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\def\RunningAuthor{Govindakumari R et al.}
\firstPage{5301}
\articleType{Original Article}
\receivedDate{05 Oct 2019}
\acceptedDate{16 Nov 2019}
\revisedDate{10 Nov 2019}
\journalVolume{2020, 11}
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\title{\textbf{Effectiveness of home-based cognitive training program on a cognitive level, the activity of daily living among elderly persons with mild cognitive impairment in selected community settings of Puducherry}}
\author{Govindakumari~R\textsuperscript{*}\textsuperscript{1},  
            Vijayalakshmi\textsuperscript{2},  
            Sai~Sailesh~Kumar~Goothy\textsuperscript{3}, 
            Vijay~Raghvan\textsuperscript{1}~\\[5pt]{\textsuperscript{1}Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India}~\\{\textsuperscript{2}Vignesh Nursing College, Thiruvannamalai, Tamil Nadu, India}~\\{\textsuperscript{3}Department of Physiology, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India}}

\begin{abstract}
Aging is a physiological process that leads to both biological and psychological changes. The brain undergoes structural changes as a part of aging. According to the investigator's best knowledge and based on the extensive review, no structured study was conducted in India to test the effectiveness of cognitive training program. Hence, the present study was conducted to test the effectiveness of a home-based training program on select outcomes. A total of 314 elderly participants were recruited for the study after obtaining the written informed consent.\textbf{\space }After recruiting, the participants were randomly grouped into two groups, that is control and intervention groups, with 157 participants in each group. The intervention was administered to the experimental group. The present study results suggest that the home-based cognitive training program is effective in improving cognitive functions and daily life activities. The study recommends further detailed and multi-centered studies in this area to recommend the implementation of the program in the management of the cognitive impairments of the elderly.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Home-based cognitive training program,\newline Cognition,\newline Elderly
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Govindakumari~R~\\ Phone:\ 9677428255~\\  Email:\ govind.harimukesh@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
Aging is a physiological process that leads to both biological and psychological changes. The brain undergoes structural changes as a part of aging. However, these changes in the brain are not the same in all the areas, and these changes affect the different cognitive domains in a different way\unskip~\citep{640097:15022321}. Aging is a natural process where the ability of the cells of the body declines. Along with the other cells, the brain cells also affected, which accounts for a decrease in the cognitive functions\unskip~\citep{640097:15022319}. Cognitive functions are essential for the management of daily life activities in the elderly population\unskip~\citep{640097:15022320}. Cognitive therapies have shown to have a positive impact on the cognitive functions in the elderly population. It improves synaptic transmission and prevents the formation of the Beta-amyloid proteins. This prevents the initiation of age-related decline in cognitive impairment and thus improves the cognitive functions and day-to-day functioning. 

The home-based cognitive therapy was reported to act through the principle called neuronal plasticity as the brain has the capability to habituate and learn. So, if the brain is trained properly, then the lost functions can be restored. Improvement in the major cognitive domains like attention, memory was observed, followed by home-based cognition therapy\unskip~\citep{640097:15022322}. A further advantage of this therapy is that it reduces the number of hospital visits. It also reduces the cost and hence affordable to all classes of the population. The present lack of effective drug therapy for these conditions makes it imperative to investigate other potential therapeutic interventions. Cognitive training has been described as possibly useful in improving cognitive function in elderly subjects with mild impairment and early dementia. However, there have been few well-designed studies to date, and the results are equivocal. Further to date, according to the investigator's best knowledge and based on the extensive review, no structured study was conducted in India to test the effectiveness of cognitive training program. Hence, the present study was conducted to test the effectiveness of a home-based training program on select outcomes. 
    
\section{Materials and Methods}
\textbf{Study design}

Experimental study

\textbf{Study setting}

The present study was conducted at selected community settings of Puducherry.

\textbf{Study participants} \textbf{\space }

A total of 314 elderly participants were recruited for the study after obtaining the written informed consent.\textbf{\space }A convenient sampling technique was used in the selection of the participants. The following criteria were used while recruiting the participants.

