Use of the KF Modified Story Memory Technique to Improve New Learning and Memory in Individuals with Mild Cognitive Impairment

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Project Summary Prevalence rates for Mild Cognitive Impairment (MCI) range from 7-25% for adults over the age of 60, with risk increasing with age. Impairments in new learning and memory (LM) are common in persons with MCI and negatively impact several aspects of everyday life, including independence in daily activities and social functioning. Despite the demand for LM treatments by older adults and clinicians alike, few cognitive rehabilitation (CR) protocols to date are supported by Class I research evidence, thereby limiting the degree to which potentially efficacious treatments can be applied to individuals with MCI. The Kessler Foundation modified Story Memory Technique (KF-mSMTTM) is a manualized, 10-session CR protocol designed to treat impaired LM. Over a decade of research and development conducted at our center has demonstrated the KF-mSMT to be effective for improving LM in individuals with neurological conditions (e.g., MS, TBI), across three realms of functioning (objective behavior, neural functioning, and everyday life) with improvements maintained over time. This convincing data provides Class I evidence supporting the efficacy of the KF-mSMT for improving LM in these populations. In addition, we have accumulated strong pilot data on the efficacy of the KF-mSMT in individuals with MCI, highlighting the likely successful application of the KF-mSMT to individuals with MCI. We will conduct a multi-site, double-blind, placebo-controlled randomized clinical trial (RCT), administering the KF-mSMT to 120 participants who meet criteria for MCI. Outcome will be assessed immediately following treatment, 6 months following treatment as well as 18 months following treatment to examine the long-term impact. Outcome will be measured via 3 mechanisms: (1) Neuropsychological Evaluation (NPE) to examine post-treatment changes on objective cognitive performance (2) Assessment of Global Functioning (AGF) to examine post-treatment changes in cognition in daily life and (3) functional magnetic resonance imaging (fMRI) to examine pre to post-treatment changes in patterns of cerebral activation underlying LM performance. The examination of daily life activities as an a priori endpoint in this RCT is a highly innovative aspect of the proposed work, highlighted as a significant gap in the rehabilitation literature by many experts in CR. Importantly, the rigorous research design employed in the current study is highly responsive to the objectives set forth by the NIA in their strategic directions (p.14), to “determine how individuals can maintain function with age or regain that function after loss due to immobility, illness, or trauma”, while also designed to identify the “mechanism through which common interventions, both medical and behavioral, may slow the physical and cognitive decline.”