Qualitative Analysis of the Cognition and Flow (CoGFlowS) Study: An Individualized Approach to Cognitive Training for Dementia Is Needed

Article type: Research Article

Authors: Beishon, Lucy^{a; *} | Haunton, Victoria^{a; b} | Subramaniam, Hari^c | Mukaetova-Ladinska, Elizabeta B.^{c; d} | Panerai, Ronney B.^{a; b} | Robinson, Thompson^{a; b} | Evley, Rachel^e

Affiliations: [a] Department of Cardiovascular Sciences, University of Leicester, Leicester, UK | [b] NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK | [c] The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK | [d] Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK | [e] Inflammatory, Injury & Recovery Science, School of Medicine, University of Nottingham, Nottingham, UK

Correspondence: [*] Correspondence to: Dr. Lucy Beishon, Room 419, Level 4 Clinical Sciences Building, Leicester Royal Infirmary, Leicester, LE2 7LX, UK. Tel.: +44 0116 252 3134; E-mail: Lb330@le.ac.uk.

Abstract: Background:Cognitive training (CT) may have benefits for both healthy older adults (HC) and those with early cognitive disorders [mild cognitive impairment (MCI) and dementia]. However, few studies have qualitatively evaluated home-based, computerized CT programs. Objective:We present the qualitative arm of a feasibility randomized controlled trial evaluating a CT program for HC and people living with MCI or dementia. Methods:Participants underwent semi-structured interviews after 12 weeks of CT. Where possible, participants were interviewed with their carers. The interview schedule and analysis were underpinned by the health belief model. Interviews were audio-recorded, transcribed, open-coded, and categorized into themes. The analytical framework was developed, and themes were condensed under five major categories: benefits, barriers, threat, self-efficacy, and cues to action. Results:37 participants underwent interviews. CT was feasible and acceptable to participants. Benefits included: enjoyment, improved awareness, benchmarking cognitive function, reassurance of abilities and giving back control. Barriers were more prevalent among those with dementia: problems with technology, frustration, conflict between patients and carers, apathy and lack of insight, anxiety or low mood, and lack of portability. HC and MCI perceived the severity of dementia risk as high, partially mitigated by CT. Participants living with dementia valued a more individualized approach to training, accounting for baseline characteristics. Conclusion:CT was a feasible intervention for HC and people living with dementia and MCI. Benefits were present, but the identified barriers need to be addressed for CT to be implemented successfully.

Keywords: Alzheimer’s disease, cognitive dysfunction, healthy aging, mild cognitive impairment

DOI: 10.3233/JAD-210428

Journal: Journal of Alzheimer's Disease, vol. 83, no. 1, pp. 209-225, 2021