\textbf{Inclusion criteria}


  
  \begin{enumerate}
  \item \relax The client with Age \ensuremath{\geq } 60
  \item \relax Client whose score in MMSE greater than 20
  \item \relax Clients who are a permanent resident of the locality for at least in the past 6 months. 
  \item \relax Clients who are willing to participate in the study
  \end{enumerate}
  \textbf{Exclusion criteria} \textbf{\space }


  
  \begin{enumerate}
  \item \relax  Clients with significant neurological deficit
  \item \relax  A Client who is in antidepressants
  \item \relax  Clients with a history of alcohol abuse
  \item \relax  Clients with a significant physical disability
  \end{enumerate}
  After recruiting, the participants were randomly grouped into two groups, that is control and intervention groups, with 157 participants in each group. 

\textbf{Home Based cognitive Training Programme}

Each training session comprised the following steps 

\textbf{Orientation in time and space}

Performed using external aids such as a calendar and the day's newspaper, whereby participants determined the current day, month, and year. 

\textbf{Presentation of the names}

Participants and the researcher presented their names. Verbal associations were elicited between the person's name and their appearance. 

\textbf{Visual and auditory attention exercises}

The visual attention task entailed identifying details in photographs, letters, or figures amongst several stimuli spread out on a single printed sheet, as well as spotting differences between two similar photographs, among other activities. The auditory attention exercises included tasks such as detecting words in songs and identifying whether two consecutively repeated sequences of numbers or words matched or differed. 

\textbf{Memory exercises using visual aids}

The categorization strategy with ecological tasks were used, i.e., simulated activities of daily living, graded from simple to more complex. Grocery items were used in the early stages of training progressing to supermarket item lists only, by the end of the training. 

\textbf{Transfer task}

Practical tasks from activities of daily living were used, such as to the supermarket, giving and checking change, etc. The older adults were expected to calculate the total cost of the purchase and offer change or check the change received.

Cognitive training was given to all eligible subjects individually two sessions weekly continuously for a period of 1 month i.e., a total of 8 sessions. Each session will take approximately 1 hour.

\textbf{Ethical considerations}

The present study protocol was approved by the institutional human ethical committee. The study was conducted as per the guidelines of ICMR. 

\textbf{Data analysis}

Data was analyzed using SPSS 20.0. Data were expressed in frequency and percentage and mean and SE. The paired and unpaired t-test was used to observe the significance of the difference. A chi-square test was used to observe the association. A 


