Experience and participation implications of daily enhancement meaningful activity in persons with mild cognitive impairment

Abstract

Background: Persons with Mild Cognitive Impairment (PwMCI) battle progressive disengagement from personally meaningful activities that results in functional decline. Little is known about PwMCI experience of engaging in meaningful activities and relationships among MCI stage, confidence, depressive symptoms, and function. Daily Engagement of Meaningful Activity (DEMA) is a multicomponent, family-focused, tailored intervention designed to benefit PwMCI and their caregivers by facilitating goal identification, preserve engagement, and support adjustments to cognitive and functional changes. Objectives: The aims of this secondary analysis were to: (i) describe PwMCI experience of engagement in DEMA, (ii) evaluate for potential relationship among MCI stage, confidence, depressive symptoms, activity type, activity performance, physical function and (iii) evaluate ability of select outcomes to predict change in depressive symptoms and physical function, (iv) determine difference between participants when sub-grouped by ICF level. Methods: Mixed methodology was used to conduct a secondary analysis from the parent study. The parent study used a two-group randomized trial involving PwMCI and informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N=20, Information Support N = 20) examined outcomes at baseline, posttest and follow-up. Analysis employed: (i) Colaizzi's Method of empirical phenomenology to describe PwMCI experience of engagement in activity intervention related to perceptions of changes in confidence, activity performance, and physical function; (ii) Pearson's and Spearman's correlation to ascertain relationship; (iii) Linear regression to model the relationship between explanatory and dependent variables; (iv) Independent t-test to determine significant difference in activities and physical function. Results: Qualitative themes confirm improved awareness, adjustment, problem-solving, confidence and optimized function. Significant correlations were found at baseline and posttest for MCI stage, depressive symptoms, activity type and physical function. At posttest, change in self-rated performance predicted change in depressive symptoms. Additionally, those who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Conclusion: Qualitative themes and quantitative results clearly indicate the positive impact of DEMA. Future research should employ a larger, randomized controlled longitudinal trial to ascertain DEMA impact on physical function, reduction of participation restriction and improved QOL.