Mindfulness Awareness Practice (MAP) to Prevent Dementia in Older Adults with Mild Cognitive Impairment: Protocol of a Randomized Controlled Trial and Implementation Outcomes
, Lei Feng 4, Johnson Fam 1,4, Iris Rawtaer 5, Alan Prem Kumar 6,7, Grishma Rane 6,7, Irwin Kee-Mun Cheah 8, Ratha Mahendran 9, Yuan Kun Lee 10, Ene Choo Tan 11, Lee Gan Goh 12, Ee Heok Kua 1,4 and Rathi Mahendran 1,4,*Round 1
Reviewer 1 Report
This study protocol details background, methods and procedures of a study on the effects of mindfulness practice on cognitive development in MCI. Results are not presented, but are presented in separate publications. The study has been competently designed and executed from what I can tell from the study protocol. The protocol is written clearly and understandably. I have only two minor points:
Page 2, line 58 (“…, one but all…”): This sentence is grammatically awkward and hard to understand.
Figure 1 is missing information on Ns.
No results are presented in this paper, this is merely a study protocol. I assume that this type of paper is suitable for publication in this journal, but in my area, the information given in this paper would be published within the article(s) that also present(s) the results.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The protocol presented by the authors is clarifying, and can serve as a reference for other researchers when carrying out similar studies or replicating results.
However, there is a very important aspect that the authors themselves point out in lines 378-387 (Trial status section): the interventions and data collection have already been completed, and part of the analyses have already been completed and published in 5 articles (references 54,57,58,80,81). Based on this statement, it would have been ideal to publish this Protocol before the research was carried out and, above all, before the results were published.
In this sense, in my opinion, this article does not really add anything that would make a substantial contribution to the publications that the authors themselves have already published, describing the results of most of the dependent variables that they intend to study.
It would have made sense if it had been published before the results were made public. However, at the moment it is rather a redundant study, and for this reason (not because of the quality of the work, which in itself is of interest), it does not qualify for publication in a high-impact Journal.
However, if the editors consider publishing it, I make the following considerations:
1-I suggest that the authors clarify the aspects already pointed out at the beginning of the article, in the introductory or review part of the state of the art, or at least mention this aspect as a limitation.
2-On the other hand, I strongly recommend that the authors take into account and/or cite in the text the reference of the following study:
Poisnel, G., Arenaza-Urquijo, E., Collette, F., Klimecki, O. M., Marchant, N. L., Wirth, M., Frison, E. (2018). The Age-Well randomized controlled trial of the Medit-Ageing European project: Effect of meditation or foreign language training on brain and mental health in older adults. Alzheimer's & Dementia: Translational Research & Clinical Interventions, 4, 714-723. doi:10.1016/ j.trci.2018.10.011.
This is a very similar study PROTOCOL (although the sample is not persons with Mild cognitive impairment), published in 2018, several years in advance. In this work, the authors also aim to study the efficacy of mindfulness in preventing Alzheimer's Disease. They evaluate the same type of dependent variables, and propose a more sustained practice over time of mindfulness training (9 months) and also add training in self-compassion (another 9 months); they also employ an active control group, and also use another passive control group (waiting list). As in the study cited above, in this work by Kheng et al (2021), adding this active control group considerably improves the effectiveness conclusions that can be reached; I consider it very wise to use this active control strategy proposed by MacCoon et al (2012), as I am not aware of any other study that employs it so far.
However, using also a passive control group (waiting list) could have helped to evaluate the efficacy of mindfulness training and also of the training used as active control. This could be noted in a final section of limitations or proposals for future work.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
I consider that the authors have made very significant and valuable contributions in this revision that significantly improve the first version.
It is worth highlighting the wisdom of including aspects of "... implementation outcomes" in the title, which significantly improve the Originality / Novelty of the content, as well as the Significance of Content and Interest to readers.
In addition, I also value very positively that the authors have introduced references to similar works in the area of research, and that they point out that this is a pioneering work in terms of the use of a long-term mindfulness protocol with this type of population in an Asian population.
Author Response
We thank the reviewer for the positive comments.
