جستجوی مقالات مرتبط با کلیدواژه « mild cognitive impairment » در نشریات گروه « روانشناسی »

One of the most critical and fundamental issues about human mental health in the middle years of life and the elderly is Mild Cognitive Impairments (MCI), known as the precursor stages of Alzheimer’s disease. Hence, conducting scientific studies on people with MCI is vital due to the intermediate role of these problems and their pathological position as a prognosis for more severe cognitive impairments. The lack of research exploring key factors affecting the well-being of individuals with MCI, combined with the absence of conceptual and structural models in this domain, underscores the importance of this study. Given the rising life expectancy and the growing aging population, it critical to focus on enhancing the mental and cognitive-emotional abilities of middle-aged and elderly individuals. By identifying the influential elements across various aspects of MCI, clinicians can develop tailored rehabilitation programs and interventions that address the specific needs and bolster the weaknesses of those affected by cognitive deficits. Therefore, this research investigates the mediating role of ego strength in how attachment styles impact executive functions in individuals with MCI.

The present study was a cross-sectional correlational study. The statistical population includes all people over 40 years of age in Tehran, Iran, with mild pathological symptoms of cognitive impairments who were referred to the Alzheimer’s Association of Tehran in the second six months of 2022. In this study, 364 people were selected using the available sampling method. The criteria for entering the research include being 40 years old or older (being in the age group of the middle-aged and elderly), the presence of mild pathological diagnostic criteria (noted in the file of people referring to the Alzheimer’s Association of Iran by an expert), obtaining a score lower than 27 in the short mental status assessment scale, agreeing to participate in the study, responding to the scales and tools used, mastering the Persian language, and having a sixth-grade education or higher. The exclusion criteria of the research were being under 40 years old (given that 40 is considered the end of youth and the beginning of middle age), incomplete completion of research tools, the presence of severe physical or psychiatric disorders, suffering from Alzheimer’s disease or advanced dementia, and severe sensory-motor and physical disabilities. In this research, ethical considerations were taken into consideration, including the principle of secrecy and confidentiality, the consent of each person to participate in the research, and the possibility of withdrawing cooperation in case of unwillingness. The research tools were the Brief Mental Status Assessment Scale (MMSE), Attachment Styles Questionnaire (RASS), Adult Executive Function Scale (ADEXI), Ego Strength Questionnaire (PIES), and Cognitive Flexibility Scale (CFI). Pearson correlation, structural equation modeling, and SPSS version 24, and AMOS version 24 software were used for data analysis.

The study results revealed the fit of the desired model. Furthermore, the direct effect of the variable of secure attachment to the variable of executive functions was insignificant (T=0.243, β=0.012). The direct effect of the variable of avoidant attachment on the variable of executive functions was insignificant (T=1.236, β=0.064). The direct effect of the anxious attachment variable on the executive functions variable was insignificant (T=-0.643, β=-0.036). The direct effect of the ego strength variable on the executive functions variable was insignificant (T=9.736, β=0.793). The direct effect of the secure attachment variable on the ego strength variable is significant (T=3.681, β=0.187). The direct effect of the avoidant attachment variable on the ego strength variable is significant (T=3.213, β=0.165). Additionally, the direct path effect of the anxious attachment variable to ego strength was significant (T=-6.592, β=-0.363). In addition, the obtained results indicate the indirect effect of the variable of secure attachment to the variable of executive functions through ego strength (β=0.138, P=0.002), the indirect effect of the variable of avoidant attachment to the variable of executive functions through ego strength means (β=0.204, P=0.002), and the indirect effect of the anxious attachment variable on the executive functions variable through ego strength were significant (β=-0.196, P=0.001). In addition, ego strength had a mediating role in the relationship between attachment styles and executive function symptoms.

According to the results of this study, seemingly, in addition to the existence of genetic and hereditary preparations in people suffering from cognitive impairments, attachment styles, specifically with the role that ego strength plays in this, can play parts in the beginning or progression of executive dysfunctions. The results of this study can be a point of hope for further studies in this field and help in formulating interventions to increase the ego capability of people with mild cognitive impairments whose executive functions are somehow impaired.

