Learning to live with a loved one with mild cognitive impairment: Effectiveness of a waiting list controlled trial of a group intervention on significant others' sense of competence and well-being

Item does not contain fulltextThis controlled study examines the efficacy of a comprehensive group program aimed at care partners of patients with mild cognitive impairment (MCI), which comprises elements of psychoeducation, cognitive rehabilitation, and cognitive behavioral therapy. Pre- and posttreatment quantitative and qualitative data were collected in the significant others of 84 patients with MCI, 27 of whom had first been assigned to a waiting list, thus serving as their own control group. Also, the significant others rated their sense of competence, well-being, distress, acceptance, helplessness, and awareness. Quantitative data analysis did not reveal statistically significant differences between the control and the intervention condition, but qualitative results suggest that at program completion the significant others reported gains in knowledge, insight, acceptance, and coping skills. In the present sample of significant others, the group intervention was not proven effective. Suggestions for program adjustments and alternative outcome measures are discussed.11 p

Mild Cognitive Impairment

Mild cognitive impairment (MCI), a heterogeneous disorder, is frequently diagnosed by geriatricians and neurologists and is a hot topic in research. MCI refers to cognitive impairment that is worse than would be expected on the basis of age but which does not meet the criteria for dementia. The diagnosis is based on the patient history and an interview with an informant, preferably supplemented with objective tests to establish the cognitive status of the patient. MCI is an important risk factor for the development of dementia: annually 5-15% of patients with MCI develop dementia. There is currently no treatment for MCI, but it is important to treat possible organic factors. For now, it is important for the general practitioner to know the background of diagnosed MCI or reported mild cognitive problems, and to support and guide patients and their relatives. There is no added benefit to the general practitioner making the diagnosis.</p

Conceptualisation of self-management intervention for people with early stage dementia

Dementia is a major challenge for health and social care services. People living with dementia in the earlier stages experience a "care-gap". Although they may address this gap in care, self-management interventions have not been provided to people with dementia. It is unclear how to conceptualise self-management for this group and few published papers address intervention design. Initial focusing work used a logic mapping approach, interviews with key stakeholders, including people with dementia and their family members. An initial set of self-management targets were identified for potential intervention. Self-management for people living with dementia was conceptualised as covering five targets: (1) relationship with family, (2) maintaining an active lifestyle, (3) psychological wellbeing, (4) techniques to cope with memory changes, and (5) information about dementia. These targets were used to focus literature reviewing to explore an evidence base for the conceptualisation. We discuss the utility of the Corbin and Strauss (Unending work and care: managing chronic illness at home. Jossey-Bass, Oxford, 1988) model of self-management, specifically that self-management for people living with dementia should be conceptualised as emphasising the importance of "everyday life work" (targets 1 and 2) and "biographical work" (target 3), with inclusion of but less emphasis on specific "illness work" (targets 4, 5). We argue that self-management is possible for people with dementia, with a strengths focus and emphasis on quality of life, which can be achieved despite cognitive impairments. Further development and testing of such interventions is required to provide much needed support for people in early stages of dementia