Implementation of an evidence-based, multifaceted cognitive training program within the clinical setting for older adults ‘at-risk’ of cognitive decline

Background: Major depressive disorder is common and disabling. While affective symptoms of depression typically resolve with a depressive episode, neurocognitive impairment frequently persists. Yet, available treatments for major depression do not address neurocognitive impairment. Cognitive training represents a promising and novel therapeutic intervention in this regard. Yet, cognitive training programs are largely unavailable within the clinical setting. Aims: This research aims to: a) critically examine the evidence for cognitive training in major depression; and b) explore the feasibility of implementing an evidence-based healthy brain ageing cognitive training program, Club Connect, in two groups of ‘at risk’ older adults (i.e. those with mild cognitive impairment and those with major depressive disorder) in a clinical, metropolitan setting. Methods: The first aim was achieved with two publications, both of which examined the evidence for cognitive training in major depression. The second aim was achieved by conducting two empirical studies. The first used several iterative pilot studies with a pre-post single arm design and the second used a feasibility randomised controlled trial to adapt and examine the feasibility of implementing Club Connect within the clinical setting. Results: The critical examination of the literature confirmed that cognitive training is an effective intervention in major depression. Further, two empirical studies, demonstrated feasibility, tolerability and acceptability in adapting and translating Club Connect within the Older People’s Mental Health Service at St Vincent’s Hospital, Sydney, in two groups of ‘at risk’ older adults. Implications: Further research exploring the implementation, efficacy and sustainability of cognitive training in the clinical setting is warranted, which together with the findings from this body of research, may assist health- and policy-decision makers to increase service provision of cognitive training