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Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions

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Abstract

To evaluate the efficacy of cognitive rehabilitation therapies (CRTs) for mild cognitive impairment (MCI). Our review revealed a need for evidence-based treatments for MCI and a lack of a theoretical rehabilitation model to guide the development and evaluation of these interventions. We have thus proposed a theoretical rehabilitation model of MCI that yields key intervention targets–cognitive compromise, functional compromise, neuropsychiatric symptoms, and modifiable risk and protective factors known to be associated with MCI and dementia. Our model additionally defines specific cognitive rehabilitation approaches that may directly or indirectly target key outcomes–restorative cognitive training, compensatory cognitive training, lifestyle interventions, and psychotherapeutic techniques. Fourteen randomized controlled trials met inclusion criteria and were reviewed. Studies markedly varied in terms of intervention approaches and selected outcome measures and were frequently hampered by design limitations. The bulk of the evidence suggested that CRTs can change targeted behaviors in individuals with MCI and that CRTs are associated with improvements in objective cognitive performance, but the pattern of effects on specific cognitive domains was inconsistent across studies. Other important outcomes (i.e., daily functioning, quality of life, neuropsychiatric symptom severity) were infrequently assessed across studies. Few studies evaluated long-term outcomes or the impact of CRTs on conversion rates from MCI to dementia or normal cognition. Overall, results from trials are promising but inconclusive. Additional well-designed and adequately powered trials are warranted and required before CRTs for MCI can be considered evidence-based.

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Acknowledgments

This material is the result of work supported with resources and the use of facilities at the Portland Veterans Affairs Medical Center, Portland, Oregon and Oregon Health & Science University, Portland Oregon. This work is in part supported by VA Merit Review awards to DS and JK, a grant from the National Institute on Drug Abuse to MH (2P50DA018165-06A1), and grants from the National Institute on Aging to JK (P30AG08017; P30AG024978). All authors read and approved the final contents of the manuscript.

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The authors have declared that there are no conflicts of interest.

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Authors and Affiliations

  1. Research & Development Service, Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA

    Marilyn Huckans & Daniel Storzbach

  2. Behavioral Health and Clinical Neurosciences Division, Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA

    Marilyn Huckans, Lee Hutson & Daniel Storzbach

  3. Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA

    Marilyn Huckans & Daniel Storzbach

  4. Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA

    Elizabeth Twamley

  5. Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Dr., San Diego, CA, 92093, USA

    Elizabeth Twamley

  6. Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA

    Elizabeth Twamley

  7. Department of Psychology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA

    Amy Jak

  8. Department of Neurology, Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Rd, Portland, OR, 97239, USA

    Jeffrey Kaye

  9. Layton Aging and Alzheimer’s Disease Center, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA

    Jeffrey Kaye

  10. Oregon Center for Aging and Technology (ORATECH), Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    Jeffrey Kaye

  11. Portland VA Medical Center (MHN), 3710 SW US Veterans Hospital Rd., Portland, OR, 97239, USA

    Marilyn Huckans

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  1. Marilyn Huckans
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  2. Lee Hutson
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  3. Elizabeth Twamley
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Correspondence to Marilyn Huckans.

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Huckans, M., Hutson, L., Twamley, E. et al. Efficacy of Cognitive Rehabilitation Therapies for Mild Cognitive Impairment (MCI) in Older Adults: Working Toward a Theoretical Model and Evidence-Based Interventions. Neuropsychol Rev 23, 63–80 (2013). https://doi.org/10.1007/s11065-013-9230-9

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