Mild cognitive impairment (MCI) affects as many as 20% of older adults who are at a greater risk of developing Alzheimer's disease (AD). MCI involves functional decline that may include decrements in engagement in meaningful activities and one's own sense of confidence/mastery, and it is associated with depressive symptoms, poor satisfaction with family communication, and declining physical function. Existing interventions for MCI patients and caregivers often focus on a single problem, such as memory or physical activity and there are no available multi-faceted supportive care interventions to meet the needs of the MCI patients and their caregivers in order to prevent premature disengagement and risk for depressive symptoms. The Daily Enhancement of Meaningful Activity (DEMA) intervention uses a family dyadic, strengths-based, and positive health approach that builds on existing dyadic skills and values to accomplish meaningful activity engagement to address the priority needs for efficacious interventions to prevent premature disengagement and depressive symptoms in MCI patients. The DEMA builds on our previous descriptive work and gerontology theory, the model human occupation, and components of the Problem-Solving Therapy. Our preliminary findings showed that the intervention and measures were acceptable, and suggestions were solicited from the participants for improving delivery. The purpose of this pilot study is to 1) evaluate the feasibility and satisfaction of the revised DEMA intervention;and 2) estimate effect sizes for the intervention through the incorporation of a comparison group. The MCI-caregiver dyads (n = 36 dyads) will be randomized to the DEMA or informational support groups;each group will receive 6 bi-weekly sessions (2 face-to-face and 4-phone delivered) with a trained intervener. The data from MCI patients and caregivers outcomes will be collected at pre-intervention, immediately (two weeks) post-intervention, and 3 months post-program evaluation. Descriptive statistics analysis will be used for satisfaction with and perception of the DEMA or informational support groups and general linear mixed models will be used to estimate the effect sizes of the intervention on the proximal and distal outcomes. Findings will inform the design of a subsequent R01 to: 1) test the efficacy of DEMA for MCI patient-caregiver dyads in a longitudinal randomized clinical trial;and 2) explore the costs/benefits of implementation. If it is found to be efficacious, DEMA has the potential to slow the rate of disability progression from MCI to AD and improve quality of life outcomes for patients and caregivers.

Public Health Relevance

Mild cognitive impairment (MCI) affects one of fifth older adults, who are at a greater risk of developing Alzheimer's disease (AD) and experience various difficulties and decrease their quality of life. This study is to evaluate the feasibility and satisfaction of the revised Daily Enhancement of Meaningful Activity intervention (DEMA);and estimate effect sizes for the intervention through the incorporation of a comparison group. The DEMA uses a family dyadic, strengths-based, positive health approach that builds on existing dyadic skills and values to accomplish meaningful activity engagement to address the priority needs for efficacious interventions to prevent premature disengagement and depressive symptoms in MCI patients.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21NR013755-02
Application #
8505035
Study Section
Special Emphasis Panel (ZRG1-NRCS-G (08))
Program Officer
Tully, Lois
Project Start
2012-07-05
Project End
2014-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
2
Fiscal Year
2013
Total Cost
$184,860
Indirect Cost
$66,360
Name
Indiana University-Purdue University at Indianapolis
Department
None
Type
Schools of Nursing
DUNS #
603007902
City
Indianapolis
State
IN
Country
United States
Zip Code
46202
Austrom, Mary Guerriero; Lu, Yvonne Yueh-Feng; Perkins, Anthony J et al. (2014) Impact of Noncaregiving-Related Stressors on Informal Caregiver Outcomes. Am J Alzheimers Dis Other Demen 29:426-432