What's a “Cognitive” Intervention? The PICC-M Framework to Distinguish Cognitive Remediation, Stimulation, Training, Therapy, and Rehabilitation

Abstract

Psychosocial interventions targeting cognition improve objective cognitive test performance, strategy use, emotional well-being, and quality of life in individuals with mild cognitive impairment and early dementia. These interventions have been labeled as cognitive training, cognitive remediation, cognitive rehabilitation, cognitive stimulation, and overlap with cognitive (psycho)therapy. The inconsistent labeling of the interventions has resulted in ambiguity of what a cognitive intervention entails and limits the translation of interventions into clinical practice. To address this, we propose a new framework, “PICC-M”, that classifies cognitive interventions based on five active ingredients or the mechanisms resulting in clinically significant change. These ingredients are psychotherapeutic support (P), individualized patient goals (I), cognitive exercises (C), compensatory strategies (C), and metacognitive strategies (M). We examine three intervention programs to illustrate how this framework clarifies each intervention's active ingredients and their relation to cognitive, psychological, and functional outcomes. The PICC-M framework lays the foundation for dismantling studies to isolate and test the effectiveness of specific active ingredients and ultimately support clinical delivery of evidence-based interventions for older individuals with neurocognitive deficits.