الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cognitive health is one of the important factors in ensuring the quality of life of older
adults. It helps them to maintain social connectedness, ongoing sense of purpose, and the
abilities to function independently, to permit functional recovery from illness or injury, and
to cope with residual functional deficits.
Mild cognitive impairment (MCI) represents an intermediate state of cognitive
function between the changes seen in aging and those fulfilling the criteria for dementia.
Individuals with MCI have mild, but measurable, changes in their cognitive abilities that
are noticeable to the person affected and to family members and friends, but that do not
affect the individual’s ability to carry out everyday activities. Several risk factors have
been identified for MCI. These include non-modifiable risk factors such as age, sex,
genetic factors, and modifiable risk factors such as level of education, vascular risk factors,
cardiovascular outcomes, neuropsychiatric conditions, and presence of biomarkers.
MCI has a greater risk of progression to dementia; therefore, it needs to be prevented
or lowered. Up till now, there is no cure for MCI that stops or reverses it. However, there is
some evidence that suggests that non-pharmacological interventions, such as cognitive
interventions and physical exercise, may be beneficial for elderly with MCI.
The aim of this work was to study the effectiveness of cognitive stimulation therapy
(CST) for elderly with MCI in Alexandria. Specific objectives included, identifying the
prevalence and determinants of MCI, assessing functional activities, quality of life and
depression among a sample of elderly and designing, implementing and evaluating the
impact of CST on cognitive functions, functional activities, quality of life and depression
among those with MCI.
The study was conducted in two phases:
Phase I: a cross sectional design in which all elderly homes were visited to recruit
elderly eligible for the study was used. The study included elders aged 60 years or more,
who were able to communicate and accepted to participate in the study with a total number
of 218 elderly. All elderly interviewed completed a structured predesigned questionnaire to
collect socio-demographic data, personal habits and medical history. Also, elderly were
subjected to the Arabic version of Mini Mental State Examination (MMSE), Geriatric
Depression Scale Short Form (GDS), Quality of life - Alzheimer’s disease scale (QoLAD),
Katz Scale for Activity of Daily Living (ADL) and Lawton scale for Instrumental
Activities of Daily Living (IADL).
Phase II: a quasi-experimental design (non-randomized controlled design) was used
to implement the intervention program. Elderly who accepted to participate in the
intervention program were included in the intervention group until reaching 20 elderly and
the remaining 20 were assigned to the control group. An individual cognitive stimulation
therapy program was designed to enhance elderly cognitive and social functions and to
improve their quality of life and daily activities. Each individual cognitive stimulation
therapy was composed of 14 sessions of themed activities which were run twice weekly for
seven weeks. Each session lasted 30-45 minutes. The evaluation of the program was
Summary
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carried out twice; immediately after the program completion and three months later for
both groups (intervention and control groups) using the following tools; Arabic version of
MMSE, GDS-short form, QoL-AD, Katz scale for ADL and Lawton scale for IADL. Each
elderly home was visited twice weekly for 7 weeks to complete the program followed by
the first post intervention assessment and the second post intervention assessment was
done three months after program completion.
The main results of this study could be summarized as follows:
Prevalence of cognitive impairment was 28.9% (21.6% mild cognitive impairment and
7.3% moderate cognitive impairment)
Mild and moderate cognitive impairment were more common among females than
males (23% and 11.1% for females vs. 19.3% and 1.2% for males respectively)
Increasing age was associated with increasing rate of cognitive impairment; 27.8% of
elderly aged (80-93) had mild cognitive impairment compared to 12.9% of elderly aged
(60- <70).
Higher percentages of mild cognitive impairment were among elderly who were single
and widowed (28.6% and 25.25 respectively) compared to those who were married
(12.5%). Also, higher percentages of moderate cognitive impairment were among
elderly who were single and widowed (14.3% and 9.4% respectively) compared to those
who were married (0.0%) and the differences were statistically significant (p= 0.015)
The lower the educational level, the higher the rate of cognitive impairment as 33.9%
and 16.9% of elderly who were illiterate or could read and write had mild and moderate
cognitive impairment respectively compared to 10.1% and 4.35% of elderly who were
university graduates or higher
Subjective complaint of memory problems was significantly associated with higher
rates of both mild and moderate cognitive impairment (29.7% vs. 14.5% for mild
cognitive impairment and 12.9% vs. 2.6% for moderate cognitive impairment, p=0.000)
Practicing hobbies was significantly associated with lower rates of both mild and
moderate cognitive impairment (11.8% and 4.4% vs. 26.0% and 8.7% respectively,
p=0.020). Similarly, practicing regular physical activities was associated with lower
rates of both mild and moderate cognitive impairment (7.4% and 3.7% vs. 23.6% and
7.9% respectively), although the differences were not statistically significant (p=0.091).
