Aim:
Medical cardiovascular risk factors (hypertension, hyperlipidaemia, and diabetes, i.e. ‘3 Highs’) increase the risk of cognitive decline in middle-aged adults. In Singapore, certain populations are disproportionately affected by these chronic conditions and face barriers to adhering to cognitive interventions. To support preventive health and equitable access to cognitive programmes, this study evaluated the efficacy and reach of a group-based cognitive intervention (Train-Your-Brain; TYB) for middle-aged adults with the ‘3 Highs’.

Participants & Methods:
One hundred adults aged 40-64 years old with hypertension, hyperlipidaemia, and/or type 2 diabetes were recruited from polyclinics in Singapore and block-randomised into intervention or control (n=50 each). The intervention comprised 8 weekly, one-hour virtual sessions delivered by clinical neuropsychologists, incorporating psychoeducation of lifestyle, mood management, and cognitive strategies. Cognition was measured at baseline and follow-up using the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT). Programme reach was evaluated through mixed-method surveys and analysed using Poisson regression and thematic analysis. Cognitive change was analysed using multiple linear regression.

Results:
Participants were mostly female (68%), with a mean age of 57.86 years (SD=4.86) and 14.64 years of education (SD=3.30). Attrition rate was low (11%) and not associated with demographic or comorbidity status. Scheduling conflicts were the main reason for withdrawal. No significant between-group differences were observed for MoCA (β = 0.08, 95% CI [-0.78, 0.93], p = .85) and SDMT (β = 1.36, 95% CI [-1.11, 3.83], p = .28), likely due to a ceiling effect. Demographic factors did not predict cognitive change scores. While attendance was high (87.3%), males attended 24.1% fewer sessions than females (p=.06); Malay and Indian participants attended 131% more and 47.1% fewer sessions than Chinese participants respectively (p=.30; p=.005). Younger and more educated participants showed marginally higher attendance (p=.18; p=67). 27.9% of participants reported adherence-related barriers including technical difficulties and time constraints due to work schedules. Most participants (69.8%) supported subsidised programme delivery through existing initiatives (e.g. SkillsFuture), while 4.7% preferred the programme to be free-of-charge.

Goals/Conclusion:
The TYB programme achieved high attendance, although participation varied across demographic groups. Cognitive improvements were not observed, likely due to the relatively healthy sample, but longer-term follow-ups may reveal delayed benefits. Expanding session timings and recruitment strategies could improve engagement amonst male, older, and less educated patients across ethnic groups. Additional support for participants with demanding work schedules or lower digital literacy, alongside partial or full programme subsidies, may further increase uptake.

Aim:
Chronic conditions increase the risk of cognitive decline in middle-aged adults. However, previous intervention studies focused mostly on efficacy. Considering the increasing interest in translational research, this Hybrid Type I study investigates the efficacy and feasibility of a group-based cognitive intervention programme (Train-Your-Brain; TYB) for middle-aged adults with key cardiovascular risk factors.

Participants & Methods:
One hundred adults aged 40-64 years old with hypertension, hyperlipidaemia, and/or type 2 diabetes were recruited from polyclinics in Singapore, and block-randomised into intervention or control (n=50 each). The TYB intervention comprised 8 weekly, one-hour virtual sessions delivered by clinical neuropsychologists, incorporating psychoeducation of lifestyle, mood management, and cognitive strategies. Cognition was measured at baseline and follow-up using the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT). Feasibility of scaling up through primary care nurses was evaluated through programme adherence (using the eNACT competency checklist), the recruitment of nurses as local champions (future facilitators), and mixed-method surveys. Multiple linear regression was conducted to examine cognitive change. Feasibility outcomes were assessed using the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) implementation science framework.

