The literature contained within this thesis aims to synthesise and explore the application of Acceptance and Commitment Therapy (ACT) in older adult populations and investigate the utility of neuropsychological assessment in prognostic predictions for those with amnestic Mild Cognitive Impairment (aMCI).
The first chapter contains a systematic review of ACT for older adults. With recent geropsychological literature supporting the compatibility between ACT and later life stages, and adaptations for older adults recommended across several papers, a review of studies was timely. Four databases returned 875 potential articles that were reduced to ten. Variability within the studies across design, attrition and representation of older adults inhibited the ability to make inference regarding acceptability. The promising nature of significant outcomes and high client satisfaction are put forward and recommendations made for future studies.
The second chapter explores the prognostic utility of cognitive Intra-Individual Variance (IIV), as measured using scores from the Repeatable Battery of the Assessment of Neuropsychological Status (RBANS) in patients with aMCI. Data collected in routine clinical practice over seven years was analysed to identify any relationships between IIV and conversion to a dementia syndrome. Significant relationships between language and other cognitive domains scores, and risk of conversion, are plotted on survival curves and discussed.
The third chapter explores the implications of former chapters for theory, research and clinical practice. Issues surrounding labels of impairment are discussed alongside person-centred care in memory clinics. Conflict between ACT and research processes are expanded upon, and recommendations made for future studies. Finally, reflections on the process of completing this thesis are shared, rooting the beginning of this work in a therapeutic relationship, and discussing the importance of supervision in research.