Preserving the cognitive ability of the elderly is a common issue of concern among researchers and health policymakers (1). Mild cognitive impairment (MCI) is a concerning condition indicating an elderly person's cognitive abilities are less than expected (3-5). Researchers interested in aging research strive to prevent the progression of cognitive problems as much as possible by identifying the cognitive problems of the MCI elderly as early as possible or, if this goal is not met, to compensate for their cognitive problems by developing rehabilitation packages (11). Evidently, cognitive rehabilitation packages cannot be provided without first understanding the cognitive problems of the elderly with MCI (15). According to the previous studies, the majority of those studies conducted for developing cognitive rehabilitation packages for the elderly have used the results of quantitative studies as the basis for choosing cognitive tasks (6, 11, 14, 16-19); this is even though in these studies, the actual view of the elderly themselves, or people who know them well, has never been asked. The current study used a qualitative research method to identify the cognitive problems of the Iranian elderly with mild cognitive impairment (MCI) to address these limitations. Besides, the results can be used to develop a cognitive rehabilitation package for the Iranian elderly with MCI.

The current study was a qualitative thematic analysis study that followed the method proposed by Braun and Clarke (27). The statistical population consisted of all Iranian elderly with MCI. The study sample included 14 elderly subjects with MCI diagnoses, seven relatives of elderly MCI patients (informants), and five specialists in providing mental health services to the elderly (Two psychiatrists, two psychologists, and one nurse), for a total of 26 subjects. The subjects were all Kerman city residents, and the study occurred between the summer and fall of 2021. Data Saturation was used to determine the adequacy of the sample size. The NUCOG test and a semi-structured in-depth interview were used as research tools (28). Guba and Lincoln's four recommended criteria (i.e., Credibility, Dependability, Confirmability, and Transformability) were used to assess the trustworthiness of the research data (31).
The data analysis process was carried out in six comprehensive steps:

Familiarization with the data,
Generation of initial codes,
Search for themes,
Review of the identified themes,
Definition and naming of themes,
Production of the final report.

As Figure 1 illustrates, the cognitive problems of the Iranian MCI elderly fall into two broad categories: Main problems and side problems. The main cognitive problems include four themes a) memory problems, b) attention problems, c) executive function problems, and d) language problems. Besides the main problems, another theme under the title of anxious mood has also been extracted (side problems).

Figure 1. Final thematic map related to the cognitive problems of the Iranian MCI elderly

A more in-depth investigation revealed that the theme of memory problems in the Iranian elderly is more of an episodic memory type; this means that their most common type of forgetfulness is related to forgetfulness in daily affairs. In terms of attention, they have problems in all four general areas of attention, i.e., shifting attention, selective attention, sustained attention, and divided attention. The theme of executive function problems in Iranian MCI elderly was so diverse that it included problems in all three general areas of executive functions, i.e., cognitive flexibility, inhibitory control, and working memory. In addition, the theme of linguistic problems in the Iranian MCI elderly manifested in difficulty finding words. Furthermore, Iranian elderly with MCI demonstrated a high level of emotional and mood problems, prompting the extraction of another theme from the data under the heading of anxious mood theme.

The current study's findings are consistent with previous research that has shown that the MCI elderly have problems with memory (6-8), attention (6-8), executive functions (7-9), and language (7, 8). An intriguing finding from the current study was that the problems of the Iranian elderly were significantly more prominent in some aspects of a cognitive domain than in others. For example, in the field of memory, the problems of the Iranian elderly were mainly of the episodic variety (and not other types of memory such as procedural, semantic, and the like). Similarly, regarding language, the Iranian MCI elderly had more difficulty finding words than other problems (such as Neologism, understanding, and the like). As a result, relying on such findings is critical for developing rehabilitation packages for the Iranian MCI elderly. Another intriguing finding was that, while the study was designed to identify cognitive problems in the elderly with MCI, the majority of subjects raised issues related to mood and emotional aspects of their lives due to the MCI disorder. This prompted the researchers to propose another theme; i.e., anxious mood; something more than the cognitive problems that the current study focused on (the main problems). Indeed, it appears that cognitive rehabilitation programs tailored to the Iranian elderly should include tasks that address both their primary (cognitive) issues, as well as their secondary issues (anxious mood).
Ethical Considerations
Compliance with ethical guidelines
The ethical principles included in this study were the subjects' arbitrary participation in the research, adherence to confidentiality principles, and informed consent. Additionally, the study was approved by the Research Ethics Committee of the University of Isfahan (Approval ID: IR.UI.REC.1400.49).
Authors' contributions
This article is part of Mohammad Ghaderi Rammazi's PhD dissertation at the University of Isfahan (IranDoc tracking code: 1617543). All authors participated in the ideation, writing, editing, and preparation of the article's final version.
Funding
This research was funded with the support of the Cognitive Science and Technologies Council (CSTC; tracking code: 10567).