Results:
Results are presented according to the RE-AIM framework. Reach: Participants were mostly female (68%), with a mean age of 57.86 years (SD=4.86) and 14.64 years of education (SD=3.30); younger, male, and less educated patients were underrepresented. Attrition rate was low (11%), with most participants citing scheduling conflicts. Effectiveness: Both groups showed negligible changes in cognition, and between-group differences were not significant (MoCA: β=0.08, 95% CI [-0.78, 0.93], p=.85; SDMT: β=1.36, 95% CI [-1.11, 3.83], p=.28), likely reflecting high baseline cognition. Adoption: Participants were recruited from 3 of 26 polyclinics, with 67% from one polyclinic. While all local champions were willing to conduct the programme during working hours, 20% expressed concerns about organisational adoption due to manpower and time constraints. Implementation: Attendance was high (85.8%, SD=19.9%) and programme delivery fidelity was strong (mean score 37.0/39). Maintenance: 98% of participants intended to continue applying the cognitive strategies learned. Local champions highlighted the need for facilitator training, institutional funding, and multi-stakeholder collaboration to support sustainability.

Goals/Conclusion:
The TYB programme demonstrated strong fidelity and high attendance. Cognitive improvements were non-significant, likely reflecting the healthy sample, but longer-term follow-ups may reveal greater effects. Diversifying session timings and recruitment strategies could reduce drop-outs and improve uptake by male, younger, and less educated patients. Sustainable adoption of the programme by polyclinics would require system-level funding, collaborations, and high-quality training.

Background:
Psychological distress is highly prevalent following traumatic brain injury (TBI), with individuals frequently experiencing depression, anxiety, and challenges in adjusting to post-injury life. Acceptance and Commitment Therapy (ACT) targets psychological flexibility—the capacity to remain present, open, and engaged in values-based action despite difficult internal experiences—as a core mechanism of change. This presentation will provide the current evidence on the effectiveness of ACT, particularly the ACT-Adjust program, in improving psychological outcomes for individuals with moderate to severe TBI and investigations into mechanisms of change. Furthermore, it will provide a brief overview of the adaptation and validation of appropriate outcome measures to measure meaningful clinical change.
Methods:
A series of studies—including a conceptual review, cross sectional studies, validation studies, feasibility trials, pilot randomized controlled trial (RCT), and a multi-site non-inferiority RCT protocol—have investigated and evaluated ACT for TBI in Australia. These studies incorporated validated measures of psychological flexibility (e.g., Acceptance and Action Questionnaire variants) alongside outcomes such as depression, anxiety, stress, and participation. Early feasibility studies explored dyadic ACT delivery, while later trials compared ACT-Adjust to active control conditions and waitlist groups. Recent research extended delivery to videoconferencing formats, enabling comparison with face-to-face interventions. Assessments using appropriately validated measures were conducted at baseline, post-intervention, and follow-up to examine both clinical outcomes and process-level changes in psychological flexibility.
Results:
Across studies, ACT interventions were found to be feasible and acceptable for individuals with severe TBI. Pilot RCT findings indicated significant reductions in depression and stress compared to control conditions. Improvements in psychological flexibility were observed in several studies, though results were variable and not always statistically significant. Importantly, secondary analyses and broader ACT literature suggest that increases in psychological flexibility are associated with reductions in distress and greater engagement in meaningful activities, supporting its role as a mediating process. Feasibility and engagement with ACT processes—such as acceptance, cognitive defusion, and values-based action—were consistently reported. Emerging findings indicate videoconference delivery of ACT is comparable to face-to-face formats, enhancing accessibility without compromising therapeutic outcomes. More recent research has extended to neuropsychological mechanisms, examining the relationship between cognitive processes (e.g., inhibitory control and cognitive flexibility) and psychological inflexibility following TBI. This work integrates neuropsychology with contextual behavioural science, offering a more comprehensive account of how cognitive impairments interact with emotional and behavioural adjustment.
Conclusions:
There is a growing body of evidence supporting ACT as a promising intervention for psychological adjustment following TBI, with psychological flexibility as a central therapeutic target. While reductions in emotional distress are robust, further large-scale trials are needed to clarify the extent to which changes in psychological flexibility mediate long-term functional outcomes. Future research should prioritise refined measurement of flexibility processes and explore mechanisms of change across diverse delivery formats, including eHealth interventions.