The mean score of GDS slightly increased with increased cognitive impairment (mean
score of GDS was 2.3± 2.9 and 2.6±2.9 for mild and moderate cognitive impairment
respectively compared to 1.9± 2.7 for those with no cognitive impairment) but the
differences were not statistically significant (p=0.491).
The mean score of ADL was lower among elderly with mild and moderate cognitive
impairment (3.4±2.1 and 3.0±2.7 respectively) compared to elderly with no cognitive
impairment (4.9±1.7) and the differences were statistically significant (p=0.000).
Similarly, the mean score of IADL was lower among elderly with mild and moderate
cognitive impairment (6.9±4.7 and 5.7±5.1 respectively) compared to elderly with no
cognitive impairment (10.8±4.7) and the differences were statistically significant
(p=0.000)
The mean score of Qol-AD was lower among elderly with mild and moderate cognitive
impairment (32.4±7.1 and 31.0±8.2 respectively) compared to elderly with no cognitive
impairment (36.4±6.0) and the differences were statistically significant (p=0.000).
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On logistic regression, the independent factors which were significantly associated with
cognitive impairment were: being widowed or single, being illiterate or just able to read
and write, subjective complaints of memory problems, higher level of dependency in
IADL living and lower QoL.
In the intervention phase; the mean score of MMSE for the intervention group showed
significant increase at the end of the program (post-intervention I) compared to baseline
(pre-intervention) (23.00 ± 2.24 and 20.45 ± 1.82 respectively, p3=0.000) and this was
followed by slight decrease at follow up (3 months later) (22.45± 4.21). On the other
hand, participants among the control group had no significant changes in their mean
score across time (20.80± 1.57 at pre-intervention, 20.35± 2.45 at post-intervention I
and 20.30± 2.20 at post-intervention II, p2=0.253).
Regarding depression, the mean score of the intervention group showed 32.0%
decrease from baseline to post-intervention I, while the mean score of the control group
showed 19.57% increase from baseline to post-intervention I and the difference was
statistically significant (p=0.002). Also, the mean score of the intervention group
showed 30.46% decrease from baseline to post-intervention II, while the mean score of
the control group showed 18.58% increase from baseline to post-intervention II and the
difference was statistically significant (p=0.005).
Concerning quality of life, the mean score of the intervention group showed no change
immediately after program termination (post-intervention I) compared to baseline (preintervention)
(34.00±6.60 and 34.00±6.50 respectively) and this was followed by slight
decrease at follow up (32.85± 5.96). On the other hand, participants among the control
group had slight decrease in their mean score across time (30±7.52 at pre-intervention,
29±8.75 at post-intervention I and 28.4±8.71 at post-intervention II).
Both the intervention and control groups showed no statistically significant differences
between the different assessment phases concerning their ADL (p=0.939 and 0.692
respectively) and IADL (p2=0.368 and 0.607 respectively).
Regarding the response of the participants to the intervention program showed that
nearly two thirds of the intervention group had great interest in program sessions (60%)
and had great communication during the sessions (65%). The majority of the
intervention group (70 %) enjoyed the sessions and had good mood while practicing the
activities. Most of the participants (80%) reported a great overall satisfaction with the
program.
Based on these results the following are recommended:
Developing key messages regarding cognitive aging to increase public understanding
about cognitive aging and promote activities that help maintain cognitive health.
Encouraging elderly and their family members to discuss their concerns and questions
regarding cognitive health.
Conducting health education programs helping the elderly to adopt healthy life style
Training health professionals to build their professional skills to provide early detection
and management of mild cognitive impairment.
Implementing cognitive stimulation therapy as a routine care in geriatric homes.
Further randomized intervention studies with larger sample size are required to provide
more definitive evidence of the benefits of cognitive stimulation to elderly with mild
cognitive impairment and also to assess the cost-effectiveness of such program.