Key Takeaways
Extended Takeaways
- The trial targeted a distinctly high-risk population rather than unselected older adults: eligibility required an MDRS >79, corresponding to the top 20% risk percentile with hazard ratio=3.2, 95% CI: 2.1–4.8, which supports using multimodal risk stratification when deciding who may benefit most from preventive intervention.
- The cognitive signal was selective rather than global across all domains: significant gains were seen in MoCA (t=2.106, P= .037, d=0.327) and ROCFT immediate recall (t=2.42, P=.017, d=0.376) and long-delayed recall (t=2.797, P=.006, d=0.434), while verbal memory, naming, fluency, attention, balance, and health behavior measures did not differ significantly between groups.
- Engagement benchmarks were concrete and potentially usable in practice: cognitive training and cognitive rehabilitation were prescribed 3–5 times per week for at least 120 minutes weekly, and high overall adherence was defined as ≥2,562 points across 6 months.
- Overall adherence level was not associated with better outcomes, but module-specific participation was: high participation in daily health lifestyle records improved AVLT long-delayed recall (t =−2.277, P=.025, Cohen d=0.607), and high participation in cognitive rehabilitation improved AVLT recognition recall (H =8.557, P=.014, η2 =0.104) and STT-A performances (H =14.48, P <.001, η2 =0.177).
- Patients with non-amnestic MCI appeared more responsive than those with amnestic MCI, with significant effects in the non-amnestic subgroup for MoCA (t=2.420, P= .017), AVLT long-delayed recall (t =2.120, P=.036), ROCFT immediate recall (t =3.138, P=.002), ROCFT long-delayed recall (t =3.912, P<.001), STT-A (Z=−2.029, P=.042), and UCLA Loneliness Scale (Z=−2.021, P = .043).
- Feasibility was strong in this older cohort: 154 of 166 randomized participants completed post-intervention assessment, and 69 of 83 participants in the intervention group met criteria for high adherence, suggesting that app-based delivery with passive tracking plus active follow-up can be workable even in adults with a mean age of 74.83 ±5.44 years in the intervention group.
