Advances in Cognitive Sciences

fa مشکلات شناختی سالمندان ایرانی مبتلا به نقص شناختی خفیف: مطالعه‌ای کیفی در راستای تدوین بسته توانمندسازی شناختی Cognitive problems of Iranian elderly with mild cognitive impairment: A qualitative study for developing a cognitive rehabilitation package روان شناسی شناختی پژوهشي اصیل Research <div style="text-align: justify;">مقدمه: ساخت بسته‌های توان‌بخشی شناختی جز با شناخت دقیق مشکلات شناختی سالمندان میسر نیست. در پژوهش حاضر، با به ‌کارگیری یک روش پژوهش کیفی، شناسایی مشکلات شناختی سالمندان ایرانی مبتلا به نقص شناختی خفیف (MCI) مدنظر قرار گرفت. روش کار: نوع پژوهش، کیفی از نوع تحلیل مضامین بود. جامعه هدف شامل تمامی سالمندان ایرانی مبتلا به MCI بود. تعداد 14 مشارکت‌کننده سالمند با تشخیص MCI، 7 فرد آگاه از وضعیت افراد سالمند (افراد مطلع) و 5 فرد متخصص آشنا به امور مراقبتی از سالمندان، جمعاً به تعداد 26 نفر، به ‌عنوان اعضای نمونه در پژوهش حاضر مشارکت داشتند. این افراد به شکل هدفمند انتخاب شدند و مبنای کفایت حجم نمونه نیز اصل اشباع داده‌ها بود. یافته‌ها: نتایج نشان داد سالمندان ایرانی مبتلا بهMCI  در حیطه شناختی با دو نوع کلی مشکلات دست‌وپنجه نرم می‌کنند: مشکلات شناختی اصلی و مشکلات جانبی. مشکلات اصلی شامل مضامین مشکلات حافظه (عمدتاً از نوع حافظه رویدادی)، توجه (شامل مشکلات تغییر توجه، توجه گزینشی، حفظ توجه و توجه پراکنده)، کارکردهای اجرایی (شامل مشکلات حافظه کاری، مشکلات در کنترل بازداری و مشکلات در حیطه انعطاف‌پذیری شناختی) و مضمون مشکلات زبانی (عمدتاً از نوع یافتن کلمات) بود. در کنار مشکلات اصلی، مشکلات دیگری تحت عنوان مضمون خلق مضطرب نیز از داده‌ها استخراج گردید. نتیجه‌گیری: فهم عمیق از نوع مشکلات شناختی که سالمندان ایرانی مبتلا به MCI واقعاً با آن روبهرو هستند، در کنار اهمیت توجه به وضعیت خلقی سالمندان که عملکرد شناختی آنان را تحت تأثیر قرار می‌دهد، یافته‌هایی است که می‌تواند پژوهشگران ایرانی را در ساخت بسته‌های توانمندسازی شناختی مؤثرتر برای سالمندان یاری رساند.  </div> <div style="text-align: justify;">Introduction Preserving the cognitive ability of the elderly is a common issue of concern among researchers and health policymakers (1). Mild cognitive impairment (MCI) is a concerning condition indicating an elderly person's cognitive abilities are less than expected (3-5). Researchers interested in aging research strive to prevent the progression of cognitive problems as much as possible by identifying the cognitive problems of the MCI elderly as early as possible or, if this goal is not met, to compensate for their cognitive problems by developing rehabilitation packages (11). Evidently, cognitive rehabilitation packages cannot be provided without first understanding the cognitive problems of the elderly with MCI (15). According to the previous studies, the majority of those studies conducted for developing cognitive rehabilitation packages for the elderly have used the results of quantitative studies as the basis for choosing cognitive tasks (6, 11, 14, 16-19); this is even though in these studies, the actual view of the elderly themselves, or people who know them well, has never been asked. The current study used a qualitative research method to identify the cognitive problems of the Iranian elderly with mild cognitive impairment (MCI) to address these limitations. Besides, the results can be used to develop a cognitive rehabilitation package for the Iranian elderly with MCI. Methods The current study was a qualitative thematic analysis study that followed the method proposed by Braun and Clarke (27). The statistical population consisted of all Iranian elderly with MCI. The study sample included 14 elderly subjects with MCI diagnoses, seven relatives of elderly MCI patients (informants), and five specialists in providing mental health services to the elderly (Two psychiatrists, two psychologists, and one nurse), for a total of 26 subjects. The subjects were all Kerman city residents, and the study occurred between the summer and fall of 2021. Data Saturation was used to determine the adequacy of the sample size. The NUCOG test and a semi-structured in-depth interview were used as research tools (28). Guba and Lincoln's four recommended criteria (i.e., Credibility, Dependability, Confirmability, and Transformability) were used to assess the trustworthiness of the research data (31). The data analysis process was carried out in six comprehensive steps:</div> <ol> <li style="text-align: justify;">Familiarization with the data, </li> <li style="text-align: justify;">Generation of initial codes, </li> <li style="text-align: justify;">Search for themes, </li> <li style="text-align: justify;">Review of the identified themes, </li> <li style="text-align: justify;">Definition and naming of themes, </li> <li style="text-align: justify;">Production of the final report.