A Multicomponent Cognitive Intervention May Improve Self-Reported Daily Function of Adults With Subjective Cognitive Decline

Abstract

Importance: Limited evidence exists to support cognitive intervention improving the daily function of adults with subjective cognitive decline (SCD).

Objective: To examine the preliminary efficacy of a group-based multicomponent cognitive intervention that integrates Lifestyle Redesign^® (LR) techniques.

Design: Single-arm two-period crossover trial; 16-wk waiting period, 16-wk intervention, and 16-wk follow-up.

Setting: Memory clinic in a medical center, Taiwan.

Participants: Purposive sample of adults ages >55 yr with SCD.

Intervention: Sixteen 1.5-hr weekly multicomponent sessions of cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention.

Outcomes and Measures: Primary outcomes were (1) self-reported daily function, measured with the Activities of Daily Living Questionnaire (ADLQ) and Cognitive Failure Questionnaire; (2) performance-based daily function, measured with the Brief University of California San Diego Performance-Based Skills Assessment–Traditional Chinese Version; and (3) functional cognition, measured with the Contextual Memory Test (CMT) and Miami Prospective Memory Test. Secondary outcomes included cognitive functions, anxiety, and depression.

Results: Seventeen participants completed the intervention; 4 missed the follow-up. The generalized estimating equations model showed significant changes from baseline to pretest (control) and pretest to posttest (intervention) on the ADLQ (p = .014) and CMT–delayed (p = .003). Effects remained at the 16-wk follow-up. After adjusting for the effects of covariates, the self-reported daily function of participants ages ≤ 63 yr improved more than that of other participants (p = .003).

Conclusions and Relevance: Multicomponent cognitive interventions integrating LR techniques may improve self-reported daily function and context-dependent memory function of adults with SCD, with efficacy sustained at follow-up.

What This Article Adds: A group-based multicomponent cognitive intervention consisting of cognitive training, cognitive rehabilitation, psychoeducation, and lifestyle intervention may provide benefits for the daily function and cognitive function of adults with SCD.

This study examines the preliminary efficacy of a group-based multicomponent cognitive intervention that integrates Lifestyle Redesign^® techniques to improve the daily function of adults with subjective cognitive decline.

Individuals with subjective cognitive decline (SCD) perceive difficulties in cognition but perform normally on cognitive tests (Jessen et al., 2014). Because adults with SCD are twice as likely to develop dementia as those without SCD (Mitchell et al., 2014), they could be the most important target population for dementia prevention.

Adults with SCD commonly experience difficulties in daily function, cognitive problems, and negative mood. Cognitive-related difficulties in daily function, such as frequent misplacement of objects and difficulty retaining names or words, often induce frustration, fear of continued deterioration, and loss of self-confidence, which further inhibits engagement in daily activities and social interactions, thus exacerbating cognitive decline (Rotenberg et al., 2020). The complex interaction among cognitive function, performance of instrumental activities of daily living, psychological well-being, and social participation of adults with SCD should be considered when designing cognitive interventions for this population.

Cognitive interventions include cognitive training, cognitive rehabilitation, psychological intervention, lifestyle intervention, and so forth (Huckans et al., 2013). Cognitive training entails the repeated practice of structured tasks to enhance or restore specific cognitive abilities. Cognitive rehabilitation is a unique, individualized approach involving goal setting and strategy development to address cognitive difficulties in real life and improve performance of daily activities (Clare & Woods, 2004). Psychological intervention aims to improve psychological well-being (depression, anxiety, and insomnia) by using relaxation exercises and psychoeducation to increase participants’ awareness of their mental health and encourage them to adapt (Huckans et al., 2013). Lifestyle intervention focuses on educating participants on health management and adoption of a healthy lifestyle (e.g., Mediterranean diet; regular participation in physical, social, and cognitive activities) to manage modifiable risk factors and delay cognitive decline (Livingston et al., 2017).

Previous research on intervention for SCD has examined the benefits of single- and multicomponent cognitive interventions. For example, recent meta-analyses have shown that cognitive interventions lead to improvement in specific cognitive functions and overall well-being but not in general cognitive function and daily functional performance (Bhome et al., 2018; Smart et al., 2017). Furthermore, the gain in cognitive function had limited transfer effects on everyday performance. Because difficulties with daily activities are often the reason why adults with SCD seek medical help, there is an urgent need for an intervention that can improve daily function in and perceived performance of cognitively challenging daily activities. Compared with single-component interventions, multicomponent interventions combine multiple types of cognitive interventions and demonstrate greater potential to have transfer effects on everyday outcomes (Sherman et al., 2017). However, few studies have investigated the efficacy of a function-oriented multicomponent intervention for adults with SCD.

