Cognitive Rehabilitation and Telehealth Videoconferencing: Developing an Accessible Intervention for Subjective Cognitive Impairment, Mild Cognitive Impairment, and Dementia

Abstract

This dissertation contributes to the growing body of research needed to make cognitive rehabilitation for individuals with dementia more accessible to rural families. Our population is aging, and with age comes both normal and abnormal cognitive aging. In Canada, the proportion of older adults is increasing at a greater rate in rural compared to urban areas, which suggests a high need for dementia care that is accessible to rural families. Teleheath videoconferencing is one way to make treatment more accessible. Over the course of three studies, this dissertation developed goal-oriented cognitive rehabilitation as an intervention for individuals with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and dementia due to AD, and adapted treatment to be delivered through telehealth videoconferencing. Study 1 reported a strong preference for telehealth delivered treatment over in-person treatment, and initial treatment goals focused on memory, household activities, other cognitive domains, recreation, and higher order tasks. Responders were similar to non-responders in severity, depression, and caregiver burden, but results suggested differences in awareness and neuropsychiatric symptoms. Cognitive rehabilitation targets functional goals, and Study 2 worked to inform treatment development by focusing on the cognitive correlates of function. Hierarchical regression analyses suggested that immediate memory, executive functions, apathy, and depression accounted for unique variance in instrumental activities of daily living in the clinical sample of individuals diagnosed with no cognitive impairment, MCI, dementia due to AD, and non-AD dementia. The objective of Study 3 was to explore delivering cognitive rehabilitation through telehealth videoconferencing, and to compare in-person delivery to videoconferencing delivery. Using a combined between-subjects, multiple baseline single case experimental design cognitive rehabilitation was delivered to six participants with either SCI, MCI, or early stage dementia due to AD. Participants were randomly assigned to receive treatment in-person or through videoconferencing. Modifying treatment for telehealth required greater reliance on verbal description, but between-group outcomes were similar with good completion rates and high levels of improved goal performance. Overall, this body of work contributes to developing cognitive rehabilitation for individuals with SCI, MCI, and early stage AD. There is a need to continue to adapt this intervention to telehealth videoconferencing and it is feasible to do so.