</li> </ol> <div style="text-align: justify;">Results As Figure 1 illustrates, the cognitive problems of the Iranian MCI elderly fall into two broad categories: Main problems and side problems. The main cognitive problems include four themes a) memory problems, b) attention problems, c) executive function problems, and d) language problems. Besides the main problems, another theme under the title of anxious mood has also been extracted (side problems). Figure 1. Final thematic map related to the cognitive problems of the Iranian MCI elderly A more in-depth investigation revealed that the theme of memory problems in the Iranian elderly is more of an episodic memory type; this means that their most common type of forgetfulness is related to forgetfulness in daily affairs. In terms of attention, they have problems in all four general areas of attention, i.e., shifting attention, selective attention, sustained attention, and divided attention. The theme of executive function problems in Iranian MCI elderly was so diverse that it included problems in all three general areas of executive functions, i.e., cognitive flexibility, inhibitory control, and working memory. In addition, the theme of linguistic problems in the Iranian MCI elderly manifested in difficulty finding words. Furthermore, Iranian elderly with MCI demonstrated a high level of emotional and mood problems, prompting the extraction of another theme from the data under the heading of anxious mood theme. Conclusion The current study's findings are consistent with previous research that has shown that the MCI elderly have problems with memory (6-8), attention (6-8), executive functions (7-9), and language (7, 8). An intriguing finding from the current study was that the problems of the Iranian elderly were significantly more prominent in some aspects of a cognitive domain than in others. For example, in the field of memory, the problems of the Iranian elderly were mainly of the episodic variety (and not other types of memory such as procedural, semantic, and the like). Similarly, regarding language, the Iranian MCI elderly had more difficulty finding words than other problems (such as Neologism, understanding, and the like). As a result, relying on such findings is critical for developing rehabilitation packages for the Iranian MCI elderly. Another intriguing finding was that, while the study was designed to identify cognitive problems in the elderly with MCI, the majority of subjects raised issues related to mood and emotional aspects of their lives due to the MCI disorder. This prompted the researchers to propose another theme; i.e., anxious mood; something more than the cognitive problems that the current study focused on (the main problems). Indeed, it appears that cognitive rehabilitation programs tailored to the Iranian elderly should include tasks that address both their primary (cognitive) issues, as well as their secondary issues (anxious mood). Ethical Considerations Compliance with ethical guidelines The ethical principles included in this study were the subjects' arbitrary participation in the research, adherence to confidentiality principles, and informed consent. Additionally, the study was approved by the Research Ethics Committee of the University of Isfahan (Approval ID: IR.UI.REC.1400.49). Authors' contributions This article is part of Mohammad Ghaderi Rammazi's PhD dissertation at the University of Isfahan (IranDoc tracking code: 1617543). All authors participated in the ideation, writing, editing, and preparation of the article's final version. Funding This research was funded with the support of the Cognitive Science and Technologies Council (CSTC; tracking code: 10567). Acknowledgments The authors with this express their gratitude to all the participants and people who facilitated the implementation of this research in any way. Conflicts of interest This article contains no conflicts of interest.</div> نقص شناختی خفیف, توجه, حافظه, کارکرد اجرایی, ایران Mild cognitive impairment, Attention, Memory, Executive function, Iran 1 14 http://icssjournal.ir/browse.php?a_code=A-10-1566-2&slc_lang=fa&sid=1 Mohammad Ghaderi Rammazi محمد قادری رمازی 100319475328460015751 100319475328460015751 No PhD Student of Psychology, Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran دانشجوی دکتری روان‌شناسی، گروه روان‌شناسی، دانشکده علوم تربیتی و روان‌شناسی، دانشگاه اصفهان، اصفهان، ایران Mahgol Tavakoli ماهگل توکلی m.tavakoli@edu.ui.ac.ir 100319475328460015752 0003-2246-2647-0003 Yes Associate Professor of Psychology, Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran دانشیار روان‌شناسی، گروه روان‌شناسی، دانشکده علوم تربیتی و روان‌شناسی، دانشگاه اصفهان، اصفهان، ایران Majid Barekatain مجید برکتین 100319475328460015753 100319475328460015753 No Professor of Psychiatry, Department of Psychiatry and Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran استاد روان‌پزشکی، مرکز تحقیقات نوروساینس و گروه روان‌پزشکی، دانشکده پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران Ahmad Abedi احمد عابدی 100319475328460015754 100319475328460015754 No Associate Professor, Department of Psychology and Education of People with Special Needs, Isfahan University, Isfahan, Iran دانشیار گروه روان‌شناسی کودکان با نیازهای خاص، دانشکده علوم تربیتی و روان‌شناسی، دانشگاه اصفهان، اصفهان، ایران