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\caption{\boldmath {Frequency and percentage-wise distribution of demographic variables among elderly persons with mild cognitive impairments } }
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 &
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  \cAlignHack 3.64 &
  \cAlignHack 0.162\\
\cAlignHack  &
  Urban &
  \cAlignHack 12 &
  \cAlignHack 40 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack (df=2) &
  \cAlignHack \\
\cAlignHack  &
  Semi Urban  &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack  &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
\cAlignHack 4 &
  Education: &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack  &
  No formal education &
  \cAlignHack 4 &
  \cAlignHack 13.3 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack 2.4 &
  \cAlignHack 0.663\\
\cAlignHack  &
  Up to primary education  &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack (df=4) &
  \cAlignHack \\
\cAlignHack  &
  Up to Higher secondary  &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack  &
  Graduate-level  &
  \cAlignHack 4 &
  \cAlignHack 13.3 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack  &
  Others  &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 3 &
  \cAlignHack 10 &
  \cAlignHack  &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
\cAlignHack 5 &
  Occupation: &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack  &
  Homemaker &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 0.797 &
  \cAlignHack 0.939\\
\cAlignHack  &
  Coolie &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack (df=4) &
  \cAlignHack \\
\cAlignHack  &
  Self employee &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 4 &
  \cAlignHack 13.3 &
  \cAlignHack  &
  \cAlignHack \\
\cAlignHack  &
  Govt. employee &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack  &
  \cAlignHack \\
 &
  Private employee &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack  &
  \\
 &
   &
   &
   &
   &
   &
   &
  \\
\cAlignHack 6 &
  \multicolumn{2}{p{\dimexpr(.26950000000000003\linewidth-2\tabcolsep)}}{Marital status:} &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \\
 &
  Single &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack 13 &
  \cAlignHack 43.3 &
  \cAlignHack 0.635 &
  \cAlignHack 0.426\\
 &
  Married &
  \cAlignHack 20 &
  \cAlignHack 66.7 &
  \cAlignHack 17 &
  \cAlignHack 56.7 &
  \cAlignHack (df=1) &
  \\
 &
   &
   &
   &
   &
   &
   &
  \\
\cAlignHack 7 &
  Religion: &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \\
 &
  Muslim &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack 12 &
  \cAlignHack 40 &
  \cAlignHack 1.32 &
  \cAlignHack 0.517\\
 &
  Christian &
  \cAlignHack 11 &
  \cAlignHack 36.7 &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack (df=2) &
  \cAlignHack \\
 &
  Hindu &
  \cAlignHack 11 &
  \cAlignHack 36.7 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack  &
  \cAlignHack \\
 &
  Others &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack  &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
\cAlignHack 8 &
  \multicolumn{2}{p{\dimexpr(.26950000000000003\linewidth-2\tabcolsep)}}{Type of family:} &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
 &
  Nuclear family  &
  \cAlignHack 9 &
  \cAlignHack 30 &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack 2.05 &
  \cAlignHack 0.358\\
 &
  Joint family &
  \cAlignHack 15 &
  \cAlignHack 50 &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack (df=2) &
  \cAlignHack \\
 &
  Extended family &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack  &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
\cAlignHack 9 &
  \multicolumn{2}{p{\dimexpr(.26950000000000003\linewidth-2\tabcolsep)}}{Monthly family income:} &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
 &
  Less than Rs.5000 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 3.24 &
  \cAlignHack 0.356\\
 &
  Rs.5000-10000 &
  \cAlignHack 4 &
  \cAlignHack 13.3 &
  \cAlignHack 9 &
  \cAlignHack 30 &
  \cAlignHack (df=3) &
  \cAlignHack \\
 &
  Rs.10001-15000 &
  \cAlignHack 12 &
  \cAlignHack 40 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack  &
  \cAlignHack \\
 &
  Above Rs.15000 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
   &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
10 &
  \multicolumn{3}{p{\dimexpr(.3993\linewidth-2\tabcolsep)}}{Status of Co-morbid disease:} &
   &
   &
   &
  \\
 &
  Diabetes mellitus/Other endocrine disorders &
  \cAlignHack 11 &
  \cAlignHack 36.7 &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack 2.16 &
  \cAlignHack 0.453\\
 &
  Hypertension/other cardiac disorder &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 12 &
  \cAlignHack 40 &
  \cAlignHack (df=2) &
  \cAlignHack \\
 &
  Respiratory disorder &
  \cAlignHack 12 &
  \cAlignHack 40 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack  &
  \cAlignHack \\
 &
  Any other disorders &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack  &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
11 &
  \multicolumn{2}{p{\dimexpr(.26950000000000003\linewidth-2\tabcolsep)}}{Status of caregiver: } &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack \\
 &
  First degree relatives &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 11 &
  \cAlignHack 36.7 &
  \cAlignHack 1.29 &
  \cAlignHack 0.524\\
 &
  Second-degree relatives  &
  \cAlignHack 14 &
  \cAlignHack 46.7 &
  \cAlignHack 12 &
  \cAlignHack 40 &
  \cAlignHack (df=2) &
  \cAlignHack \\
 &
  Guardians &
  \cAlignHack 9 &
  \cAlignHack 30 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack  &
  \cAlignHack \\
 &
  Others  &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack 0 &
  \cAlignHack  &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
12 &
  \multicolumn{2}{p{\dimexpr(.26950000000000003\linewidth-2\tabcolsep)}}{Duration of care providing:} &
   &
   &
   &
   &
  \\
 &
  1 to 2 years &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack 3.01 &
  \cAlignHack 0.389\\
 &
  3 to 4 years &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack (df=3) &
  \cAlignHack \\
 &
  4 to 6 years &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack  &
  \cAlignHack \\
 &
  Above 5 years &
  \cAlignHack 10 &
  \cAlignHack 33.3 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack  &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
 &
   &
   &
   &
   &
   &
   &
  \\
13 &
  \multicolumn{2}{p{\dimexpr(.26950000000000003\linewidth-2\tabcolsep)}}{Age of the caregiver: } &
  \cAlignHack  &
   &
   &
   &
  \\
 &
  20-30 years &
  \cAlignHack 11 &
  \cAlignHack 36.7 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 1.763 &
  \cAlignHack 0.184\\
 &
  31-40 years &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack 9 &
  \cAlignHack 30 &
  \cAlignHack (df=3) &
  \cAlignHack \\
 &
  41-50 years &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack  &
  \cAlignHack \\
 &
  51-60 years &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack  &
  \cAlignHack \\
 &
   &
   &
   &
   &
   &
   &
  \\
14 &
  Gender of the caregiver:  &
   &
  \cAlignHack  &
   &
   &
   &
  \\
 &
  Female &
  \cAlignHack 14 &
  \cAlignHack 46.7 &
  \cAlignHack 9 &
  \cAlignHack 30 &
  \cAlignHack 1.76 &
  0.184\\
 &
  Male &
  \cAlignHack 16 &
  \cAlignHack 53.3 &
  \cAlignHack 21 &
  \cAlignHack 70 &
  \cAlignHack (df=1) &
  \\
 &
   &
   &
   &
   &
   &
   &
  \\
15 &
  Education of caregiver: &
   &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \cAlignHack  &
  \\
 &
  No formal education &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 0.356 &
  0.986\\
 &
  Up to primary education  &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack (df=3) &
  \\
 &
  Up to Higher secondary  &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack  &
  \\
 &
  Graduate-level &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack  &
  \\
 &
  Others  &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 4 &
  \cAlignHack 13.3 &
  \cAlignHack  &
  \\
 &
   &
   &
   &
   &
   &
   &
  \\
16 &
  \multicolumn{2}{p{\dimexpr(.26950000000000003\linewidth-2\tabcolsep)}}{Occupation of caregiver:} &
   &
   &
   &
   &
  \\
 &
  Homemaker  &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 2.13 &
  \cAlignHack 0.712\\
 &
  Coolie &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 4 &
  \cAlignHack 13.3 &
  \cAlignHack (df=4) &
  \\
 &
  Self employee &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack  &
  \\
 &
  Govt.employee &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack 8 &
  \cAlignHack 26.7 &
  \cAlignHack  &
  \\
 &
  Private employee &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 5 &
  \cAlignHack 16.7 &
  \cAlignHack  &
  \\
 &
   &
   &
   &
   &
   &
   &
  \\
17 &
  Monthly income of caregiver:  &
   &
   &
   &
   &
   &
  \\
 &
  Less than Rs.5000 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 4 &
  \cAlignHack 13.3 &
  \cAlignHack 1.784 &
  \cAlignHack 0.618\\
 &
  Rs.5000-10000 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 6 &
  \cAlignHack 20 &
  \cAlignHack (df=3) &
  \cAlignHack \\
 &
  Rs.10001-15000 &
  \cAlignHack 7 &
  \cAlignHack 23.3 &
  \cAlignHack 11 &
  \cAlignHack 36.7 &
  \cAlignHack  &
  \cAlignHack \\
 &
  Above Rs.15000 &
  \cAlignHack 9 &
  \cAlignHack 30 &
  \cAlignHack 9 &
  \cAlignHack 30 &
  \cAlignHack  &
  \cAlignHack \\
\tblbottomrule 
\end{longtable}
\endgroup
\makeatletter\@ifundefined{TwoColDocument}{}{\twocolumn}\makeatother 

