An examination of cognitive andpsychological outcomes of aneuroeducation programme forindividuals living with Mild CognitiveImpairment and their families.

Background The definition of Mild Cognitive Impairment (MCI) is a cognitive decline more advanced than one would expect based on a person’s age, but not severe enough to obtain a diagnosis of dementia. Current literature varies on potential causes for MCI, and also on the impact that depression, stress and anxiety may have on this neurodegenerative condition. Many MCI patients go on to develop Alzheimer’s Disease (AD). However, research has indicated that MCI patients can benefit from different types of intervention programmes. This study had a number of aims including, (i) to examine the impact of a non-pharmacological intervention, a four-week neuroeducation programme, on both patients with MCI and their family members, on various tests of cognition, stress, depression and anxiety; (ii) to follow up and qualitatively explore, using semi-structured interviews, the general impact and usefulness of the neuroeducation programme; (iii) given the global impact of Covid-19, our third aim was to examine, again using semi-structured interviews and interpretative phenomenological analysis (IPA), the impact of the pandemic on patients with MCI and their family members. Methods The study involved testing a sample of five participants, three with MCI, and two family members (FM) who did not have MCI. This project used a mixed methods design in which to analysis the data collected. All participants were given an initial battery of cognitive and psychological tests including the Control Autonomy, Self-realisation and Pleasure scale (CASP-19), the Satisfaction with Life Scale (SWLS), the Hospital Anxiety and Depression Scale (HADS), the Community Integration Questionnaire (CIQ), the Cognitive Failures Questionnaire (CFQ), the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Exam (MMSE). Following this, participants were provided with a 40-minute video file weekly to watch, over a 4-week period and began in February 2021; this was conducted online due to the Covid-19 pandemic. Weekly topics included: MCI and what it is; MCI and its relationship to AD; MCI and life satisfaction; community integration; and MCI and its relationship to diet and exercise. Following this four-week neuroeducation programme, participants were asked to complete the same battery of cognitive and psychological tests (with alternative versions where possible). Then, in a semi-structured interview, participants were asked to provide an assessment of the programme, whether they felt that it had had an impact, whether they found it useful and whether they would change aspects of their lifestyle as a direct result of the programme. Finally, patients were asked to assess the impact that Covid-19 was having on their lives, including restrictions and fear around the disease. Results Results from the pre- and post-intervention battery of tests showed minimal and limited changes in either cognitive (CFQ, MMSE, MoCA) or psychological measures (HADS, CASP-19, SWLS). In terms of the assessing the programme itself, IPA revealed three key themes which included Understanding, Lack of Time/Confidence and Intention to make lifestyle changes after the intervention. Although most participants (both MCI patients and family members) stated that they wouldn’t change their current lifestyle in terms of diet or exercise, they understood the importance of these factors via the programme. Six common themes emerged following our qualitative analysis on the questions relating to the impact of Covid-19, these included: Family; Negative Emotions; Acceptance and Resilience; Anxiety; and Restriction/Confinement. The interviews highlighted the importance of family, social and care-networks in providing support and encouraging resilience. However, despite this, the patients reported much anxiety around the disease itself, their own situation (especially MCI patients), and anger due to restrictions imposed and the limited contact allowed, brought about through the various government preventative measures. Discussion and Conclusions Although the participant numbers in the current study are small, and any definitive conclusions are difficult to make, we have shown that a neuroeducation programme may be a useful tool to provide patients with MCI and their family members with an additional understanding of the disorder and possible ways to improve lifestyles. In addition, the study highlights the importance of talking to patients and family members to better understand their worries and situation. As might be expected, Covid-19 had a particular impact that led to anger and anxiety among all participants, but also led to a better appreciation of family and an emerging sense of resilience. Such themes should be further explored among other clinical populations as well as in the general society. Future research in this area should aim to expand the numbers in both the MCI and family members, systematically compare a neuroeducation programme to other types of interventions, and conduct follow-up interviews that track changes in themes across time for both patients and families.

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