Effects of a mindfulness-based versus a health self-management intervention on objective cognitive performance in older adults with subjective cognitive decline (SCD): a secondary analysis of the SCD-Well randomized controlled trial
Authors: Whitfield Tim , Demnitz-King Harriet , Schlosser Marco , Barnhofer Thorsten , Frison Eric , Coll-Padros Nina , Dautricourt Sophie , Requier Florence , Delarue Marion , Gonneaud Julie , Klimecki Olga M. , Lutz Antoine , Paly Léo , Salmon Eric , Schild Ann-Katrin , Walker Zuzana , Jessen Frank , Chételat Gaël , Collette Fabienne , Wirth Miranka , Marchant Natalie L. ,   The Medit-Ageing Research Group, Michon Amélie , Sanchez-Valle Raquel , Schwars Claudia , Lai Cindy , Coueron Roxane , Arenaza-Urquijo Eider M. , Poisnel Géraldine , Delphin-Combe Floriane , Asselineau Julien , Krolak-Salmon Pierre , Molinuevo José Luis , Allais Florence , Bachelet Romain , Belleoud Viviane , Benson Clara , Bosch Beatriz , Casanova Maria Pilar , Espérou Hélène , Goldet Karine , Hamdidouche Idir , Leon Maria , Meiberth Dix , Mueller Hendrik , Mueller Theresa , Ourry Valentin , Reyrolle Leslie , Salinero Ana , Sannemann Lena , Satgunasingam Yamna , Steinhauser Hilde , Vuilleumier Patrik , Wallet Cédrick , Wingrove Janet 
Published: September 2022

Background

Older individuals with subjective cognitive decline (SCD) perceive that their cognition has declined but do not show objective impairment on neuropsychological tests. Individuals with SCD are at elevated risk of objective cognitive decline and incident dementia. Non-pharmacological interventions (including mindfulness-based and health self-management approaches) are a potential strategy to maintain or improve cognition in SCD, which may ultimately reduce dementia risk.

Methods

This study utilized data from the SCD-Well randomized controlled trial. One hundred forty-seven older adults with SCD (MAge= 72.7 years; 64% female) were recruited from memory clinics in four European countries and randomized to one of two group-based, 8-week interventions: a Caring Mindfulness-based Approach for Seniors (CMBAS) or a health self-management program (HSMP). Participants were assessed at baseline, post-intervention (week 8), and at 6-month follow-up (week 24) using a range of cognitive tests. From these tests, three composites were derived—an “abridged” Preclinical Alzheimer’s Cognitive Composite 5 (PACC5Abridged), an attention composite, and an executive function composite. Both per-protocol and intention-to-treat analyses were performed. Linear mixed models evaluated the change in outcomes between and within arms and adjusted for covariates and cognitive retest effects. Sensitivity models repeated the per-protocol analyses for participants who attended ≥ 4 intervention sessions.

Results

Across all cognitive composites, there were no significant time-by-trial arm interactions and no measurable cognitive retest effects; sensitivity analyses supported these results. Improvements, however, were observed within both trial arms on the PACC5Abridgedfrom baseline to follow-up (Δ [95% confidence interval]: CMBAS = 0.34 [0.19, 0.48]; HSMP = 0.30 [0.15, 0.44]). There was weaker evidence of an improvement in attention but no effects on executive function.

Conclusions

Two non-pharmacological interventions conferred small, non-differing improvements to a global cognitive composite sensitive to amyloid-beta-related decline. There was weaker evidence of an effect on attention, and no evidence of an effect on executive function. Importantly, observed improvements were maintained beyond the end of the interventions. Improving cognition is an important step toward dementia prevention, and future research is needed to delineate the mechanisms of action of these interventions and to utilize clinical endpoints (i.e., progression to mild cognitive impairment or dementia).

Trial registration

ClinicalTrials.gov, NCT03005652.