Cognitive training to reduce incidence of cognitive impairment in older adults

认知训练可降低老年人认知障碍的发生率

• 批准号: 10334504
• 负责人: Jerri Edwards
• 金额: $ 702.6万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10334504
• 关键词: Activities of Daily Living; Address; Administrator; Advertisements; Age-associated memory impairment; Alzheimer' s Disease; Amyloid; Apolipoprotein E; Attenuated; Categories; Clinical; Clinical Trials; Cognition; Cognitive; Communities; Control Groups; Critiques; Data; Dementia; Diagnosis; Diagnostic; Disease; Drops; Education; Effectiveness; Elderly; Enrollment; Evaluation; Exhibits; Experimental Designs; Failure; Funding; Genotype; Goals; Health; Impaired cognition; Incidence; Institutional Review Boards; Intervention; Knowledge; Life; Location; Marketing; Measurement; Media Campaign; Medical; Memory; Minority Recruitment; Mission; Monitor; Neuropsychological Tests; Neuropsychology; Outcome; Participant; Personal Satisfaction; Phase; Population; Positron-Emission Tomography; Prevalence; Prevention; Prevention trial; Preventive; Protocols documentation; Public Health; Randomized; Randomized Clinical Trials; Reporting; Research; Research Design; Research Personnel; Risk; Safety; Sampling; Telephone; Testing; Time; Training; Training Programs; Translations; United States National Institutes of Health; Visit; active control; amyloid pathology; apolipoprotein E-4; arm; bilingualism; clinical diagnosis; clinical practice; cognitive ability; cognitive function; cognitive training; computer game; computerized; cost; dementia risk; disability; effective intervention; effectiveness testing; functional decline; genetic analysis; genetic testing; implementation facilitation; improved; innovation; instrumental activity of daily living; mild cognitive impairment; prevent; primary endpoint; processing speed; recruit; screening; social media; theories; treatment arm; trial design; web page; β-amyloid burden

PROJECT SUMMARY Dementia is the most expensive medical condition in the US. There is an urgent need to intervene to curb the increasing prevalence of dementia in our population. Strong preliminary data from more than 18 ran- domized clinical trials demonstrate that computerized, cognitive speed of processing training (SPT) im- proves cognition and transfers to improved instrumental activities of daily living. Recent evidence further indicates that SPT may reduce dementia risk. Analyses of 10-year data from the ACTIVE trial revealed that older adults randomized to SPT were 29% less likely to develop dementia. Moreover, those who com- pleted additional training had a 48% reduced risk of dementia across 10 years. Two limitations of this study were a lack of clinical diagnosis of dementia and use of a no-contact control condition. Thus, an im- portant question is, “Can SPT be successfully implemented to reduce incidence of mild cognitive impair- ment (MCI) or dementia?”. Our primary goal is to test the effectiveness of SPT to reduce incidence of MCI or dementia. The Preventing Alzheimer's with Cognitive Training-PACT field trial advances prior research by rigorously implementing SPT in a large population of cognitively normal older adults and ex- amining the primary endpoint of MCI or dementia clinical diagnoses. Older adults are randomized to SPT or an active control arm of cognitive stimulation (i.e., computer games) and progression to MCI or demen- tia will be clinically assessed after 3 years. We further will explore if SPT effects are moderated by the de- gree of amyloid pathology or apolipoprotein E4 status. To demonstrate feasibility, our investigative team is implementing the study protocol in an R56 phase and successfully enrolled 744 older adults at the time of proposal submission. Three years after enrollment, we will re-assess study participants to identify those exhibiting cognitive decline. Such participants will be provided a thorough medical evaluation to clinically ascertain MCI or dementia diagnosis. Those classified as MCI or dementia will further complete an amy- loid PET scan and genetic testing. This non-pharmacological prevention trial is innovative with a highly efficient experimental design and optimized SPT training protocols including an active control group. The proposed research will determine if SPT successfully reduces incidence of MCI or dementia. This out- come will be significant in that if an intervention can delay the onset of dementia by only one year, there will be ~9.2 million fewer cases of the disease by 2050, substantially reducing cost. Positive results would support use of a relatively inexpensive and easy to apply intervention that could delay or prevent the on- set of Alzheimer’s disease and/or related dementias. Such an outcome would justify further research to identify mechanisms of action. Results will inform clinical practice of effective interventions to attenuate age-related cognitive and functional decline and thereby improve public health.

项目摘要 痴呆症是美国最昂贵的医疗状况。迫切需要干预以遏制 我们人群痴呆症患病率的增加。来自18多个超过18的强大初步数据 主导的临床试验表明，计算机化的处理训练的认知速度（SPT）IM- 证明认知和转移以改善日常生活的工具活动。最近的证据 表明SPT可能会降低痴呆症风险。积极试验的10年数据的分析显示 随机分为SPT的老年人患痴呆症的可能性降低了29％。而且，那些com的人 额外的培训在10年中降低了痴呆症的风险48％。这两个局限性 研究是缺乏痴呆症的临床诊断和无接触控制条件的使用。那，一个 便携式问题是：“可以成功实施SPT以减少轻度认知障碍的发生率 MENT（MCI）还是痴呆症？”。我们的主要目标是测试SPT的有效性以降低发生率 MCI或痴呆症。预防阿尔茨海默氏症具有认知训练-PACT现场试验的进步 通过严格实施SPT在大量认知正常的老年人中进行的研究 汇总MCI或痴呆症临床诊断的主要终点。老年人被随机分为SPT 或认知刺激（即计算机游戏）的主动控制部门以及向MCI或Demen的发展 TIA将在3年后对TIA进行临床评估。我们将进一步探讨SPT效应是否通过DE-调节 淀粉样病理或载脂蛋白E4状态的GREE。为了证明可行性，我们的调查团队是 在R56阶段实施研究方案，并在开始时成功招募了744名老年人 提案提交。入学后三年，我们将重新评估研究参与者以确定这些参与者 表现出认知能力下降。将向此类参与者提供临床上的全面医学评估 确定MCI或痴呆诊断。被归类为MCI或痴呆症的人将进一步完成Amy- 牵引PET扫描和基因检测。这项非药理学预防试验具有创新性 有效的实验设计和优化的SPT训练方案，包括主动对照组。这 拟议的研究将确定SPT是否成功降低了MCI或​​痴呆症的发生率。这个 即将来临，如果干预措施只能将痴呆症的发作延迟一年， 到2050年，该疾病的病例将大大降低。积极的结果将是 支持使用相对便宜且易于应用的干预措施，这可能会延迟或阻止这种干预措施 一组阿尔茨海默氏病和/或相关痴呆症。这样的结果将证明进一步的研究合理 确定作用机制。结果将为有效干预措施的临床实践提供依据 与年龄有关的认知和功能下降，从而改善了公共卫生。