\begin{table*}[!htbp]
\caption{\boldmath {Cognitive, the activity of daily living, caregiver burden, and quality of life of control and experimental groups} }
\label{tw-5cafc6b5c6a2}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.0672\linewidth-2\tabcolsep}p{\dimexpr.12090000000000002\linewidth-2\tabcolsep}p{\dimexpr.16839999999999996\linewidth-2\tabcolsep}p{\dimexpr.14679999999999996\linewidth-2\tabcolsep}p{\dimexpr.12959999999999997\linewidth-2\tabcolsep}p{\dimexpr.1208\linewidth-2\tabcolsep}p{\dimexpr.12000000000000002\linewidth-2\tabcolsep}p{\dimexpr.12629999999999999\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}S. No & Parameter  & Group & Mean\ensuremath{\pm}SE & \multicolumn{2}{p{\dimexpr(.2504\linewidth-2\tabcolsep)}}{\cAlignHack  Paired `t'-test } & \multicolumn{2}{p{\dimexpr(.24630000000000003\linewidth-2\tabcolsep)}}{\cAlignHack Un paired `t'-test }\\
\rowcolor{kwdboxcolor} &  &  &  & Con- pre test - post test & Experimental pre -post  & Con- pre test {\textendash}experimental pre test & Control post {\textendash} experimental post \\
\tblmidrule 
1 &
   &
  Control pre test  &
  22\ensuremath{\pm}0.17 &
   &
   &
   &
  \\
 &
  Cognitive level  &
  Control post test  &
  22.23\ensuremath{\pm}0.19 &
  t=2.97 \mbox{}\protect\newline p=0.005** &
   &
  t=1.486 \mbox{}\protect\newline p=0.143 &
  t=18.86 \mbox{}\protect\newline p{\textless}0.001***\\
 &
   &
  Experimental pre test  &
  22.36\ensuremath{\pm}0.17 &
   &
  t=35.94 \mbox{}\protect\newline p{\textless}0.001*** &
   &
  \\
 &
   &
  Experimental post test  &
  27.03\ensuremath{\pm}0.16 &
   &
   &
   &
  \\
2 &
   &
  Control pre-test  &
  40.47\ensuremath{\pm}1.17 &
  t=3.24 \mbox{}\protect\newline p=0.002* &
   &
   &
  \\
 &
   &
  Control post test  &
  40.73\ensuremath{\pm}1.16 &
   &
   &
   &
  \\
 &
  The activity of daily living  &
  Experimental pre test  &
  39.93\ensuremath{\pm}1.21 &
   &
  t=25.22 \mbox{}\protect\newline p{\textless}0.001*** &
   &
  \\
 &
   &
  Experimental post test  &
  21.2\ensuremath{\pm}1.07 &
   &
   &
  t=0.316 \mbox{}\protect\newline p=0.753 &
  t=12.39 \mbox{}\protect\newline p{\textless}0.001***\\
 &
   &
  Control post test  &
  67.8\ensuremath{\pm}2.11 &
   &
   &
   &
  \\
 &
   &
  Experimental pre test  &
  68.27\ensuremath{\pm}1.94 &
   &
  t=15.59 \mbox{}\protect\newline p{\textless}0.001*** &
   &
  \\
 &
   &
  Experimental post test  &
  37.07\ensuremath{\pm}2.29 &
   &
   &
   &
  \\
 &
   &
  Experimental post test  &
  222.9\ensuremath{\pm}4.97 &
   &
   &
   &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
probability value of less than 0.05 was considered significant.
    
