Implementing Personalised Cognition-Oriented Treatments for Older People with Mild Cognitive Impairment: Translating Evidence into Practice

Abstract

Older adults with Mild Cognitive Impairment (MCI) are at increased risk of progression to dementia, positioning them as a key target group for secondary prevention. Cognition-oriented treatments (COTs) are effective in improving cognitive and functional outcomes; however, despite international guideline recommendations, they remain underutilised in Australian clinical and community settings. This thesis addresses this translational gap by examining the implementation of COTs across real-world contexts. Guided by implementation science and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework, a series of interrelated studies investigated the multilevel processes required to embed evidence-based COTs into routine care. Findings revealed a persistent evidence–practice disconnect: Australian clinical neuropsychologists strongly support COTs, yet delivery is constrained by limited training opportunities and organisational barriers. Targeted capacity-building within memory clinic services emerged as a critical enabler of implementation. In collaboration with the Australian Dementia Network (ADNeT), this research evaluated the long-term sustainability of COT integration across five memory clinics using mixed-methods data from neuropsychologists and service managers, identifying key facilitators and barriers to maintenance. To address workforce and system-level constraints, a parallel program of work was undertaken with Dementia Australia, where Dementia Support Specialists were trained to deliver a tailored COT program. Feasibility, acceptability, and sustainability were evaluated after a nine-month implementation period, supporting transition to an ongoing service. Together, these findings advance understanding of the practical and systemic conditions required to implement and sustain COTs, providing actionable guidance to improve equitable access to evidence-based interventions for people with MCI.