Supplement to Cognitive training to reduce incidence of cognitive impairment in older adults

项目摘要 痴呆症是美国最昂贵的医疗条件。迫切需要进行干预以遏制 我们人口中痴呆症的发病率不断上升。来自18个以上的初步数据显示， 国内的临床试验表明，计算机化的认知处理速度训练（SPT）， 证明认知并转移到改善的工具性日常生活活动。最近的证据进一步 表明SPT可以降低痴呆风险。对ACTIVE试验10年数据的分析显示， 随机接受SPT的老年人患痴呆症的可能性降低了29%。此外，那些来自- 在10年内，完全额外的训练可以降低48%的痴呆症风险。这有两个限制 研究缺乏痴呆症临床诊断和使用非接触控制条件。因此，一个IM- 一个重要的问题是，“SPT能否成功地实施，以减少轻度认知障碍的发生率- 是MCI还是痴呆？”我们的主要目标是测试SPT降低发病率的有效性 轻度认知障碍或痴呆通过认知训练预防阿尔茨海默氏症-PACT现场试验进展 通过在大量认知正常的老年人和前 确定MCI或痴呆临床诊断的主要终点。老年人随机接受SPT 或认知刺激的主动控制臂（即，电脑游戏）和进展到MCI或demen- TIA将在3年后进行临床评估。我们将进一步探讨SPT效应是否受到去- 淀粉样病变或载脂蛋白E4状态的程度。为了证明可行性，我们的调查小组 在R56阶段实施研究方案，并成功招募了744名老年人， 提案提交。入组三年后，我们将重新评估研究参与者，以确定 表现出认知能力下降这些参与者将接受全面的医学评估， 确定MCI或痴呆诊断。那些被归类为MCI或痴呆症的人将进一步完成一项amy- loid PET扫描和基因检测这项非药物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，包括积极的对照组。的 拟议的研究将确定SPT是否成功降低MCI或痴呆症的发病率。把这个拿出来- 如果干预措施可以将痴呆症的发病推迟一年， 到2050年，将减少920万病例，大大降低成本。积极的结果将 支持使用相对便宜且易于实施的干预措施，可以延迟或防止发生 阿尔茨海默病和/或相关痴呆的集合。这样的结果将证明进一步的研究是合理的， 确定行动机制。结果将告知临床实践有效的干预措施，以减轻 与年龄相关的认知和功能下降，从而改善公众健康。

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.