\section{Results and Discussion}
Table~\ref{tw-56c1ce09429d} depicts that in experimental group, 60 to 70 years were 4 (13.3\%), 71 to 75 were 4 (13.3\%), 76 to 80 were 7 (23.3\%), 80 to 85 were 8 (26.7\%) and above 85 were 7 (23.3\%). As well in control group 60 to 70 years were 5 (16.7\%), 71 to 75 years were 5 (16.7\%), 76 to 80 years were 9 (30\%), 81 to 85 years were 9 (30\%) with homogeneity mean difference 4 and p {\textendash} value 0.364. 11 (36.6\%) were females and 19 (63.3\%) were male in experimental group. 9 (30\%) were females and 21 (70\%) were males in control group with mean difference 0.3 and p {\textendash} value 0.584. 8 (26.7\%) in rural, 12 (40\%) in urban and 10 (33.3\%) in semi urban in experimental. 14 (46.7\%) in rural, 6(20\%) in urban, 10 (33.3\%) in semi urban in control group with mean difference 2 and p {\textendash} value 0.162. 4 (13.3\%) had no formal education, 8 (26.7\%) studied up to primary education, 7 (23.3\%) studied up to higher secondary, 4 (13.3\%) graduated, and 7 (23.3\%) were other in experimental group. 6 (20\%) had no formal education, 8 (26.7\%) studied up to primary education, 7 (23.3\%) up to higher secondary, 6 (20\%) graduated and 3 (10\%) others in control group. Mean difference 4 and p- value 0.663. Regarding occupation 5 (16.7\%) were homemaker, 7 (23.3\%) were coolie, 5 (16.7\%) were self employee, 7 (23.3\%) were govt. employee, 6(20\%) were private employee in experimental group. 5 (16.7\%) were homemaker, 5 (16.7\%) were coolie, 4 (13.3\%) were self employee, 8 (26.7\%) were govt. employee and 8 (26.7\%) were private employee In control group. Mean difference 4 and p- value 0.939. 

