Awareness of baseline functioning and sensitivity to improvement in older people with and without mild cognitive impairment receiving a computerized functional skills training program.

Objectives: To examine the relative ability of participants with Mild Cognitive Impairment (MCI) to self-assess their cognitive performance and training gains.

Design: Randomized clinical trial with baseline and post treatment objective and self -report assessments.

Setting: Multiple community centers in New York City and South Florida.

Participants: MCI (n = 84) participants and individuals with normal cognition NC (n = 68).

Intervention: MCI participants were randomized to receive fully remote functional skills training (FUNSAT) alone or with Computerized Cognitive Training (CCT), while NC participants received FUNSAT alone twice a week for up to 12 weeks.

Measurements: Gains in performance of trained functional skills, performance-based assessments of cognition and functional capacity, and global and specific self-reports of functional abilities.

Results: Baseline performance for all performance-based variables was significantly worse in the MCI participants, all p < .001, all d> .77. Training-related Improvements were found for all variables for both groups, all p < .001, all d> .54. However, baseline group differences in global and specific self-reports were smaller all p > .02, d< .44, than objective performance differences. Baseline reports of global functioning were correlated with baseline performance variables in both groups, although no self-reported changes in either global or specific self-reports were significant for either sample.

Conclusions: Participants with MCI underestimated their performance deficits at baseline. Self-reports of changes in everyday functioning do not track the substantial objective changes. Previous studies have reported a lack of sensitivity to training gains in several different conditions. Strategies to increase awareness of training gains may be required to sustain treatment benefits.