iMeditate at Home for Older Adults With Mild Cognitive Impairment and Caregivers

The breath counting task has been proposed and validated as a behavioural measure of mindfulness (Atchley et al., 2016; Levinson et al., 2014; Milz, Faber, Lehmann, Kochi, \& Pascual-Marqui, 2014). Participants are asked to breathe normally and count their breaths repeatedly from 1 to 9, pressing one button for counts 1 - 9 and another button for count 9. If the participant loses count, they press a different button to restart the count at 1. A respiration belt will be used to validate the breathing count accuracy.

The MAAS is a 15-item self-administered scale that evaluates the experience of mindfulness in a general, everyday context (Brown \& Ryan, 2003). Respondents rate on a six-point scale how frequently they have certain experiences. Higher scores correspond to greater levels of trait mindfulness.

The PSS-10 (Cohen et al., 1983) measures an individual's perception of how uncontrollable, unpredictable and overloading aspects of their life are on a 5-point scale ranging from 0 (never) to 4 (very often). The change from baseline to the midpoint of the intervention will be examined to determine the effect over a shorter timespan.

The BDI-II (Steer, Brown, Beck, \& Sanderson, 2001) is a 21-item scale scored on a 4-point scale and measures the intensity of self-reported depressive symptoms over the past two weeks, with higher scores representing worse symptoms. The BDI-II has been used with older adults and caregivers of dementia patients (Segal, Coolidge, Cahill, \& O'Riley, 2008; Takai et al., 2009)

The BSI (Derogatis, 2001) is an 18-item questionnaire that assesses the magnitude of depression, anxiety, and somatic symptoms over the past week using a 5-point scale, from "not at all" to "extremely". The BSI has been used in older adults and caregivers of dementia patients (Anthony-Bergstone et al., 1988; Petkus et al., 2010).

The WEMWBS measures mental well-being, with a focus on positive aspects (Tennant et al., 2007). It has 14 items with 5 response categories, summed to a single score from 14 to 70. The WEMWBS has been used in caregivers of persons with dementia (Orgeta, Lo Sterzo, \& Orrell, 2013).

This 26-item questionnaire assesses quality of life across four domains: physical, psychological, social, and environmental ("Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment," 1998) using a 5-point scale. It has been used in older adults, patients with dementia, and caregivers of Alzheimer's patients (Danucalov, Kozasa, Afonso, Galduroz, \& Leite, 2017; von Steinbüchel, Lischetzke, Gurny, \& Eid, 2006).

The PROMIS® (Patient-Reported Outcomes Measurement Information System) Sleep disturbance 8a is an 8-item self-rated index of sleep quality and sleep habits during the last seven days (Full, Malhotra, Crist, Moran, \& Kerr, 2019). Higher values correspond to greater levels of sleep disturbance.

MMQ-Ability scale is a subscale of the MMQ that provides a measure of self-perception of everyday memory ability over the past two weeks, using 18 items rated on a 5-point scale ranging from "strongly agree" to "strongly disagree". High total scores indicate higher perceived ability. The MMQ was designed to be used in clinical assessment and interventions (Troyer \& Rich, 2002), has been normed on older adults, and used with individuals with mild cognitive impairment (Kinsella et al., 2009; Troyer \& Rich, 2002).

The MMQ-Satisfaction scale evaluates overall concern or satisfaction with one's memory over the past two weeks using 18 items rated on a 5-point scale, ranging from "strongly agree" to "strongly disagree". High total scores indicate higher satisfaction. The MMQ was designed to be used in clinical assessment and interventions (Troyer \& Rich, 2002), has been normed on older adults, and used with individuals with mild cognitive impairment (Kinsella et al., 2009; Troyer \& Rich, 2002).

The 10-item Conor-Davidson Resilience Scale is a self-administered questionnaire that evaluates an individual's resilience over the past month. Respondents rate their agreement on 10 items on a scale from 0 (not true at all) to 4 (true nearly all the time). The final score is calculated by summing all the items (Campbell-Sills \& Stein, 2007), with higher scores reflecting greater resilience.

