Glynda Jane Kinsella

Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as ‘core business’; and finally, (v) a call to action.

Examine quality of life (QoL) and psychological health after mild traumatic brain injury (mTBI) in older people (65+ years) at 3- and 6-month follow-up and explore which injury factors predicted QoL. mTBI patients were compared to trauma comparison (TC) and community comparison (CC) groups. QoL and psychological health were measured at both timepoints. After accounting for 3-month psychological health, injury severity, neuroimaging, and 3-month neuropsychological performance were assessed as predictors of 6-month QoL. Overall 3-month QoL was lower for mTBI (Cohen's d = 0.938) and TC (Cohen's d = 0.485) groups compared to CCs, but by 6 months only mTBI patients continued to report poorer overall QoL (Cohen's d = 0.577) and physical QoL (Cohen's d = 0.656). Despite group differences, QoL for most (~92%) was within normative limits. 3-month psychological health predicted QoL 6-months postinjury (β = -.377, 95% CI -.614, -.140) but other proposed risk factors (GCS <15, neuroimaging, 3-month neuropsychological performance) did not uniquely predict QoL. Older adults following mTBI reported lower QoL up to 6-months postinjury compared to non-injured peers, indicating that mTBI patients were particularly susceptible to ongoing differences in QoL 6-months postinjury.

Understanding the strategies people with amnestic mild cognitive impairment (aMCI) spontaneously use can inform targeted memory training.Strategy use was observed for 99 people with aMCI and 100 he...

Subjective Cognitive Decline (SCD) in older adults has been identified as a risk factor for dementia, although the literature is inconsistent, and it is unclear which factors moderate progression from SCD to dementia. Through separate meta-analyses, we aimed to determine if SCD increased the risk of developing dementia or mild cognitive impairment (MCI). Furthermore, we examined several possible moderators. Longitudinal studies of participants with SCD at baseline, with data regarding incident dementia or MCI, were extracted from MEDLINE and PsycINFO. Articles were excluded if SCD occurred solely in the context of dementia, MCI, or as part of a specific disease. Pooled estimates were calculated using a random-effects model, with moderator analyses examining whether risk varied according to SCD definition, demographics, genetics, recruitment source, and follow-up duration. Risk of study bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. 46 studies with more than 74,000 unique participants were included. SCD was associated with increased risk of developing dementia (HR = 1.90, 95% CI 1.52–2.36; OR = 2.48, 95% CI 1.97–3.14) and MCI (HR = 1.73, 95% CI 1.18–2.52; OR = 1.83, 95% CI 1.56–2.16). None of the potential moderating factors examined influenced the HR or OR of developing dementia. In contrast, including worry in the definition of SCD, younger age, and recruitment source impacted the OR of developing MCI, with clinic samples demonstrating highest risk. SCD thus represents an at-risk phase, ideal for early intervention, with further research required to identify effective interventions for risk reduction, and cognitive-behavioural interventions for cognitive management. PROSPERO, protocol number: CRD42016037993

Introduction: In the context of limited research assessing outcomes following mild traumatic brain injury (mTBI) in older adults, this study evaluated cognitive outcomes through prospective memory, and expected that performance of an older mTBI group (≥65 years) would be lower compared to orthopedic and community controls. The study also explored whether cognitive resources (retrospective memory, executive function) moderated any association between presenting Glasgow Coma Scale (GCS) and prospective memory. Method: At three-months post-injury, a mTBI group (n = 39), an orthopedic control group (n = 63), and a community control group (n = 46) completed a neuropsychological assessment, including (i) prospective memory, using a standardized paper-and-pencil task (Cambridge Prospective Memory Test), an augmented reality task and a naturalistic task, and (ii) standardized measures of retrospective memory (Hopkins Verbal Learning Test) and executive function (Trail Making Test). Group performances were compared, and bootstrapped moderation analyses evaluated the role of cognitive resources in the relationship between GCS and prospective memory outcome. Results: The mTBI group, as compared to community controls, performed significantly lower on the augmented reality task (d = −0.64 to d = −0.79), and there was a small-moderate but non-significant effect (d = −0.45) on the naturalistic task. There were no differences between the mTBI group and orthopedic controls. Retrospective memory was a unique predictor of the augmented reality task (B = 1.83) and moderated the relationship between presenting GCS and the naturalistic task (B = −5.60). Executive function moderated the association between presenting GCS and augmented reality (B = −1.13) and naturalistic task (B = −1.57). Conclusions: At three-months post-mTBI, older adults are at risk of poor cognitive performance; and the relationship between GCS and prospective memory can be moderated by cognitive resources. Further follow-up is indicated to determine whether impairments resolve or persist over time.