We hypothesized that integrating Lifestyle Redesign^® (LR) delivery methods (Jackson et al., 1998), such as didactic presentation, peer exchange, direct experience, and personal exploration, into a cognitive intervention could help participants (1) explore and gain better insights into their cognitive difficulties, (2) apply cognitive strategies to their daily lives, and (3) gain peer support to improve their psychological well-being. By using principles of behavior change, LR helps participants create habits and routines that increase meaningful participation with sustained effects (Jackson et al., 1998).

This study examined the preliminary efficacy, primarily in daily function and cognitive function, of a group-based multicomponent cognitive intervention program for adults with SCD, integrating the principles of cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention with LR techniques.

Method

Design and Participants

In this single-arm, two-period crossover trial, 17 participants received a multicomponent 16-wk cognitive intervention. Primary and secondary outcomes were assessed four times: at baseline (Time 0), 16 wk after baseline, preintervention (Time 1), post-intervention (Time 2), and 16 wk postintervention (Time 3). The T1 − T0 difference yielded the effects of the control arm. The T2 − T1 difference yielded the effects of the intervention arm.

From January to August 2019, we recruited individuals diagnosed with SCD by physicians at a memory clinic in a medical center. The inclusion criteria were as follows: (1) age >50 yr, (2) consistent self-perceived cognitive decline unrelated to an acute event, (3) normal neuropsychological performance (better than −1.5 SD of their age- and education-matched norm), (4) being literate, (5) no difficulties performing basic activities of daily living, (6) not in a depressive episode (Geriatric Depression Scale–Short Form score of <8; Lee et al., 1993), and (7) attending ≥12 of the 16 sessions. The exclusion criteria were as follows: (1) met the criteria for mild cognitive impairment (MCI; Petersen et al., 2001) or dementia, (2) diagnosed with another neurological condition that could lead to cognitive decline, or (3) had a severe visual or hearing impairment or unstable medical condition that could interfere with participation.

A sample size of 19 was estimated by G*Power (Version 3.1.9.4) with a .22 effect size (Smart et al., 2017), a .7 pre- and posttest correlation coefficient level, a .05 significance level, and a .80 statistical power.

Multicomponent Cognitive Intervention

The intervention program consisted of cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention. Two experienced occupational therapists in the Department of Occupational Therapy (≤5-min walking distance of the hospital) led the program. (See the Supplemental Appendix, available online with this article at https://research.aota.org/ajot, for intervention protocol details.) Every 1.5-hr weekly session consisted of the following:

▪ A 10-min warm-up

▪ Thirty-five minutes of cognitive training that addressed complex attention, language, reasoning, spatial relationship, executive functioning, and so forth

▪ Thirty-five minutes of (1) cognitive rehabilitation (e.g., developing and practicing strategies to address cognitive problems) or lifestyle intervention (e.g., introducing Mediterranean diet), alternated weekly, and (2) psychological intervention (e.g., relaxation and psychoeducation that increases metacognition)

▪ Starting in the 7th wk, establishment of individualized goals (e.g., exercise 3 days/wk), with progress check-ins every 2 wk

▪ Ten minutes for assignment of homework (e.g., reflection diary, paper-and-pencil tasks).

Outcome Measures

The three primary outcomes were as follows:

Self-reported daily function: The Activities of Daily Living Questionnaire (ADLQ; Johnson et al., 2004) was used to assess functioning in six areas: self-care, household care, employment and recreation, shopping and money, travel, and communication; and the Cognitive Failure Questionnaire (Broadbent et al., 1982) was used to assess frequency of everyday cognitive problems.

Performance-based daily function: The Brief University of California San Diego Performance-Based Skills Assessment–Traditional Chinese Version (Gomar et al., 2011) was used to assess everyday functioning of financial and communication skills.

Functional cognition (cognitive ability to perform daily life tasks): The Contextual Memory Test (CMT; Toglia, 2004) was used to assess context-dependent memory function, self-efficacy, and strategy use in daily contexts, and the Miami Prospective Memory Test (Hernandez Cardenache et al., 2014) was used to assess prospective memory (i.e., remembering intended actions in complex real-life situations).