Regarding marital status 10 (33.3\%) were single, 20 (66.7\%) were married in experimental group and 13 (43.3\%) were single, 17 (56.7\%) were married in control group. Mean difference 1 and p- value 0.426. Regarding religion in experimental group, 8 26.7 were Muslim, 11 36.7 were Christian, 11 36.7 Hindu. In control group 12 (40\%) Muslim, 10 (33.3\%) Christian, 8 (26.7\%) Hindu. The mean difference 2 and the p- value 0.517. In experimental group, 9 (30\%) nuclear family, 15 (50\%) joint family, 6 (20\%) extended family. In control group 10 (33.3\%) nuclear family, 10 (33.3\%) joint family, 10 (3303\%) extended family. The mean difference was 3 and the p- value 0.356. In experimental group 7 (23.3\%) earned less than Rs 5000, 4 (13.3\%) Rs 5000 to 10000, 12 (40\%) Rs 10001 to 15000, 7 (23.3\%) Rs above15000. In control group 7 (23.3\%) Rs less than 5000, 9 (30\%) Rs 5000 to 10000, 7 (23.3\%) Rs 10001 to 15000, 7 (23.3\%) Rs above 15000. The mean difference was 3 and the p- value 0.356. In experimental group 11 (36.7\%) had diabetic and other endocrine disorders, 7 (23.3\%) hypertension and other cardiac disorder, 12 (40\%) respiratory disorder in control group 10 (33.3\%) diabetic and other endocrine disorder , 12 (40\%) hyper tension and other cardiac problems, 8(26.7\%) respiratory disorders. The mean difference was 2 and the p- value 0.453. In experimental group 7 (23.3\%) first degree relatives provided care, 14 (46.7\%) second degree relatives, 9 (30\%) guardians. In control group 11 (36.7\%) first degree relatives, 12 (40\%) second degree relatives, 7 (23.3\%) guardians. The mean difference 2 and the p- value 0.524. In experimental group 7 (23.3\%) provided 1 to 2 years of duration, 5 (16.7\%) 3 to 4 years, 8 (26.7\%) 4 to 6 years , 10 (33.3\%) above 5 years. In experimental group 8 (26.7\%) 1 to 2 years, 10 (33.3\%) 3 to 4 years, 6 (20\%)4 to 6 years, 6 (20\%) above 5 years. The mean difference was 3 and the p- value 0.389. In experimental group 11(36.7\%) 20 to 30 years, 8 (26.7\%) 31 to 40 years, 6 (20\%) 41 to 50 years, 5 (16.7\%) 51 to 60 years. In control group 7 (23.3\%) 20 to 30 years, 9 (30 \%) 31 to 40 years, 8 (26.7\%) 41 to 50 years, 6 (20\%) 51 to 60 years. The mean difference was 3 and the p- value 0.184. In experimental group 14 (46.7\%) female, 16 (53.3\%) male. In control group 9 (30\%) female and 21(70\%). The mean difference was 1 and the p- value 0.384. In experimental group 6 (20\%) had no formal education, 7 (23.3\%) primary education, 5 (16.7\%) higher secondary , 7 (23.3\%) graduated. In control group7 (23.3\%) no formal education, 7 (23.3\%) primary education, 6 (20\%) higher secondary, 4 (13.3\%) graduated. The mean difference was 3 and the p- value 0.986. In experimental group 5 (16.6\%) homemaker, 7 (23.3\%) coolie, 5 (16.7\%) self employee, 6 (20\%) govt. employee, 7 (23.3\%) private employee. In control group 5 (16.7\%) homemaker, 4 (13.3\%) coolie, 8 (26.7\%) self employee, 8 (26.7\%) govt. employee, 5 (16.7\%) private employee. The mean difference was 4 and the p- value 0.712. In experimental group 7 (23.3\%) care giver earned less than Rs 5000, 7 (23.3\%) earned Rs 5000 to 10000, 7 (23.3\%) Rs 10001 to 15000, 9 (30\%) above 15000. 