This investigation assessed the relationship between subjective self-reports and objective measures of prospective memory with forty-eight healthy, community-dwelling older-adults (> 65 years). The Prospective and Retrospective Memory Questionnaire provided the self-report data, the Cambridge Prospective Memory Test was used as a clinic-based test, and the Telephone Task (telephoning the examiner at irregular, pre-scheduled times across one week) was used as a naturalistic measure. The self-reported difficulties were negatively associated with performance on the naturalistic task, r (41) = -0.341, p = r (41) = 0.312, p = <0.05. Tests of retrospective memory (delayed recall) and executive function (attention set-shifting) did not individually predict performance on any of the prospective memory measures. Incorporating naturalistic probes of prospective memory performance into a clinical assessment may allow insight into the experience of prospective memory challenges in older-age clients.

This study investigated caregiver outcomes when a psychoeducation program for older people with dementia and caregivers is modified to extend practice in memory strategies. Moderation effects of increased memory strategy use were also explored. Fifty-six care dyads participated in the multicenter, randomized controlled trial comparing psychoeducation (active control) with psychoeducation and memory strategy practice (intervention). Primary outcome was memory strategy use; secondary outcome was caregiver emotional reactivity (burden, depression, and anxiety). Results showed memory strategy use significantly increased following psychoeducation for both groups. However, psychoeducation combined with memory strategy practice resulted in a significant reduction in depression for caregivers reporting at least mild baseline symptoms. Greater use of memory strategies moderated the relationship between burden and depression following intervention. Psychoeducation programs that incorporate practical memory strategy training may offer more substantial outcomes.

Objective: In the context of the positive impact of cognitive interventions for age-related memory concerns, clinicians are seeking information about variables that predict optimum client response. In this study of older adults, the aim was to investigate baseline predictors of gain in memory performance, i.e. prospective memory, following a memory intervention. Methods: One hundred and one healthy older adults (H0A) and 73 older people with amnestic mild cognitive impairment (aMCI) were evaluated at 6-months after participating in a 6-week memory group intervention (LaTCH). The outcome measure was a clinic-based prospective memory task. Baseline predictors included demographic variables (age, gender, education), baseline prospective memory, and cognitive resources (retrospective memory, executive function). Results: Thirty percent of the HOA and 16% of the aMCI cohorts demonstrated reliable training effects on prospective memory test performance at 6-month assessment. Through hierarchical regressions in the HOA cohort, executive function (working memory, attention set shifting) rather than retrospective memory was the best predictor of change in prospective memory. Moderated regression did not demonstrate any interactions between retrospective memory and executive function. For the memory impaired cohort (aMCI), better baseline retrospective memory predicted greater gain in prospective memory but only when executive function was also high. Conclusions: Memory groups can improve performance on clinic-based prospective memory tests in older people with concerns about memory performance, suggesting the value of further translation studies to demonstrate functional real-world gains and quality of life improvement after training. These interventions may be especially effective for those older people with better executive function (working memory, attention set shifting).

Objectives: Older people with mild cognitive impairment (MCI) are seeking interventions for maintaining independence. This study investigates the feasibility of translating a research‐evaluated memory group (LaTCH) into a community‐based organisation by evaluating the experiences of clients and trained staff.Methods: Dementia Australia staff trained as facilitators of memory groups for 274 people with MCI and families. Clients and staff were interviewed regarding experiences from group participation.Results: Clients and staff reported benefits of shared experience through group participation, leading to greater use of compensatory strategies. Staff observed client improvement in memory‐related self‐confidence, thereby reducing anxiety and increasing re‐engagement in life activities. In their own professional roles, staff reported increased self‐efficacy, leading to greater role satisfaction. Several challenges in running and sustaining the program were also identified.Conclusions: Memory group interventions can be feasibly delivered in a community setting and increase service access opportunities for older people with memory problems.