Providing access to cognitive interventions for patients with Subjective Cognitive Decline (SCD) and Mild Cognitive Impairment (MCI) in regional memory clinics

The primary objective of this study is to expand access to cognitive interventions for people at risk of developing dementia in regional areas of Australia, where such services are limited. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study adapts an existing clinician training package, originally delivered in metropolitan memory clinics by the Australian Dementia Network (ADNeT) Cognitive Interventions Working Group, to suit regional needs. The 18-month study will train clinical neuropsychologists at three regional memory clinics to deliver evidence-based, cognitive interventions and assess implementation success. The study proceeds in three sequential stages: clinician training, supported implementation, and maintenance. 1. Clinician training: (a) Online Training (6 weeks) Clinicians complete six self-paced (1-2 hour) modules over six weeks via the CogTale platform. Completion of each module unlocks the next module, ensuring the training is followed in a structured, sequential order. The modules cover theoretical foundations, evidenced-based intervention techniques, and applications for cognition, memory, goal setting, and wellbeing. They also include implementation strategies, modifiable risk factors for dementia and practical considerations. Content includes didactic content, embedded videos, practical resources, and case vignettes and practical resources such as clinical guidelines, worksheets, and manuals (e.g. La Trobe and Caulfield Hospital (LaTCH) and Health Brain Ageing programs). (b) Two-day, in-person workshop Within one month of completing the online modules, the clinicians from all sites attend a two-day, in-person workshop in Melbourne led by clinical neuropsychologists (KP, SN, ABH). The workshop compliments the digital toolkit by offering interactive learning, peer discussion, and a structured forum to consolidate content, examine cognitive intervention delivery, and identify potential barriers to delivering cognitive interventions.   2. Supported implementation (9-months) Following the in-person workshop, clinicians enter a nine-month supported implementation phase, integrating cognitive interventions into routine practice. This phase includes fortnightly one-hour supervision sessions via Teams with clinical neuropsychologists (KP, ABH). Sessions focus on key implementation elements, including recruitment strategies and intervention delivery.   During the implementation phase, clinicians integrate their training into routine practice by offering evidence-based cognitive interventions to their patients. Clinicians select appropriate cognitive interventions from the training toolkit through a flexible, patient-centred process that integrates clinical judgement with practical considerations. Key factors guiding intervention selection include (1) Assessing individual needs - clinicians begin by understanding the participant's cognitive profile, daily challenges, and personal goals, (2) Relevant background considerations - intervention materials and delivery methods are adapted to align with the participant's preferences, and (3) Clinic feasibility - the choice between group-based and one-on-one formats depends on clinic resources, staffing, and participant availability. Participants may be offered interventions such as (1) Goal Setting - where clinicians support participants to identify meaningful personal goals (e.g. remembering to take medication daily) and develop practical strategies to achieve them, (2) Spaced Retrieval -  a memory technique where participants practice recalling information at gradually increasing intervals to strengthen retention, or (3) Memory Strategy Training - where participants learn and apply techniques such as visual imagery, categorisation, and use of external aids (e.g. reminder apps) to support everyday memory tasks.  Interventions are delivered in-person or via telehealth, in small groups or one-on-one formats. For example, the LaTCH program requires participants to attend six weekly two-hour small group sessions. Each session focuses on a key aspect of cognition. Participants begin by learning how memory works and what influences it, including lifestyle, health, and emotional factors. They are introduced to practical memory strategies (e.g. visual imagery, categorisation, and association) across two sessions, with opportunities to practice and apply these techniques. Later sessions focus on sleep, exercise, nutrition, and social engagement to support cognitive wellbeing. Participants are asked to attend sessions regularly to build continuity, participate in discussion to reinforce strategies and foster peer support, practice cognitive strategies introduced during the sessions both in-session and at home, set personal goals and reflect on progress throughout the program. All participants with SCD/MCI complete self-report research questionnaires 1-2 weeks prior to completing their cognitive intervention and two weeks after completing their final intervention session. The questionnaires include the Multifactorial Memory Questionnaire (MMQ), Personal Goals Questionnaire, and Normalcy Inventory.   Clinicians submit data via REDCap at four time points: baseline (prior to training), fortnightly during the 9-month implementation phase, post-implementation, and post-maintenance phase. Baseline data includes prior training in interventions, use of cognitive interventions in current practice, and self-rated confidence, knowledge, and skills. During implementation, clinicians submit fortnightly data on their clinical practice, detailing patient volume, intervention offers, delivery, and uptake as well as intervention characteristics (type, format, frequency, duration), fidelity, and time requirements. At the completion of the 9-month implementation phase, they repeat self-assessment questionnaires and complete a 30-minute semi-structured Teams interview with a research assistant (RA) to explore implementation barriers and facilitators. 3. Maintenance (6 months) Clinicians then enter a 6-month maintenance phase without supervision, assessing sustained delivery. At the end of the 6-month maintenance phase, they complete a final interview with an RA to evaluate long-term feasibility and sustainability. All interviews are conducted by a psychology trained RA with no prior relationship to clinicians.