Can Adults with Mild Cognitive Impairment Build Cognitive Reserve and Learn Mindfulness Meditation? Qualitative Theme Analyses from a Small Pilot Study

Article type: Research Article

Authors: Wells, Rebecca Erwin^{a; *} | Kerr, Catherine^{b; 1} | Dossett, Michelle L.^c | Danhauer, Suzanne C.^d | Sohl, Stephanie J.^d | Sachs, Bonnie C.^a | Feeley, Jacquelyn Walsh^e | Wolkin, Jennifer^f | Wall, Robert^g | Kaptchuk, Ted^h | Press, Daniel Z.^h | Phillips, Russell S.ⁱ | Yeh, Gloria Y.ⁱ

Affiliations: [a] Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA | [b] Department of Family Medicine and Mindfulness-Wellness Program, Brown University School of Medicine, Providence, RI, USA | [c] Department of Medicine and Benson-Henry Institute for Mind Body Medicine, Division of General Internal Medicine, Massachusetts General Hospital; and Harvard Medical School, Boston, MA, USA | [d] Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC, USA | [e] Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA | [f] BrainCurves, New York, NY, USA | [g] Mclean Hospital Borden Cottage, Camden, ME, USA | [h] Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA | [i] Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Correspondence: [*] Correspondence to: Rebecca Erwin Wells, MD, MPH, Department of Neurology, Wake Forest Baptist Health, 6th floor Janeway Tower, Medical Center Boulevard, Winston-Salem, NC 27157, USA. Tel.: +1 336 716 2357; Fax: +1 336 716 7790; E-mail: [email protected].

Note: [1] Cathy Kerr unexpectedly passed away prior to this publication. This work could not have been completed without her effort and inspiration, and this manuscript is published in her honor.

Abstract: Background/Objective:High levels of chronic stress negatively impact the hippocampus and are associated with increased incidence of mild cognitive impairment (MCI) and Alzheimer’s disease. While mindfulness meditation may mitigate the effects of chronic stress, it is uncertain if adults with MCI have the capacity to learn mindfulness meditation. Methods:14 adults with MCI were randomized 2:1 to Mindfulness Based Stress Reduction (MBSR) or a wait-list control group. We conducted qualitative interviews with those who completed MBSR. Transcribed interviews were: a) coded using an emergent themes inductive approach informed by grounded theory; b) rated 0–10, with higher scores reflecting greater perceived benefit from, and understanding of, mindfulness meditation. Ratings were correlated with daily home practice times and baseline level of cognitive function. Results:Seven themes emerged from the interviews: positive perceptions of class; development of mindfulness skills, including meta-cognition; importance of the group experience; enhanced well-being; shift in MCI perspective; decreased stress reactivity and increased relaxation; improvement in interpersonal skills. Ratings of perceived benefit and understanding ranged from 2–10 (mean = 7) and of 0–9.5 (mean = 6), respectively. Many participants experienced substantial benefit/understanding, some had moderate, and a few had minimal benefit/understanding. Understanding the key concepts of mindfulness was highly positively correlated with ≥20 minutes/day of home practice (r = 0.90) but not with baseline cognitive function (r = 0.13). Conclusions:Most adults with MCI were able to learn mindfulness meditation and had improved MCI acceptance, self-efficacy, and social engagement. Cognitive reserve may be enhanced through a mindfulness meditation program even in patients with MCI.

Keywords: Alzheimer’s disease, meditation, mild cognitive impairment, mindfulness, randomized clinical trial, yoga

DOI: 10.3233/JAD-190191

Journal: Journal of Alzheimer's Disease, vol. 70, no. 3, pp. 825-842, 2019