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Effects of an empowerment-based educative psycho-behavioral program on neuropsychiatric symptoms among persons with mild cognitive impairment: A mixed methods study

International Journal of Nursing Studies. Jan;137:104381. 2023
Lin R.S.Y.*, Yu D.S.F.*, Chau P.H.*, Li P.W.C.*


Background: Mild cognitive impairment refers to the transitional stage between normal aging and dementia. While managing the cognitive symptoms receives most research attention, neuropsychiatric symptoms, particularly depression and anxiety, affect up to 80% of this cohort and detrimentally impact disease progression. Evidence-based interventions to support this preclinical cohort to cope with the neuropsychiatric symptoms are yet to be developed.

Objectives: To test the effects of an empowerment-based educative psycho-behavioral program on neuropsychiatric symptoms, cognitive function, and health-related quality of life among older adults with mild cognitive impairment and explore the engagement experience and perceived effects of the program.

Design: An explanatory sequential mixed methods design comprises a single-blinded randomized controlled trial and a descriptive qualitative study.

Setting and participants: This study was conducted in five social facilities in three major geographic districts in Hong Kong from August 2020 to November 2021. Community-dwelling adults aged ≥50 with mild cognitive impairment were included.

Methods: A total of 171 participants were randomly assigned to either a 13-week empowerment-based educative psycho-behavioral program on stress adaptation, cognitive coping and knowledge enhancement (intervention group; n = 86), or a generic health education program (control group; n = 85). Mild Behavioral Impairment Checklist, Geriatric Depression Scale Short Form, Apathy Evaluation Scale, Kessler Psychological Distress Scale, Montreal Cognitive Assessment, Memory Inventory for Chinese, and Short Form Health Survey were administered at baseline, immediately after the program completion, and four weeks thereafter. Individual, semi-structured interviews were conducted to explore the engagement experience and perceived effects of the program.

Results: The mean age of the participants was 69.1 years (SD = 8.1), and 87.7% were female. Using generalized estimating equation, the intervention group had significantly greater improvement in overall neuropsychiatric symptoms (β = -1.49, p = 0.044), apathy (β = 2.14, p = 0.018), anxiety (β = -0.53, p = 0.009), and subjective memory complaints (β = -1.97, p = 0.003) than the control group upon completion of the intervention, such positive effects lasted to four weeks thereafter. Delayed effects were also shown on depression (β = 0.86, p = 0.008) and global cognitive function (β = 0.86, p = 0.008). The qualitative data converges with the quantitative evaluation; 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 effects.

Conclusions: This study revealed the beneficial effects of the empowerment-based educative psycho-behavioral program on improving neuropsychiatric symptoms and cognitive function of older adults with mild cognitive impairment. The findings support the application of a comprehensive empowerment approach to enhance psychological well-being of this cohort.

Registration number: HKUCTR-2915 (HKU Clinical Trial Registry).

Tweetable abstract: Neuropsychiatric symptoms received less attention in the management of mild cognitive impairment. An empowerment-based educative psycho-behavioral program shows benefits on these prevalent manifestations.

Keywords: Cognitive function; Empowerment-based nursing care; Health-related quality of life; Mild cognitive impairment; Mixed methods; Neuropsychiatric symptoms; Psycho-behavioral program; Randomized controlled trial.

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(*Corresponding Author)