Secondary outcomes were cognitive function and levels of anxiety and depression. The Montreal Cognitive Assessment (Nasreddine et al., 2005) was used to assess general cognition. The Word Sequence Learning Test (WSLT; Chen, 2014) was used to assess arbitrary verbal associations. The Color Trails Test Parts 1 (CTT–1) and 2 (CTT–2; D’Elia et al., 1996) were, respectively, used to assess attention and executive function. The Logical Memory (LM) and Family Picture (FP) subtests of the Wechsler Memory Scale, Third Edition (Wechsler, 1997), were used to assess verbal and visual memory, respectively. The Beck Anxiety Inventory (BAI) was used to assess anxiety (Balsamo et al., 2018), and the Geriatric Depression Scale–Short Form (GDS–S; Chin et al., 2014) was used to assess depression. (See Table A.2 in the Supplemental Appendix for further details.) All functional and cognitive outcome assessments were administered by the same occupational therapist (Yuan Ling Tang) and psychologist, respectively, independent of the intervention. We also recorded participants’ narrative feedback about the intervention and the changes experienced at the posttest and follow-up assessments.

Statistical Analysis

We used R 4.1.3 software. A two-sided p ≤ .05 was considered statistically significant. Multivariate analysis was conducted by fitting several multiple linear regression models to examine the effects of our intervention versus the control condition on the primary and secondary outcomes by means of the generalized estimating equations (GEE) method (Liang & Zeger, 1986). Because of the small sample size of this pilot study, we computed the GEE robust standard errors using the fully iterated jackknife variance estimator (Paik, 1988). See the Supplemental Appendix for technical details.

Results

Twenty-eight eligible participants were recruited; 10 declined to participate, and 1 did not respond to our inquiry. Seventeen participants completed the intervention, but 4 missed the follow-up (Time 3) because of coronavirus disease 2019 restrictions. The average number of sessions attended was 14.71 (SD = 1.36). The baseline characteristics of the participants are listed in Table 1 (see Table A.3 for further details).

Table 1.

Baseline Demographic and Clinical Characteristics

Variable	M (SD)
Age, yr	68.82 (5.84)
Gender, %
Female	12 (70.59)
Male	5 (29.41)
Education, yr	13.88 (2.26)
Measure
MoCA	25.29 (3.85)
STAI–T	39.65 (5.56)
BAI	6.12 (4.78)
GDS–S	2.59 (1.87)

Note. N = 17. BAI = Beck Anxiety Inventory; GDS–S = Geriatric Depression Scale–Short Form; MoCA = Montreal Cognitive Assessment; STAI–T: State–Trait Anxiety Inventory–Trait Anxiety.

Training Effects of the Intervention Over Time

Time 2 Versus Time 1

As shown in the first part of Table 2, conditioning on the value of ADLQ at Time 0, the mean score on the ADLQ at Time 2 was 2.15 less than that at Time 1 (p = .014), indicating that self-reported daily function improved. Similarly, improvements were found in the context-dependent memory function (CMT–delayed), visual memory (FP–immediate and FP–delayed), and verbal memory (LM–delayed; all ps < .05), with an unexpected deterioration in arbitrary verbal association (WSLT–recognition; p = .001).

Table 2.

