations
- Mayo Clinic (US)
- University of Washington (US)
- University of Florida (US)
- Corresponding author
- Chandler, Melanie J.
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2019-05-17
- Volume
- 2
- Issue
- 5
- Pages
- e193016
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC6537922
- OpenAlex
- W2945345107
- Cited by
- 75
- References
- 33
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 9 · 2023: 8 · 2022: 12 · 2021: 18 · 2020: 7 · 2019: 4
- FWCI
- 8.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Patient-Centered Outcomes Research Institute (CER‐1306‐01897, 1306-01897)
- National Institutes of Health
- H2020 European Research Council
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- mild cognitive impairment, behavioral interventions, quality of life, older adults, computerized cognitive training, yoga, wellness education, support groups, mood, self-efficacy, activities of daily living, comparative effectiveness, booster sessions, partner support, Alzheimer's disease prevention, multicomponent intervention
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Male, Quality of Life, Yoga, Cognitive Behavioral Therapy, Treatment Outcome, Self Efficacy, Cognitive Dysfunction
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