Web-enabled social interaction to delay cognitive decline among seniors with MCI: Phase I

基于网络的社交互动可延缓 MCI 老年人认知能力下降：第一阶段

• 批准号: 9930344
• 负责人: HIROKO Hayama DODGE
• 金额: $ 40.23万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9930344
• 关键词: Adherence; Advanced Development; Age; Aged, 80 and over; Aging; Algorithms; Alzheimer' s Disease; Amygdaloid structure; Area; Atrophic; Attention; Brain; Brain imaging; Characteristics; Cognition; Cognitive; Communication; Communities; Control Groups; Cross-Sectional Studies; Dementia; Developed Countries; Developing Countries; Diffusion Magnetic Resonance Imaging; Elderly; Face; Feasibility Studies; Filler; Functional Magnetic Resonance Imaging; Funding; Future; Health; Hippocampus (Brain); Home environment; Impaired cognition; Incidence; Internet; Intervention; Interviewer; Language; Lead; Location; Low income; Magnetic Resonance Imaging; Meals on Wheels; Memory; Michigan; Monitor; Moods; Oregon; Outcome; Outcome Measure; Participant; Personal Computers; Personal Satisfaction; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Prefrontal Cortex; Prevalence; Prevention; Prevention approach; Protocols documentation; Public Health; Randomized; Research Project Grants; Rest; Risk Factors; Sample Size; Sampling; Social Interaction; Social Network; Social isolation; Speech; Speed; Structure; Technology; Temporal Sulcus; Time; Training; Treatment Efficacy; United States National Institutes of Health; Well in self; aged; aging population; base; behavioral clinical trial; cognitive function; cost effective; efficacy study; efficacy trial; epidemiology study; ethnic minority population; executive function; group intervention; high risk; imaging study; improved; inclusion criteria; instrumental activity of daily living; intervention cost; intervention effect; mild cognitive impairment; morphometry; phase 1 study; phase I trial; primary outcome; recruit; secondary outcome; social; therapy development; touchscreen; user-friendly; web-enabled; week trial

Larger social networks and/or more frequent social interactions are associated with lower incidence of AD, at the population level; increasing social interaction may be a promising intervention for improving the cognitive well-being of older adults. In our previous randomized controlled behavioral clinical trial, we developed a conversation-based social interaction cognitive stimulation protocol delivered by trained interviewers through personal computers, webcams, and a user-friendly interactive Internet interface with a touch screen (ClinicalTrials.gov:NCT01571427). Daily 30-minute face-to-face communications were conducted over a 6- week trial period in the intervention group. Despite a small sample size, this pilot study (completed 6/30/2014) demonstrated feasibility, high adherence in an elderly population (mean age 80 years) and efficacy in language-based executive functions among the intervention group in comparison to the control group. Based upon these positive results, we propose a Phase I trial to advance development of this intervention. Primary aim (Aim 1) is to examine the efficacy of our intervention on cognitive functions among the target group - those aged 80 and older with MCI and limited opportunities of social interactions. Our primary outcomes are cognitive functions in the domains of language, attention, executive and memory functions, and secondary outcomes are a targeted IADL function (medication use and adherence) and overall emotional well-being (mood, self-rated health). Person-specific levels of social interactions (i.e., average conversation outside of the trial) will be monitored and controlled in the analyses. Exploratory Aim 2 is to examine whether the intervention could lead to changes in speech and language characteristics over time by analyzing recorded daily conversational sessions, based on our promising cross-sectional findings in this area. Exploratory Aim 3 is to examine underlying mechanisms of efficacy by assessing pre- and post- trial changes inhippocampal, dorsolateral prefrontal cortex, amygdala and other ROIsusing MRI and unbiased whole brain assessment (voxel-based morphometry), and structural and functional connectivity using diffusion tensor imaging (DTI) and resting state functional MRI (R-fMRI). A total of 144 MCI subjects will be recruited and randomized at Portland, Oregon, and Detroit, Michigan, collaborating with Meals on Wheels and Area Agency on Aging (AAA) at both locations, creating a large sampling frame of those with low income and from ethnic minorities. Half of the participants will be randomly selected and invited to participate in the brain imaging study. Increasing daily social contact through communication technologies could offer a cost-effective home- based prevention that could slow cognitive decline, delay the onset of AD, and thereby reduce the overall societal burden of dementia. The oldest old is the fastest growing segment of the population in most developed countries, and face the highest risk of developing dementia and social isolation (risk factors of adverse health outcomes). User-friendly sustainable prevention approaches are urgently needed in this population.

较大的社交网络和/或更频繁的社交互动与AD的发病率较低有关 人口水平；增加社交互动可能是改善认知能力的有希望的干预措施 老年人的福祉。在以前的随机对照行为临床试验中，我们开发了 训练有素的访调员通过 带有触摸屏的个人计算机，网络摄像头和用户友好的交互式Internet接口 （ClinicalTrials.gov：NCT01571427）。每天进行30分钟的面对面通信 干预组的周期试验期。尽管样本量很小，但该试点研究（完成了6/30/2014） 表现出可行性，老年人口（平均80岁）的依从性高以及有疗效 与对照组相比，干预小组中基于语言的执行功能。 基于这些积极的结果，我们提出了I阶段试验以推动这一发展的发展 干涉。主要目的（目标1）是检查我们干预对认知功能的疗效 目标群体 - 年龄在80岁及以上的MCI和社交互动机会有限的人。我们的 主要结果是语言，注意力，执行和记忆领域的认知功能 功能和次要结果是靶向的IADL功能（用药和依从性）和总体 情绪健康（情绪，自我评估的健康）。特定于人的社会互动水平（即平均 在审判之外的对话）将在分析中受到监控和控制。探索目标2是 检查干预是否可以随着时间的推移导致语音和语言特征的变化 根据我们在该领域有希望的横截面发现，分析记录的每日对话会议。 探索目的3是通过评估试验前和试验后的变更来检查疗效的潜在机制 内外侧前额叶皮层，杏仁核和其他Rois roissed MRI和无偏见的整个大脑 评估（基于体素的形态计）以及使用扩散张量的结构和功能连接性 成像（DTI）和静止状态功能性MRI（R-FMRI）。总共将招募144名MCI主题 在俄勒冈州波特兰和密歇根州底特律随机分组，与车轮和地区代理商合作 在两个地点的衰老（AAA）上，创建了低收入和族裔的大型抽样框架 少数民族。一半的参与者将被随机选择并邀请参加大脑成像研究。 通过通讯技术增加日常社交接触可能会提供具有成本效益的房屋 - 基于预防，可能会减慢认知能力下降，延迟AD的发作，从而减少整体 痴呆症的社会负担。最古老的是最发达的人口中增长最快的部分 国家，面临发展痴呆症和社会隔离的最高风险（不良健康的危险因素 结果）。在该人群中迫切需要使用用户友好的可持续预防方法。