Authors (including presenting author) :
Chan WKV, Lin HC, Chan TL, Cheung H, Liu KY
Affiliation :
Occupational Therapy Department, Pamela Youde Nethersole Eastern Hospital
Introduction :
Hong Kong’s elderly population has been escalating as a result of improvement in health care and medical treatment. With an ageing population, symptoms of Mild Cognitive Impairment (MCI) are commonly encountered. According to a local study by Lam et al, the overall prevalence of MCI for persons aged 70 years or above was 8.5% (Lam et. al, 2008). MCI has received increasing attention because of its increased risk of developing Alzheimer’s disease (AD). Prospective study in Hong Kong revealed that 15.9% of subjects with MCI had developed dementia at the end of a 2-year follow-up; hence our society and health care system should be prepared for an increasing AD-related burden(Chan et. al, 2011). Evidences indicated that computerized cognitive training can lead to moderate short-term improvements in overall cognition, verbal and non-verbal learning, psychosocial functioning, attention and working memory in people with MCI(Hill et. al, 2016). In addition, combining/conducting brain training and physical activity simultaneously is another strategy that can enhance cognitive function in this group(Gheysen et. al, 2018). Beyond its effects on cognitive outcomes, cognitive training can reduce the severity of depressive symptoms in people with MCI(Chan et. al, 2020). Unfortunately, the COVID-19 pandemic has led to the adoption of social quarantine measures affecting the provision of health care/rehabilitation services. It is expected that patients with cognitive impairment would be one of the vulnerable populations with suspension/interruption of treatments. Therefore, there is a need for developing effective strategies to reduce the risk of Cognitive and ADL decline in this population. To combat the problem, Occupational Therapy at PYNEH conducted a pilot hybrid program combining both face-to-face & telecare rehabilitation to empower MCI patients and their caregivers during this pandemic.
Objectives :
To facilitate home-based cognitive training targeting attention and memory domains
To introduce/enrich self-management strategies combating cognitive impairments in daily livings
To promote positive behavioral changes through activity engagement and social interaction for well-being
Methodology :
5 patients with HK-MoCA scored at 16th-7th percentile, together with 1 caregiver were recruited for the pilot telecare program conducted from February to April 2021. In addition to HK-MoCA, the Forward and Backward Digit Span-Sequence and an Occupational Questionnaire were administered to all participants at pre-training and 3 months post-training as outcome measures.
The telecare program has 5 sessions, comprising 3 face-to-face and 2 zoom sessions. The first session was a face-to-face session of cognitive education talk, followed by HA Go Cognitive Training activities and homework assignment. The second and fourth face-to-face session started with the Brain Gym physical activities developed by Alzheimer ’s Disease Association (ADA), followed by zoom experiential learning/practice having participants engaged in online cognitive activities to prepare/familiarize for the upcoming zoom sessions. During the third and fifth session, education on compensatory strategies and cognitive training in the domains of attention and memory were delivered via zoom.
Result & Outcome :
All 5 participants completed the program. The attendance rate and compliance to home-based activities were both 100%. The mean Forward Digit Span-Sequence score increased from 7.4 to 8 digits and 7.4 to 7.6 digits respectively, while the Backward Digit Span-Sequence score increased from 4.2 to 5 digits and 3.8 to 4.6 digits respectively. With respect to the Occupational Questionnaire, 3 participants increased the total activities counted while 4 participants increased cognitive training frequency (including cognitive games/apps and reading) after attending the program although statistical analysis revealed that there were no significant differences among these tests. Participants and their caregivers reported that they enjoyed the class dynamics and felt content that they could learn the up-to-date technologies. They also found the cognitive trainings and advices effective and built up their confidence in self-management. From the therapists’ point of view, incorporating zoom session in cognitive training helps to facilitate patient to engage home program with better compliance, and for the “shy/quiet” participants, therapists found that they have more active participation compared to face-to-face session, probably because they felt more comfortable to speak out in zoom environment.
In conclusion, the experience of this 3- month telecare cognitive program revealed that hybrid cognitive training is feasible for geriatrics population with good social support. Generally, they were receptive to try innovative media and appreciated the incorporation of interactive elements in cognitive trainings. A second phase modified program with enhanced telecare sessions was commenced in August to October 2021 and pending data collection and analysis in 1Q22. Considering the immediate need to develop treatment tools that guarantee the continuity of high-quality service and minimize the risks in the MCI population during the current pandemic, the occupational therapy department at PYNEH deems that the field of telecare for MCI patients is promising and deserves further exploration.
