Computerized Cognitive and Skills Training in Older People With Mild Cognitive Impairment: Using Ecological Momentary Assessment to Index Treatment-Related Changes in Real-World Performance of Technology-Dependent Functional Tasks

• Published in: The American journal of geriatric psychiatry 2024-04, Vol.32 (4), p.446-459
• Main Authors: Dowell-Esquivel, Courtney, Czaja, Sara J., Kallestrup, Peter, Depp, Colin A., Saber, John N., Harvey, Philip D.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Cognition; Cognitive Dysfunction - therapy; Computerized Cognitive Training; Ecological Momentary Assessment; Female; functional skills training; Humans; mild cognitive impairment; Neuropsychological Tests
• ISSN: 1064-7481; 1545-7214; 1545-7214
• DOI: 10.1016/j.jagp.2023.10.014

•What is the primary question addressed by this study?The study addressed the question of whether a fully remote cognitive and functional skills training program improved real-world performance of technology-based tasks, measured with daily ecological momentary assessment (EMA) in older adults with normal cognition and mild cognitive impairments.•What is the main finding of this study?EMA assessments demonstrated statistically significant increases in activity of both trained and untrained technology-related activities. Moreover, the degree of training gains was found to be a significant predictor of real-world performance in domains of technology utilization.•What is the meaning of the finding?These findings provide compelling evidence that a fully remote functional skills training program is both practical and efficacious, as well as providing benefits for real-world functioning. This training program has the potential to empower individuals, regardless of their cognitive status or geographical location, by enabling them to maintain or optimize their autonomy as they age. Cognitive and functional skills training improves skills and cognitive test performance, but the true test of efficacy is real-world transfer. We trained participants with mild cognitive impairment (MCI) or normal cognition (NC) for up to 12 weeks on six technology-related skills using remote computerized functional skills assessment and training (FUNSAT) software. Using ecological momentary assessment (EMA), we measured real-world performance of the technology-related skills over 6 months and related EMA-identified changes in performance to training gains. Randomized clinical trial with post-training follow-up. A total of 14 Community centers in New York City and Miami. Older adults with normal cognition (n = 72) or well-defined MCI (n = 92), ranging in age from 60 to 90, primarily female, and racially and ethnically diverse. Computerized cognitive and skills training. EMA surveys measuring trained and untrained functional skills 3 or more days per week for 6 months and training gains from baseline to end of training. Training gains in completion times across all 6 tasks were significant (p