May 12, 2015
Mayo Clinic began its Healthy Action to Benefit Independence and Thinking (HABIT) program in 2008. Since then, more than 270 couples — one person living with mild cognitive impairment (MCI) and a support partner — have completed the intensive10-day, 50-hour intervention that aims to delay or prevent progression to dementia.
HABIT was modeled on Mayo's system of outpatient rehabilitation for patients with acute brain injuries, according to Glenn E. Smith, Ph.D., L.P., Dona E. Locke, Ph.D., and Melanie J. Chandler, Ph.D., whose research on the transition from normal aging to early dementia contributed significantly to HABIT's development.
"For years, Mayo has had a robust program of interventions for brain-injured patients, and we were looking for opportunities to do the same kind of interventions for people with early changes in cognitive functioning," Dr. Chandler explains. "There is growing concern that by the time dementia is present, treatment may no longer be effective. But now, we can reliably diagnose mild cognitive impairment, and that has given rise to secondary strategies to delay its progression."
Patients with mild cognitive impairment present with subjective complaints of progressive memory changes that are supported by objective impairment in some area of cognitive function on sensitive neuropsychological tests. At the same time, the population-based Mayo Clinic Study of Aging found that about 1 in 5 cognitively normal older adults has structural and functional brain changes suggestive of Alzheimer's disease on autopsy, suggesting that cognitive reserve and resilience can sometimes offset the effects of brain pathologies.
"We are starting to recognize that there is a distinction between disease in the brain and impaired function, and that some people manage to be resilient in the face of brain disease," Dr. Locke says. "We have studied people with MCI whose declarative memory is failing but whose procedural memory is intact and may even be better than that of people with normal declarative memory. So one of the key goals of HABIT is to help people compensate for failing declarative memory by strengthening procedural memory through the use of journals to record names, appointments, medications and other important information."
In addition to memory compensation training, participants in HABIT engage in four other essential activities: group supportive therapy, daily yoga, brain fitness and wellness education.
The intended aims are to improve independence, functional status, self-efficacy and psychological well-being; foster communication between patients and caregivers; and establish supportive relationships and networks of support to decrease caregiver burden.
The HABIT program is offered four times a year at all Mayo Clinic sites. Dr. Smith leads the program at Mayo Clinic's campus in Minnesota, Dr. Locke at the campus in Arizona and Dr. Chandler at the campus in Florida.
As part of a research project, the HABIT program at all three Mayo campuses will be collecting information on patient and caregiver outcomes through early 2016. During the study, four of the five usual interventions will be given at random to help compare the effectiveness of each component with the others.
"So far, we know key measures all improve by the end of treatment and improvement continues at six months," Dr. Smith says. "Anecdotally, we know that HABIT program participants continue using the journal, so it's a powerful intervention. Whether or not it is actually delaying transfer to a nursing home or reducing caregiver burden remains to be seen — we are still collecting data. But we are certain that it's providing some sense of agency and hope for both patients and caregivers. We also provide support groups for caregivers and that is hugely important. Although behavioral interventions appear to provide some benefit for people with MCI, some of the best outcomes may actually be for caregivers."