Effects of an empowerment-based educative psycho-behavioral program on neuropsychiatric symptoms among persons with mild cognitive impairment

Abstract

Persons with mild cognitive impairment (PwMCI) experience a slight but noticeable decline in everyday functioning. Neuropsychiatric symptoms (NPS) are highly prevalent and imposed detrimental impacts on disease progression. However, the mainstay of treatments only focuses on cognitive optimization, little attention has been given to the co-existing NPS.

This study aimed to examine the effects of an empowerment-based educative psycho-behavioral (Empower-EPB) program on NPS, cognitive function, and health-related quality of life among PwMCI. It was conducted in three phases to achieve this study aim. Phase 1 study is a phenomenological study that explored the lived experience with NPS among PwMCI (n=30). This phase highlighted that living with mild cognitive impairment (MCI) was highly challenging, the cognitive afflictions together with the resultant impacts on various life domains evoked a cluster of NPS. Findings of this phase justified the urgent need for managing NPS among PwMCI and informed the design of the intervention components in Phase 3 randomized controlled trial (RCT). Phase 2 study is a validation study to examine the psychometric properties of the traditional Chinese version of the Mild Behavioral Impairment Checklist (MBI-C) among PwMCI in Hong Kong. Findings from this phase assured that the MBI-C is a reliable and valid tool to evaluate the intervention effects on NPS in the following RCT. Phase 3 study is a mixed-methods study comprising an RCT to evaluate the effects of the Empower-EPB program and a qualitative phase to explore participants’ engagement experience and perceived effects of the program.

During the Phase 3 RCT study, community-dwelling older adults with MCI were recruited from five community facilities. Eligible participants (n=171) were randomly assigned to either the intervention group (n=86) to receive a 13-week, group-based, Empower-EPB program on promoting brain health knowledge, active lifestyle, cognitive coping, and stress adaptation, or the control group (n=85) to receive a generic health education program. Generalized Estimating Equations were adopted to compare the changes in outcome measures between the two study groups at baseline (T0), immediately after the completion of the Empower-EPB program (T1), and four weeks thereafter (T2). A total of 22 participants of the Empower-EPB program completed the individual semi-structured interviews.

The findings indicated that the intervention group had significantly greater improvement in overall NPS, apathy, anxiety, and subjective memory complaints than the control group across the baseline to the endpoints at T1 and T2. Delayed effects were detected in depression and global cognitive function at T2. However, no significant effect was detected in health-related quality of life over the evaluative period. The qualitative findings provided evidence to support such promising effects; the participants indicated that the increased coping for daily hassles and emotional arousal, together with a more positive orientation towards living a fulfilling life and the future, may explain such encouraging program effects.

The findings of this study highlighted that the Empower-EPB program was effective in improving NPS among PwMCI. Future care planning should adopt a comprehensive approach with the integration of empowerment strategies to improve the overall well-being of this preclinical cohort.