Acknowledgments
The authors with this express their gratitude to all the participants and people who facilitated the implementation of this research in any way.
Conflicts of interest
This article contains no conflicts of interest.

Between 2015 and 2050, the proportion of the world's population over the age of 60 will almost double (from 12% to 22%). Aging is associated with changes in biological, physiological, psychological, behavioral, and social processes. Among these changes is a decrease in cognitive function. Mild cognitive impairment is one of the most common problems among the elderly.  Undoubtedly, mild cognitive impairment refers to an intermediate stage of cognitive impairment seen in average old age and early dementia. Mild cognitive impairment is often characterized by significant deficits in learning, attention, memory, executive function, processing speed, and semantic language. Behavioral research shows that adults with mild cognitive impairment have cognitive impairment in working memory, central executive function, and types of attention compared to healthy older adults. One of the most critical cognitive impairments in mild cognitive impairment is impaired working memory. Cognitive training and rehabilitation are the most widely used methods to improve and enhance cognitive functions. Advances in technology have led to the formation of computer cognitive training and virtual reality cognitive training that have provided more comprehensive, flexible, practical, and accessible interventions. The use of virtual reality for cognitive training with Pathological people is considered a creative innovation that uses computer software to effectively combine visual, auditory, and tactile feedback and recreate real-life environments. The present study designed and evaluated a cognitive empowerment program using virtual reality technology to improve working memory.

The present study belongs to quasi-experimental designs in terms of data collection method and applied and developmental designs in terms of purpose. It was performed on two experimental and control groups. The study’s statistical population included patients with mild cognitive impairment who, in 2019 and the first half of 2020 referred to the Brain and Cognition Clinic and Firoozgar Hospital in Tehran. A neurologist diagnosed mild cognitive impairment, and their disorder was confirmed by Addenbrooke’s cognitive examination and MRI. Accordingly, 30 subjects were randomly divided into experimental (n=15) and control (n=15) groups. In this study, the intervention is based on virtual reality as an independent variable and working memory as a dependent variable. Subscales of digit span and symbol span of third and fourth editions of the Wechsler Memory Scale (WMS) have been used to examine working memory. In the executive phase of the research, after obtaining the consent of the participants, a pre-test was performed. After completing the initial evaluations, the administrative process of the intervention began, and the sessions were held for ten sessions, three sessions per week and each session for half an hour. At the end of the course, all participants performed cognitive assessments again. Also, follow-up period evaluations were performed in accordance with previous studies one month later. It should be noted that all assessments were performed in the pre-test, final, and follow-up stages by a senior expert in the field of cognitive rehabilitation, which had received the necessary training in performing assessments. Data analysis in this study was based on the pre-test, post-test, and follow-up scores. Based on this, the mean scores of digit span and symbol span expansions in three-time stages in two training and control groups were compared using repeated-measures analysis of variance. In order to check the test assumptions, the Shapiro-Wilk test was used to check the normality of data distribution, the Levene's test was used to check the homogeneity of variances, and Mauchly’s test of sphericity was used to check the combined symmetry. Statistical methods of the present study were performed using SPSS-26 software.

The average age of the research sample is 69.47±6.02, with a minimum of 61 and a maximum of 81 years old. The results of independent t-test revealed that there was no significant difference between the age of the experimental group (mean=69.87, standard deviation=7.16) and the control group (mean=69.07, standard deviation=4.85) (t=36, P=0.72). Table 1 shows the findings related to demographic variables, including gender, job status, and level of education by experimental and control groups. The frequency of women and men is the same in both groups. The amount of chi-square obtained to compare the frequencies of the two groups in the three categories of job status is equal to 3.61, which is not statistically significant (P=0.17), so the groups in terms of job status are not significantly different from each other. Also, experimental and control groups did not have significant differences in terms of frequency in educational levels (χ2=1.73, P=0.89). The results showed a significant difference between the experimental and control groups in the digit span. There is a significant difference between the mean digit span in the pre-test stage with the two stages of post-test (P<0.0005) and follow-up (P<0.0005) as well as the two stages of post-test and follow-up. In symbol span, the results of repeated measures analysis of variance show that over time, a significant effect was observed in the mean symbol span (F (2,56)=17.41, P<0.0005, η2P=0.38). There was a significant difference between the experimental and control groups. There is a significant difference between the mean symbol span in the pre-test stage and the two post-test stages (P<0.001) and follow-up (P<0.0005). Nevertheless, the two stages of post-test and follow-up are not significantly different.

