Improving Mood in Assisted Living Using a Cognitive Training Intervention

使用认知训练干预改善辅助生活中的情绪

基本信息

批准号：
9099548
负责人：
Marianne Smith
金额：
$ 55.61万
依托单位：
UNIVERSITY OF IOWA
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-26 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9099548
关键词：
Adoption Adult Affect Anxiety Assisted Living Facilities Attention Biological Markers Climate Clinical Cognitive Communities Comorbidity Data Depressed mood Educational Intervention Effectiveness Elderly Enrollment Evaluation Family Family member Functional Magnetic Resonance Imaging Funding Health Health Care Costs Health Services Needs Hour Impaired cognition Individual Intervention Iowa Lead Life Maintenance Major Depressive Disorder Medical Mental Depression Mental Health Services Methods Mind Modeling Moods Nursing Homes Outcome Pain Participant Persons Prevalence Prevention Process Protocols documentation Provider Public Health Randomized Randomized Controlled Trials Resistance Resources Risk SF-36 Self Care Site Societies Telephone Interviews Training Training Programs Transportation Work alternative treatment arm clinically significant cognitive function cognitive process cognitive training computer game computerized depression prevention depressive symptoms disability functional disability geriatric depression global health health related quality of life improved novel premature prevent primary care setting processing speed programs social social stigma traditional care trial comparing user-friendly

项目摘要

DESCRIPTION (provided by applicant): Late-life depression is a large, escalating public health problem that often interacts with other health conditions and leads to spiraling disability that simultaneously threatens independence and health-related quality of life (HRQoL), and increases health care costs. Depression affects 24% of older adults in assisted living (AL) settings, but rates of recognition and treatment are low and underscore the need for alternative depression prevention and treatment methods in AL. A novel and promising intervention is a computerized cognitive training program known as Road Tour, which has shown serendipitous benefits for reducing depression symptoms and the onset of suspected clinical depression consistent with Beck's model of cognitive depression. As a self-directed, user-friendly "game", Road Tour overcomes common attitudinal and resource-related barriers that impede treatment in AL settings, and holds considerable promise for interrupting the potential downward spiral of depression-related disability for 1 million AL elders. The purpose of this study is to evaluate th effect of Road Tour on processing speed, depression symptoms and suspected clinical depression, and depression-related comorbidities among AL residents in Iowa. We will use a two-arm, parallel, RCT comparing Road Tour training to attention control training using computerized crossword puzzles among 300 adults 60 years old or older. We will actively engage 15-30 AL facilities as study partners who implement the training at their sites and assist with the evaluation process. RE-AIM methods will be used to develop AL-specific recruitment and enrollment protocols, educate AL staff about the study, and oversee computerized training by participating residents, as well as their family members and AL staff. Our three specific aims are to: (1) establish the effect of Road Tour on improving cognitive processing speed in AL; (2) evaluate the effect of Road Tour on reducing depressive symptoms and the risk of onset of suspected clinical depression in AL; and, (3) evaluate the effect of Road Tour on the depression-related health outcomes of anxiety, pain, and HRQoL in AL. Participants will receive 10 hours of computerized training over 5-6 weeks, and 4 hours of booster training at months 5 and 11. Outcomes are the UFOV for speed of processing (Aim 1), the CESD-12 and PHQ-9 for depressive symptoms and suspected clinical depression (Aim 2), and the SF-36 for HRQoL, the BPI for pain, and GAD-7 for anxiety (Aim 3). Data will be collected using telephone interviews at baseline, post-training (6-8 weeks), and at 26- weeks and 52-weeks. Each person will serve as their own control in linear panel analyses that use GEE to correct for clustering, as well as general linear mixed effects models. This study is the first step in evaluating depression-related outcomes of using Road Tour in AL settings. Subsequently, we will replicate the study while collecting the appropriate biomarkers and fMRIs to identify the precise mechanisms of action.

描述（由申请人提供）：晚期抑郁症是一个大型，不断升级的公共卫生问题，通常与其他健康状况相互作用，并导致螺旋残疾同时威胁到独立性和与健康相关的生活质量（HRQOL），并增加医疗保健成本。抑郁症在辅助生活（AL）环境中影响24％的老年人，但识别率和治疗率很低，并且强调了对AL中替代性抑郁症和治疗方法的需求。一种新颖而有希望的干预措施是一项计算机化认知训练计划，称为公路旅行，该计划显示了减轻抑郁症状的偶然益处，并发作可疑的临床抑郁症与贝克的认知抑郁症模型一致。作为一个自我指导，用户友好的“游戏”，公路旅行胜过了在AL环境中阻碍治疗的常见态度和与资源相关的障碍，并具有巨大的希望，可以打断100万Al Elders的抑郁症相关残疾的潜在螺旋式下降。这项研究的目的是评估道路旅行对加工速度，抑郁症状和可疑临床抑郁症的影响，以及爱荷华州AL居民的抑郁症合并症。我们将使用两臂，平行的RCT将道路旅行训练与注意力控制培训进行了使用计算机化填字游戏的注意力控制培训，其中300名60岁或以上的成年人中。我们将积极参与15-30个AL设施作为研究合作伙伴，他们在其网站上实施培训并协助评估过程。 Re-Aim方法将用于制定特定的AL招聘和入学协议，对AL员工进行研究，并通过参与居民以及其家人和AL员工来监督计算机化的培训。我们的三个具体目的是：（1）建立道路之旅对提高AL认知处理速度的影响；（2）评估道路游览对减少抑郁症状的影响以及AL中可疑临床抑郁症发作的风险；（3）评估道路之旅对AL中与抑郁症相关的焦虑，疼痛和HRQOL的健康结果的影响。参与者将在5-6周内接受10个小时的计算机培训，并在第5个月和第11个月接受4个小时的助推器培训。结果是处理速度的UFOV（AIM 1），CESD-12和PHQ-9的抑郁症状和可疑临床抑郁症（AIM 2）（AIM 2），以及HRQOL的SF-36，HRQOL，HRQOL，BPI FOR FOR FOR FOR FOR FOR FOR FOR FOR FOR FOR FOR和GAD-7）数据将在基线，训练后（6-8周）以及26-周和52周收集数据。每个人都将在线性面板分析中作为自己的控制，这些分析使用GEE校正聚类以及一般的线性混合效应模型。这项研究是评估在AL环境中使用公路旅行的与抑郁症相关的结果的第一步。随后，我们将在收集适当的生物标志物和FMRIS的同时复制研究，以识别精确的作用机理。