Whitfield, Timothy;
(2023)
Prognosis and non-pharmacological intervention in subjective cognitive decline.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: The UK prevalence of dementia is approaching 1,000,000 and will double by 2050. Interventions designed to ameliorate dementia have been unsuccessful, leading to a focus on prevention. Effective prevention will target individuals with an elevated risk of dementia; individuals with subjective cognitive decline (SCD)—who perceive cognitive impairment but score normally—are one such population. Objectives: To determine predictors of incident cognitive decline—defined as mild cognitive impairment (MCI) or dementia—in SCD patients. To evaluate the effects of mindfulness-based programmes (MBPs) and remotely-delivered lifestyle interventions on objective cognition in SCD patients and older adults. Methods: In Chapter 2 I examined the incidence of—and determined predictors of—cognitive decline in SCD. In Chapter 3 I meta-analysed objective cognitive outcomes from MBP trials. In Chapter 4 I compared the effects of an MBP versus a health-self management comparator on objective cognition in SCD patients. In Chapter 5 I meta-analysed objective cognitive outcomes from remotely-delivered intervention trials in older adults without dementia. Results: In Chapter 2, I reported that worse cognition in SCD increased the risk of cognitive decline, and the incidence of decline varied depending on which criteria were used to define MCI (MCI is exclusionary within the SCD research criteria). In Chapter 3 I found that MBPs outperformed comparators for objective cognitive outcomes (more so for older, versus younger, adults). In the study described in Chapter 4 I observed that an MBP and a health self-management comparator both improved cognition in SCD. In Chapter 5 the data I synthesised indicated that remote interventions did not outperform comparators for objective cognitive outcomes in older adults without dementia. Conclusions: This research found that worse objective cognition in SCD is associated with an increased risk of cognitive decline. Whilst MBPs improve some objective cognitive outcomes in SCD, this appears to be a non-specific effect, common to some other group-based/in-person non-pharmacological approaches. In contrast, synthesising the available evidence suggested that extant remotely-delivered lifestyle-based interventions are inefficacious for objective cognitive outcomes in older adults without dementia.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Prognosis and non-pharmacological intervention in subjective cognitive decline |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry > Mental Health of Older People |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10163647 |
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