Early intervention to promote Active and Cognitive Stimulating Lifestyle for patients with Mild Cognitive Impairment in the General Out-patient Clinics

Introduction

Mild Cognitive Impairment (MCI) might not cause significant dysfunction in daily life initially, but might result in cognitive decline without appropriate intervention. There is a service gap in managing patients with MCI in the public primary care settings. The Department of Family Medicine and Primary Healthcare (FM&PHC) in Hong Kong West Cluster (HKWC) identified a service gap after the early detection of MCI and collaborated with the Department of Occupational Therapy (OT) to develop a time-limited OT Elderly Cognitive Care Program (OTECCP) in the general out-patient clinics (GOPCs) since January 2014.

Objectives

OTECCP used an experiential learning approach to help patients and carers to understand the importance of brain health, participation in cognitive stimulating activities and active lifestyle as a potential strategy to delaying cognitive decline in MCI.

Methodology

Patients aged 60 or above in GOPCs with Abbreviated Mental Test (AMT) score ≥8 were referred to OTECCP. They were further assessed using The Montreal Cognitive Assessment Hong Kong version (HK-MoCA) and Chinese version of the Activities of Daily Living Questionnaire (ADLQ-CV). Patients with HK-MoCA score≤2 percentile were triaged to receive Specialty OT service for dementia at David Trend Rehabilitation Centre (DTRC). Patients triaged to have MCI were recruited to join the OTECCP, which included 1-4 sessions of cognitive group training and subsequence periodical active lifestyle groups within 1 year.

Results & Outcome

Of 788 patients screened from January 2014 to December 2018 (mean age 74.3 years, 60.3% women), the mean scores of AMT, HK-MoCA and ADLQ-CV were 9.1, 20.6 and 13.7 respectively. 10.5%(83) were triaged to receive Specialty OT training at DTRC. 705 patients were recruited to the OTECCP and 222 completed the one-year-follow-up re-assessment. There were significant differences between the mean scores of HK-MoCA(p< .001) and ADLQ-CV(p< .005). HK-MoCA was increased 0.96(95% CI [-1.35, -0.57]) whereas ADLQ-CV was decreased 1.82(95% CI [0.57, 3.08]). The results indicated that cognitive functions have improved and the patients have less subjective memory complaints. Upon completion of the OTECCP starting from Oct 2018, needy patients were referred to Patient Resource Centre of Queen Mary Hospital for bridging to suitable NGO partners for long term support in the community.