Intention-to-Treat Analysis of the Outcomes Over Time

Covariate^a	Regression Coefficient Estimate	Robust SE	z	p
Time 2 Versus Time 1
Primary outcomes
ADLQ^b
Intercept	6.84	1.52	20.25	<.001
ADLQ (Time 0)	0.27	0.14	3.61	.057
Time 2	−2.15	0.87	6.07	.014
UPSA–B–TC
Intercept	17.91	7.09	6.37	.012
UPSA–B–TC (Time 0)	0.45	0.11	15.98	<.001
Time 2	6.12	4.65	1.73	.189
CFQ^b
Intercept	13.94	7.71	3.27	.071
CFQ (Time 0)	0.65	0.19	11.34	<.001
Time 2	−0.94	1.48	0.40	.526
CMT–immediate
Intercept	5.48	1.47	13.88	<.001
CMT–immediate (Time 0)	0.67	0.11	37.80	<.001
Time 2	0.47	0.48	0.98	.323
CMT–delayed
Intercept	3.08	2.99	1.06	.302
CMT–delayed (Time 0)	0.74	0.22	11.10	<.001
Time 2	2.29	0.77	8.86	.003
MPMT^4a
Intercept	2.39	0.77	9.79	.002
MPMT^4a (Time 0)	0.46	0.18	6.35	.012
Time 2	−0.24	0.47	0.26	.613
Secondary outcomes
MoCA^4a
Intercept	23.80	6.80	12.25	<.001
MoCA^4a (Time 0)	0.53	0.10	25.38	<.001
Time 2	4.69	3.08	2.32	.128
WSLT correct^4a
Intercept	77.17	9.88	60.95	<.001
WSLT correct^4a (Time 0)	0.39	0.09	17.51	<.001
Time 2	−13.39	6.93	3.73	.054
WSLT recall
Intercept	1.14	0.63	3.30	.069
WSLT recall (Time 0)	0.67	0.24	7.97	.005
Time 2	0.12	0.37	0.10	.751
WSLT recognition^6a
Intercept	262.44	200.94	1.71	.192
WSLT recognition^6a (Time 0)	0.58	0.25	5.19	.023
Time 2	−182.92	56.19	10.60	.001
CTT–1 (percentile)
Intercept	62.62	10.28	37.10	<.001
CTT–1 (Time 0)	0.08	0.13	0.35	.552
Time 2	7.06	6.33	1.24	.265
CTT–2 (percentile)
Intercept	38.32	11.02	12.10	<.001
CTT–2 (Time 0)	0.44	0.16	7.48	.006
Time 2	3.76	3.59	1.10	.295
LM–immediate
Intercept	3.23	1.96	2.71	.100
LM–immediate (Time 0)	0.88	0.14	41.70	<.001
Time 2	0.29	0.33	0.79	.373
FP–immediate
Intercept	5.01	1.23	16.63	<.001
FP–immediate (Time 0)	0.61	0.10	34.25	<.001
Time 2	1.65	0.45	13.69	<.001
LM–delayed
Intercept	2.28	1.83	1.55	.213
LM–delayed (Time 0)	0.94	0.13	53.71	<.001
Time 2	0.71	0.33	4.57	.033
FP–delayed
Intercept	4.69	1.20	15.23	<.001
FP–delayed (Time 0)	0.64	0.10	44.11	<.001
Time 2	1.35	0.36	14.47	<.001
BAI^0.5a,b
Intercept	1.02	0.64	2.53	.112
BAI^0.5a (Time 0)	0.67	0.21	10.54	.001
Time 2	−0.41	0.24	2.89	.089
GDS–S^0.5a,b
Intercept	0.65	0.64	1.02	.312
GDS–S^0.5a (Time 0)	0.59	0.37	2.60	.107
Time 2	−0.35	0.20	3.03	.082
Time 3 Versus Time 2^c
Primary outcomes
ADLQ^b change score
Intercept	−0.39	1.57	−0.25	.811
ADLQ (Time 2)	−0.01	0.22	−0.07	.949
UPSA–B–TC⁴ change score
Intercept	34.08	17.22	1.98	.073
UPSA–B–TC⁴ (Time 2)	−0.41	0.36	−1.15	.273
CFQ^b change score
Intercept	−3.13	4.93	−0.64	.538
CFQ (Time 2)	−0.02	0.15	−0.11	.916
CMT–immediate change score
Intercept	4.71	1.95	2.42	.034
CMT–immediate change score (Time 2)	−0.25	0.14	−1.85	.091
CMT–delayed change score
Intercept	3.62	2.03	1.78	.102
CMT–delayed change score (Time 2)	−0.25	0.14	−1.78	.103
MPMT^4a change score
Intercept	1.98	1.01	1.96	.076
MPMT^4a (Time 2)	−0.33	0.20	−1.66	.125

Note. Boldface indicates that the pre–post comparison reveals a significant difference (p < .5). ADLQ = Activities of Daily Living Questionnaire; BAI = Beck Anxiety Inventory; CFQ = Cognitive Failure Questionnaire; CMT = Contextual Memory Test; CTT–1 = Color Trails Test–Part 1; CTT–2 = Color Trails Test–Part 2; FP = Family Picture; GDS–S = Geriatric Depression Scale–Short Form; LM = Logical Memory; MoCA = Montreal Cognitive Assessment; MPMT = Miami Prospective Memory Test; UPSA–B–TC = Brief University of California San Diego Performance-Based Skills Assessment–Traditional Chinese Version; WSLT = Word Sequence Learning Test.

Power transformations (x^q ), including natural logarithm (q = 0), square root (q = 0.5), squared (q = 2), and the power of 4 or 6, were applied to some of the continuous variables to make their distributions more symmetric.

