The Couple in Control: A Communication-Focused Program

The purpose of this study is to develop and pilot test a communication-based psychoeducation program for persons with mild cognitive impairment (MCI) and their care partners to improve their interpersonal management of MCI.

Up to 21% of older adults exhibit symptoms of mild cognitive impairment (MCI), a term used to describe a compilation of cognitive and behavioral symptoms that approach but don't meet the threshold for a dementia diagnosis. Noticeably characterized by losses in executive function and memory that can affect critical life domains like employment, housing, health care, and finances, it is also a life condition of considerable indeterminacy both for the person living with the condition and for care partners. While many individuals experience worsened symptoms leading to an Alzheimer's disease (AD) diagnosis within five years, MCI can be caused by a variety of disease processes making disease trajectory and prognosis vague and uncertain.

For most diagnosed with MCI, the experience is shared with another, typically a spouse or partner. For the dyad and both parties in an MCI couple, the period following an MCI diagnosis is often one of extended emotional turbulence and ambiguity. Care partner dyads coping with MCI face changes in role identity resulting in significant consequences for relationships. Emotional adjustment to MCI, unique for each dyad, has implications for subsequent family coping, psychological stress, physical fatigue, social isolation, decision-making, financial well-being, and more. While MCI psychoeducation programs exist, they almost always target the person with MCI and not the patient-care partner dyad. Communication patterns between patients and care partners in oncology and HIV/AIDS settings are shown to influence the coping and care outcomes of dyads. With similar communication issues noted in MCI dyads, the goal of this pilot project is to develop and test the feasibility and preliminary efficacy and evaluate acceptability of a group program, The Couple in Control (CiC), to provide couples facing MCI with communication skills and interpersonal strategies that will establish or restore a sense of agency and emotional well-being as they navigate this period of transition and uncertainty.

This study uses a one-arm, pre/post design to assess the acceptability, feasibility, and preliminary efficacy in 4 cohorts of 6 MCI dyads each (for a total of 48 individuals) to take part in a trial of the CiC program. Participants meet in virtual intervention group meetings over the course of 8 to 9 consecutive weeks and take part in structured quantitative interviews prior to the intervention and then 4 and 8 weeks post-intervention.

Eligibility Criteria:
Inclusion Criteria:

* Dyads composed of individuals with a clinician-confirmed diagnosis of MCI and a primary care partner
* Can read, speak, and understand English
* Have internet connectivity and a separate zoom-enabled device for each dyad member
* Dyads must live together, as this will provide sufficient opportunity for intervention homework and communication practice activities

Exclusion Criteria:

* Individuals who are not yet adults (infants, children, teenagers)
* Pregnant women
* Prisoners
* Individuals who are not able to clearly understand and speak English
* Those living with MCI will need to successfully complete a capacity to consent survey to be included in the study