The results revealed that the designed program affected the working memory of the elderly with mild cognitive impairment. The scores of digit span showed significant differences among the three evaluations of the experimental group; in comparison, the scores of the control group in all three evaluations were relatively constant and did not differ significantly. The results regarding the symbol span also showed a significant difference between the experimental and control groups, and this difference between the pre-test and post-test of the experimental group is also significant, but there was no significant difference from the post-test stage to follow up.

In the present study, the efficacy of an educational package was addressed based on increased cognitive, emotional, and neuro-muscular activity in depression in the elderly with mild cognitive impairment.

In this study with pre-test and post-test design and control group, 30 of the elderly with mild cognitive impairment residing in Kahrizak elderly sanatorium were selected by simple sampling and randomly divided into two experimental groups. And control. Participants’ mini-mental state examination questionnaire, depression, and social isolation completed. A-18 rehabilitation sessions program was performed in over eight weeks and two to three weeks. Data were analyzed with analysis of covariance model.

The findings were that the experimental group received cognitive rehabilitation intervention, compared with the control group, based on the mental state examination scores (F=24.30, P<0.01) significantly better cognitive function; depression ratings (F=17.67, P<0.01) lower depression rates and according to social isolationist attitudes (F=25.58, P<0.01) less social isolation.

The study results showed that increased cognitive, emotional, and neuromuscular activity is effective in improving cognitive function, reducing depression, and social isolation in mild cognitive impairment. Also, the partial square (effect size) for the effect of the independent variable on the dependent variable is 0.524, which indicates that the independent variable explains 52% of the changes in the dependent variable. In other words, education based on increased cognitive, emotional, and neuromuscular activity has affected 52% of the daily performance of the elderly (MCI). Therefore; this designed training package can probably be designed as software that includes the combined effect of the variables of this research, and more people will be treated with this package.

The purpose of this study was to investigate the effect of computerized cognitive rehabilitation therapies (CCRT) on improvement of mild cognitive impairment (MCI) and working memory capacity (WM) in elderly women. This study was a quasi experimental design with a pretest-posttest design with a control group with a one month follow-up. Subjects included 16 elderly women 65 years and older with mild cognitive impairment and low capacity of working memory at the Mehrpouyan elderly home in Behbahan city in 2018-2019. They were selected with an available sampling method and randomly placed in the experimental and control groups. Each group included 8 persons. To evaluate the Main Mental Status Examination (MMSE) (Fulestine et, al., 1975) and the Working Memory Capacity Test (Daneman & Carpenter, 1980). The experimental group was trained for 8 session with a memory rehabilitation software and the control group did not received any training. Data was analyzed with mixed analysis of variance. The scores from the MMSE and the Working Memory Capacity of the experimental group increased dramatically. As a result, computerized cognitive rehabilitation had a significant effect on the improvement of cognitive impairment and the capacity of working memory in elderly women.

The aim of this study was to investigate the effectiveness of cognitive rehabilitation, on improving the executive functions of selective attention, inhibitory control and working mwmory in elderly people with mild cognitive impairment. This experimental study was a Single Subject of type A-B, which 6 elderly (4 women and 2 men) with an average age of 62 years old were selected via  purposeful convenience sampling and randomly assigned into two groups of control (n=3) and experimental (n=3). The evaluation of selective attention and inhibitory control was done using Stroop, Go/NO Go and N-back tests, and the "ARAM" rehabilitation program was presented in 10 one-hour personal sessions for each experimental group subjective. All subjective in both groups was evaluated 6 times (before, during, just after and 2 months following the intervention) and also control group were evaluated simultaneously without receiving any interventions. Using visual analysis, collected data revealed that the scores of both tests of executive functions in experimental group, were steadily increased all through intervention, while the control group scores’ did not make significant changes. Also, two-month follow-up evaluations showed a stable improvement in executive functions of the experimental group. Therefore, it can be concluded that cognitive rehabilitation based on ARAM program has improved the functions of selective attention, inhibitory control and working memory in elderly with mild cognitive impairment. As there are many documentaries suggesting possibility of leading mild cognitive impairment to more serious cognitive disabilities such as Alzheimer’s disease, such findings can confirm possibility of improving cognitive functions of elderly people with mild cognitive impairment with, with lower therapeutic costs applying the help of technology