Longitudinal effects of behavioral interventions: A comparison using a propensity score matching model

• Published in: Alzheimer's & dementia Vol. 17; no. S7; pp. e049537 - n/a
• Main Authors: Ying, Gelan, Locke, Dona E, Chandler, Melanie, Shandera‐Ochsner, Anne, Smith, Glenn E
• Format: Journal Article
• Language: English
• Published: United States 01.12.2021
• ISSN: 1552-5260; 1552-5279
• DOI: 10.1002/alz.049537

Background Behavioral interventions are often recommended for persons with mild cognitive impairment (MCI). The Healthy Action to Benefit Independence & Thinking® Program (HABIT) has been shown to benefit activities of daily living (ADL) and self‐efficacy in patients at 6‐ and 12‐months post intervention. However, to date, the findings have been limited by comparison to a relatively small, untreated control group. This study attempted to explore HABIT ADL outcomes compared to a large, presumably untreated Alzheimer's Disease Neuroimaging Initiative (ADNI) MCI cohort. Method A total of 767 participants with MCI were selected from the ADNI database, whereas 478 participants with MCI were recruited from the HABIT IRB approved research registry. Functional outcomes were assessed with informant‐based measures ‐ Functional Activities Questionnaire (FAQ) and Everyday Cognition scale (ECOG) memory and total scores – at both 6‐month‐ and 12‐month‐follow‐ups. After near‐neighbor propensity score matching with a caliper of 0.2, 288 participants from each group were matched for the FAQ, and 333 were matched for the ECOG scores. Latent growth curve models were used to test the hypothesis that the HABIT program might delay functional decline in patients with MCI. Result After matching HABIT group continued to show higher initial scores on FAQ (b=.849, p=.013), and ECOG memory (b=.200, p=.004) and total scores (b=1.115, p<.001) compared to the ADNI group. Although an increase in scores was observed in both groups for each functional outcome, the slopes were steeper for the HABIT group for FAQ (b=1.194, p<.001), ECOG memory (b=.073, p=.019) and ECOG total (b=.383, p=.007). Conclusion Contrary to our hypothesis, in this non‐randomized study, partners of HABIT participants with MCI reported more rapid functional decline compared to those in an imaging study. This discrepancy could be due to the HABIT group’s higher baseline impairment level even after matching. Furthermore, patients with perceived more rapid decline may be more likely to seek interventions relative to those who elect to participate in a non‐interventional imaging study. In addition, the intervention sessions could prime the partners to be more scrupulous and aware when rating functional assessments. Additional randomized research may help add clarity to these findings.