The Construction and Evaluation of Multi-Domain Attention Training for Older Adults with Mild Cognitive Impairment to Improve Intensity of Attention, Executive Attention, and Spatial Orienting Attention: a Randomized Controlled Study

Background. The basic cognitive functions most affected by age are attention and memory. The core concept of attention is a fundamental principle of cognitive, all teaching and learning depends on adequate attention. Attention deficit may affect other cognitive functions such as memory, thinking, speech, behavior and learning. Memory training has been the focus of cognitive training in the past. Recently, attention training has been shown to reduce attention decline in elders. However, most previous studies included subjects with brain injury, attention deficit hyperactivity disorder or other mental illness; the effects of attention training on elderly with mild cognitive impairment have not been thoroughly evaluated. In Taiwan, the effects of multiple domain attention training on cognitive function of elders with mild cognitive impairment have not been studied before. Objective. The purpose of this 3-year study is to construct and evaluate the effects of multi-domain attention training (MAT) on intensity of attention, executive attention and spatial orienting attention of older adults with mild cognitive impairment. Design. This is a double blind randomized controlled study with a 2-armed, parallel group design. Study subjects are older adults with mild cognitive impairment living in long-term care facilities in northern Taiwan. Subjects will be randomized by the block randomization (using block size of 4) into experimental group (MAT), or active control group (Passive Information Activities, PIA). MAT training is composed of two series parts: initial attention training (36 sessions) and booster attention training (36 sessions). MAT focuses on three domains of attentions: (1) Intensity of attention (including alertness, sustained/vigilance attention); (2) executive attention (including selective, focused and divided attention); and (3) spatial orienting attention. Thirty-six sessions of Initial Attention Training will be administered to the experimental group in a 45-minute session, three times a week for 36 sessions. Six months later, 36 sessions of Booster Attention Training will be offered repeatedly to participants after the completion of initial attention training. Subjects in the active control group will conduct a total of 72 sessions of Passive Information Activities (listening to audio books and reading newspaper) complying with the arrangement in the experimental group. The evaluation of the MAT will be evaluated at baseline, immediate after, 3 months, 6 months, and 1 year after the last session. The primary outcome indicators of the training are executive attention that include: 1) selective attention assessed by the Digit Span Task (DS); 2) focused attention assessed by the Stroop Color Word Test (SCWT); and 3) divided attention evaluated using the Gordon Diagonostic System (GDS) - Adult Distractibility Task. The secondary outcome indicators are: 1) intensity of attention, alertness assessed using the Trail Making Test Part B (TMT Part B) and sustained/vigilance attention assessed by the Digit Vigilance Test (DVT); and 2) spatial orienting attention evaluated by the TMT Part A. Data Analysis. Therapeutic adherence, sample attrition rate, medication compliance and adverse events will be monitored during the study period. Missing data will be analyzed using intent-to-treat analysis. Intensity of attention, executive attention, and spatial orienting attention will be tested in the repeated measures analysis to show improvement and efficacy. For treatment efficacy over time, two groups will be compared before the intervention and during a follow-up, at 3 months, 6 months, and 1 year after the intervention. Generalized linear mixed model will be used in the repeated measures statistical analysis to estimate the long-term effect of the intervention, and controlled the effect of the latent variables. Expected contribution. This will be the first MAT program conducted targeting older adults with mild cognitive impairment in Taiwan. With rigorous design and long term follow-up, the effectiveness of MAT program in Chinese population in Taiwan can be evaluated. Results of the current study will determine the value of the MAT and provide valuable information for future utilization of this protocol.