Charlotte A. Allsop and Dr. Barbara Heise, Gerontological Nursing
Dementia is manifested by a severely limited memory and performance of cognitive abilities. Mild Cognitive Impairment (MCI) is an early stage of memory loss which can later lead to Dementia. It has been proven that you can delay cognitive dysfunction, e.g. memory, by “training the brain” through various cognitive exercises. However, those with MCI are difficult to detect because their memory loss is subtle. The purpose of this study is to first, enhance MCI recognition in elderly individuals and second, to determine the efficacy of memory training in the community.
This study was conducted in the Orem, Utah Senior Center (Friendship Center). A convenience sample of four (4) men and women ages 65 and older living in the community participated. The four participants had to score above 24 (sever cognitive impairment) and below 30 (no cognitive impairment) on The Mini-Mental Status Examination (MMSE) given to them the first time they met with the principal investigator. The study consisted of a memory training program based upon the methods of Dr. Ryuta Kawashima, a Japanese Neuroscientist. The four participants met once a week for six weeks at the senior center with the principle investigator and completed simple timed mathematical homework (multiplication, division, addition, subtraction) during the days in between. The Mini-Mental Status Examination (MMSE) was given to each participant separately the first week as well as after the program ended in order to assess the progress of cognitive function. Participants filled out a Geriatric Depression Scale (GDS), a demographic information sheet as well as a health history before the program began. The once a week meetings consisted of counting aloud to 120 as quickly as possible, memorization of words in two minutes, and reading aloud 30 colored words of a different color as fast as possible (e.g. the word red was colored yellow and read aloud as yellow). All of these tasks were timed each week. The Principal Investigator made notes of their response time and speed of processing during the memory program. Data analysis included Frequency and Descriptive properties of the MMSE scores before and after the memory training. Improvement time was recorded and averaged for the tasks done each week over the six week period. Themes were found among the Principal Investigator’s notes of the participants.
Mild cognitive impairment is manifested by subtle symptoms, but can be detected by simply administering the MMSE. All four participant MMSE scores increased after the six week program. The mean MMSE score before the memory training was 28.25 (30 is the highest you can score) with a standard deviation of .957. The mean score after training was 29.25 with a standard deviation of .957. Participants’ recorded task times did not consistently improve each week. However, each participant enhanced in observed themes of cooperation, focus, response time and speed of processing throughout the six weeks.
Follow-up studies should be constructed based upon Dr. Kawashima’s methods in a longer study with more participants to further assess the effectiveness of these memory training tools. However, based upon the results stated above, recognition of MCI should be a higher priority in the community. Implementation should be executed in Senior Centers and within healthcare settings to better prevent the fast progression of dementia. Increased awareness of cognitive function as well as provided memory training programs to those with MCI will improve dementia treatment from tertiary care to primary or prophylactic care. Prolonged memory function would result in less money spent upon dementia in the community as well as an increased sense of well being and heightened function of those who have memory impairment.
This study was presented as a power point presentation by me, the principal investigator, at the November 3rd 2008 Nursing Research Conference, co-sponsored by Intermountain Healthcare and Brigham Young University.
One of the greatest challenges that I observed while implementing my study was the difficulty in obtaining continual participation from seniors in the senior center. My four participants out of the 15-20 total participants are the only ones who stayed the entire six weeks and completed the homework. The most reported reason for non-continual participation was other activities with family or visitors. More hours of availability by the implementer may increase involvement as well as an increased amount of teaching of the importance of continual participation. I also realized how individualized the memory training is. Each participant needs one-on-one time with a helper (me) to make sure there are no mistakes and that the times are correctly recorded.
The greatest thing I learned from this study is that memory training is like life insurance. Just as you insure your life, you need to insure your memory with prophylactic cognitive training. I am graduating in April, 2009 in nursing and will be able to educate patients and other employees about memory training benefits as well as implement cognitive exercises to patients when appropriate.
- Ball, K., Berch, D. B., Helmers, K. F., et al. (2002). Effects of Cognitive Training Interventions with Older Adults. The Journal of the American Medical Association, 288(18), 2271-2281
- Beers, M. H., (2006). The Merck Manual of Geriatrics. Delirium and Dementia, 40.
- Winblad, B., Palmer, K., Kivipelto, M. et al (2004). Mild cognitive impairment – beyond controversies, towards a consensus; report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240-246.