The BSFC-s is a self-administered 10-item scale designed to measure the subjective burden felt by informal caregivers (Graessel, Berth, Lichte, \& Grau, 2014). Respondents rate their agreement on 10 items on a 4 point scale, from "strongly disagree" to "strongly agree". Higher total scores indicate greater subjective burden. This measure will be administered to the caregivers group only.

Calls for technical assistance to study staff will be logged to estimate the amount of technical assistance required during a six week intervention. The average total hours per person spent will be calculated for each group and condition.

A modified Sternberg-type visual memory task will be used to evaluate effects on memory. Participants will view two faces shown one after another and will be asked to remember the faces and the order in which they were shown. After a brief retention interval (2 s), a number '1' or '2' will cue participants to recall the first or second face. A probe face will then appear and participants will indicate with a "Yes" or "No" whether the probe face matched the cued face. Both reaction time and accuracy will be used to evaluate memory performance.

Attention will be measured using a variation of the attentional field of view task (Sekuler, Bennett, \& Mamelak, 2000). In the focused-central condition, participants need to report which one of four letters was briefly flashed in the centre of the screen. In the focused-peripheral condition, participants report in which quadrant a small white circle was flashed in the periphery. In the divided-attention condition, participants report which letter was presented in the centre of the screen and which quadrant contained a flash in the periphery. The duration of the visual stimuli is varied to determine the minimum duration required to achieve a threshold level of performance. The ratio of duration thresholds in the focused and divided conditions for both tasks is the measure of performance of interest.

Three types of tones (frequent 1000 Hz tone, rare 1700 Hz target tone, and a rare 400 Hz deviant tone) will be played at random intermittent intervals. Participants will be asked to press a button as soon as the target tone is heard and not do anything for the other tones. EEG data will be recorded with the MUSE headband. The amplitude and latency of the N2 and P3 components of the event-related potentials time-locked to the three stimuli types will be analyzed.

The TMS is a 13-item instrument assessing participants' mindfulness state immediately following an activity (Lau et al., 2006). Respondents rate their agreement with 13 statements on a 5-point scale, from "not at all" to "very much"; higher total scores correspond to greater levels of state mindfulness. Participants will complete this questionnaire once a week immediately following one of their meditation sessions. This scale will be used to examine how the quality of mindfulness changes across the six weeks of the intervention.

This questionnaire measures treatment expectancy and rationale credibility (Devilly \& Borkovec, 2000). It has been used in dementia caregivers and older adults in the context of mindfulness meditation interventions (Oken et al., 2010; Wahbeh, Goodrich, \& Oken, 2016). This scale will be used to assess whether participants in the two intervention arms have similar expectations and to examine whether expectations or credibility change from pre- to post- intervention.

The retention rate will be quantified as the proportion of participants enrolled in the study who complete the post-intervention assessment visit (Visit 3). This is a feasibility outcome variable.

The average duration (in minutes) of completed meditation sessions will be obtained for each participant to evaluate adherence to the intervention schedule. This is an acceptability outcome variable.

Study acceptability will be evaluated with a single-item question 'how satisfied are you with the meditation intervention study you just took part in', with a rating from 1 (unsatisfied) to 9 (very satisfied). Additional items in a custom-made end-of-study user feedback survey will be used to provide more insight on the acceptability of the meditation technology and the study itself.

Participants' raw EEG data will be recorded with the MUSE headband throughout all meditation sessions. The EEG power spectrum within each session be quantified with the average power at classically defined frequency bands, alpha power asymmetry, peak alpha frequency, and the slope of the aperiodic signal.

EEG data will be recorded with the Muse headband while participants are asked to sit still while looking at a fixation point on the screen for 2.5 minutes. This recording will be performed at the beginning and at the end of the assessment session. The EEG power spectral density will be quantified with the average power at classically defined frequency bands, alpha power asymmetry, peak alpha frequency, and the slope of the aperiodic signal.

EEG data will be recorded with the Muse headband while participants are asked to sit with their eyes closed for 2.5 minutes. This recording will be performed at the beginning and at the end of the assessment session. The EEG power spectral density will be quantified with the average power at classically defined frequency bands, alpha power asymmetry, peak alpha frequency, and the slope of the aperiodic signal.