Higher scores indicate worse performance.

The inverse probability weighting (IPW) method for handling the four missing values at Time 3 was used (discussed in the Supplemental Appendix).

Time 3 Versus Time 2

As shown in the second half of Table 2, conditioning on the value of ADLQ at Time 2, the mean value of the ADLQ change score (i.e., Time 3 − Time 2) was close to zero (regression estimate = −0.015, p = .949), indicating that the postintervention improvement of subjective daily function was sustained. We also found improvements in immediate context-dependent memory function (CMT–immediate), attention (CTT–1), and visual memory (FP–delayed; all ps < .05) (see Table A.4 for further details).

Time 1 Versus Time 0

The mean value of the ADLQ change score (i.e., Time 1 – Time 0) was significantly different from zero (regression estimate = 7.36, p = .004), indicating that the subjective ADL performance of the participants deteriorated from Time 0 to Time 1 (see Table A.4 for details on other outcome variables).

Comparison of ADLQ Scores: Time 2 Versus Time 1 With All Available Covariates

The two cutoff points for age, 63 and 73 yr, were estimated by fitting a multiple generalized additive model of ADLQ (Time 2 vs. Time 1). (See Figure A.2 in the Supplemental Appendix.) Table 3 shows that, after adjusting for the effects of ADLQ, GDS–S, and BAI values at Time 0 and the value of BAI at the same time as the ADLQ measurements (i.e., Times 1 and 2), the mean value of ADLQ scores among participants ages >73 yr at Time 1 was 3.52 more (worse performance) and among participants ages ≤ 63 yr at Time 2 was 3.20 less (better performance) than that for scores among the other participants at Times 1 and 2 (ps = .001 and .003, respectively). Given the adjustments for the effects of the other covariates, our intervention had better efficacy for younger participants (ages ≤ 63 yr).

Table 3.

Marginal Linear Regression Analysis of the ADLQ Score for Time 2 Versus Time 1 Comparisons, Using the Generalized Estimating Equations Method

Covariates^a	Regression Coefficient Estimate	Robust SE	Wald’s χ² Test	p
Intercept	1.89	0.52	13.11	<.001
Age > 73 yr × Time 1	3.52	1.08	10.59	.001
Age ≤ 63 yr × Time 2	−3.20	1.09	8.69	.003
ADLQ^b (Time 0) > 10.91	5.83	0.56	110.20	<.001
GDS–S^b (Time 0) > 1.63	1.87	0.45	17.31	<.001
BAI^b (Time 0) > 8.61	2.76	0.74	13.91	<.001
4.06 < BAI^b at the same time ≤ 13.08	3.68	0.82	20.24	<.001

Note. ADLQ = Activities of Daily Living Questionnaire; BAI = Beck Anxiety Inventory; GDS–S = Geriatric Depression Scale–Short Form.

The two cutoff points for age, 63.4348 and 73.2219 yr, were estimated by fitting a multiple generalized additive model of ADLQ (Time 2 vs. Time 1).

Higher scores indicate worse performance.

Discussion

We found that a group-based 16-wk multicomponent cognitive intervention integrating LR techniques significantly improved self-reported daily function and context-dependent memory function of adults diagnosed with SCD. Moreover, the effects were maintained 16 wk postintervention. Thus, the intervention has the potential to counteract the deterioration of daily function for adults with SCD. Additionally, the results showed that age can affect the intervention effects. To our knowledge, this is the first study to support the benefits of an integrated multicomponent cognitive intervention for the daily function of people in this population.

The daily function effects can be attributed to the use of both cognitive training and cognitive rehabilitation. Because previous studies have shown limited transfer of gains from cognitive training to daily performance (Bhome et al., 2018; Smart et al., 2017), we deliberately incorporated cognitive rehabilitation to encourage and facilitate the application of strategies learned to manage problems in daily real-life situations. CMT Question 15 records participants’ memorization strategies for the objects. The pre–post test response comparison showed increased use of memory strategies among participants: use of theme increasing from 4 to 7, visualization from 2 to 10, rehearsal from 1 to 2, and location from 1 to 3. Combining cognitive training and cognitive rehabilitation may have been key to improving their daily performance (Chang et al., 2021).