The mean difference was 3 and the p-value 0.618. Here parametric test, paired 't' test and unpaired 't' test used to assess the existing relationship between the variables among the level of cognition, the activity of daily living, quality of life, and caregiver burden among persons with mild cognitive impairment. Regarding the level of cognition, in paired' test p-value of control group 0.005 and in an experimental group more than 0.001. In the unpaired t-test, the comparison between the control pretest and experimental pretest, the p-value was 0.143. 

And the comparison between the control post-test and the experimental post-test p-value was more than 0.001. Regarding the activity of daily living, in paired't' test, the control group p-value 0.002 and the experimental group p-value more than 0.001. In the unpaired 't' test, the control and experimental pretest p-value were 0.753. And between the control group and the experimental group, the p-value was more than 0.001 (Table~\ref{tw-5cafc6b5c6a2}). 

Cognitive skills play an important role in the day to day functions of the old people. However, as a process of aging, the cognitive functions decline\unskip~\citep{640097:15022319,640097:15022334,640097:15022335}. The risk factors responsible for the decline in the cognitive functions are classified as modifiable and non-modifiable factors. Modifiable factors include lifestyle, education, metabolic disorders\unskip~\citep{640097:15022336}. Though this condition can be managed medically, still the treatment is not affordable to most of the public. Hence, there is a strong need for affordable treatment or management of cognitive functions in the elderly population. Home-based cognitive therapy is simple, affordable, and easy to implement, even in the elderly population. As it minimizes the cost of the treatment, it is also preferred by many of the people\unskip~\citep{640097:15022325}. 

The present study was undertaken to observe the effectiveness of the Home Based cognitive Training Programme on Cognitive level, Activity of daily living among Elderly persons with mild Cognitive Impairment in Selected Community Settings of Puducherry. There was a significant improvement in the cognition level and cognitive impairment in the experimental group when compared with the control group. Earlier studies reported that Home Based cognitive Training Programme is very effective for improving cognition in the elderly\unskip~\citep{640097:15022323,640097:15022324}. However, there are certain controversies in this aspect as some studies reported that Home Based cognitive Training Programme is beneficial\unskip~\citep{640097:15022325,640097:15022326} other studies reported there is no improvement in the cognition followed by the intervention program\unskip~\citep{640097:15022327,640097:15022328}. These differences in the results may be due to the inclusion of the participants with different age groups and from different areas. Further, there are differences in the application of training programs. The training program was reported to be beneficial when applied on a long-term basis\unskip~\citep{640097:15022329}. It was reported that there was a significant increase in the attention score, execution speed followed by the intervention\unskip~\citep{640097:15022330,640097:15022331,640097:15022332}. Our study results are in accordance with earlier studies as we have observed significant improvement in the cognitive functions followed by the intervention. 
    
\section{Conclusion}
The present study results suggest that the home-based cognitive training program is effective in improving cognitive functions and daily life activities. The study recommends further detailed and multi-centered studies in this area to recommend the implementation of the program in the management of the cognitive impairments of the elderly. 

\textbf{Conflicts of interest}

The authors declare that they have no conflict of interest for this study.

\textbf{Source of funding}

The authors declare that they have no funding support for this study.
    

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