Most interventional gains were sustained 4 mo postintervention, which can be attributed to the integration of LR principles and group-based intervention (Jackson et al., 1998). Each session included peer exchanges for sharing strategies for overcoming cognitive barriers, and opportunities for participants to explore, experience, and problem-solve during cognitive activities that are applicable to daily life. Many participants reported at follow-up that they continued to engage in healthy habits learned in the program (such as Sudoku, reading, and exercise). The integration of the LR delivery methods into a multicomponent intervention may promote long-term intervention effects (Jackson et al., 1998).

A previous meta-analysis (Borella et al., 2017) indicated that an individual’s characteristics (age or years of education) and baseline performance contribute to explaining cognitive training effects. We also observed better results for younger participants (age ≤ 63 yr) and those with better baseline ADLQ performance. These findings support the cognitive reserve concept (Borella et al., 2017) and the importance of providing cognitive intervention as early as possible. Future studies will need to use a larger sample to clarify the relationship between the effectiveness of intervention and participants’ age.

Significant improvements were observed in visual memory postintervention and in attention and visual memory at follow-up. These results are similar to those of previous meta-analyses of cognitive intervention, which have reported an overall small effect size for specific cognitive measures (Bhome et al., 2018). Meanwhile, our participants’ performance on verbal episodic memory (WSLT) declined. A prospective long-term follow-up study (Koppara et al., 2015) also found that immediate and delayed verbal recall in the SCD group was significantly worse and declined more than among those with normal cognition. Our findings indicate that a decline in arbitrary verbal association might not be easy to improve via training. In sum, a multicomponent cognitive intervention may provide specific benefits for cognitive function, especially visual memory.

Previous systematic reviews (Bhome et al., 2018; Smart et al., 2017) have indicated positive psychological effects of training, such as decreased anxiety and increased confidence. Despite no statistical changes in depression and anxiety in our study, we observed that the participants became more comfortable engaging in cognitive activities, their awareness of cognitive situations in their daily life grew along with their confidence in activity engagement, and their anxiety and depression decreased. One participant stated, “After this program, I realize that it is not possible to have no memory problems in my daily life. But I do not panic and am not afraid. I found ways [to manage them].”

This study had several limitations. Because it was a pilot study with a single-arm, two-period crossover design, we could not rule out a potential Hawthorne effect, subject-expectancy effect, and learning effect of the evaluation tools without a randomized controlled trial. Generalization should also be conservative because of the small sample size. Future randomized controlled trials can explore the intervention’s efficacy on a larger scale. Last, our participants had higher education levels than age-matched older adults in Taiwan, and they actively sought out medical assistance. It is unclear whether this intervention is suitable for clients with less motivation and limited education.

Implications for Occupational Therapy Practice

This study supports the preliminary efficacy of multicomponent cognitive group-based interventions that integrate cognitive training, cognitive rehabilitation, psychological intervention, and lifestyle intervention to improve the self-reported daily function and functional cognition of adults with SCD. The results have the following implications for occupational therapy practice:

▪ When designing cognitive interventions for adults with SCD, occupational therapy practitioners need to consider the complex interaction among cognitive function, performance of activities of daily living, psychological well-being, and social participation. Therefore, a multicomponent intervention is necessary.

▪ A multicomponent cognitive intervention may improve the self-reported daily function and context-dependent memory function of adults with SCD; its benefits are multidimensional.

▪ The delivery methods of LR may facilitate the application of skills and knowledge gained to real life, thus enhancing the benefits of the intervention.

▪ Younger older adults may benefit more from the intervention.

Conclusion

A 16-wk multicomponent cognitive intervention that incorporates cognitive training and rehabilitation, psychological and lifestyle interventions, and LR delivery methods may improve daily function and cognition. This pilot study supplemented the lack of research supporting the efficacy of cognitive intervention for the daily function of adults with SCD. Further research with a more robust design is needed to verify the results.

Supplemental Material

Supplemental Information

Supplementary material for A Multicomponent Cognitive Intervention May Improve Self-Reported Daily Function of Adults With Subjective Cognitive Decline

Supplementary material, sj-pdf-1-aot-10.5014_ajot.2023.050133.pdf for A Multicomponent Cognitive Intervention May Improve Self-Reported Daily Function of Adults With Subjective Cognitive Decline by Ling-Hui Chang, Yuan Ling Tang, Ming-Jang Chiu, Chien-Te Wu and Hui-Fen Mao in The American Journal of Occupational Therapy

Footnotes

Acknowledgments

This study was funded by Grant UN108-021 from the National Taiwan University Hospital, Taipei, Taiwan. Ling-Hui Chang and Yuan-Ling Tang contributed equally to this article.

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