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: 9348726
• 负责人: HIROKO Hayama DODGE
• 金额: $ 58.12万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9348726
• 关键词: Adherence; Advanced Development; Age; Aged, 80 and over; Aging; Algorithms; Alzheimer' s Disease; Amygdaloid structure; Area; Brain; Brain imaging; Characteristics; Cognition; Cognitive; Communication; Communities; Control Groups; Cross-Sectional Studies; Dementia; Developed Countries; Diffusion Magnetic Resonance Imaging; Elderly; Epidemiologic Studies; Episodic memory; Face; Feasibility Studies; Filler; Functional Magnetic Resonance Imaging; Funding; Future; Health; Home environment; Impaired cognition; Incidence; Internet; Intervention; Interviewer; Language; Lead; Location; Loneliness; Low income; Magnetic Resonance Imaging; Meals on Wheels; Medication Management; Michigan; Monitor; Moods; Oregon; Outcome; Outcome Measure; Participant; Personal Computers; Personal Satisfaction; Persons; Phase; Pilot Projects; Population; Prevalence; Prevention; Prevention approach; Protocols documentation; Public Health; Randomized; Recruitment Activity; Research Project Grants; Rest; Risk Factors; Sample Size; Sampling; Social Interaction; Social Network; Social isolation; Speech; Speed; Structure; Structure of superior temporal sulcus; Technology; Telephone; Temporal Sulcus; Time; Training; Treatment Efficacy; United States National Institutes of Health; aged; aging population; base; behavioral clinical trial; brain size; cognitive function; cost; cost effective; efficacy trial; ethnic minority population; executive function; group intervention; high risk; improved; inclusion criteria; instrumental activity of daily living; intervention effect; mild cognitive impairment; morphometry; phase 1 study; phase I trial; primary outcome; psychologic; secondary outcome; social; 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, while control subjects received weekly phone contacts. Despite a small sample size, this feasibility study demonstrated high adherence in an elderly population (mean age 80 years) and some efficacy in language-based executive functions and psychomotor speed. 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 two primary outcomes are cognitive functions in the domains of executive function and episodic memory using composite scores, and a secondary outcome is a targeted IADL function (medication management). Psychological well-being (mood, loneliness) and 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 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 in amygdala volume and other ROIs using MRI and unbiased whole brain assessment (voxel-based morphometry), and structural and functional connectivity between amygdala and superior temporal sulcus using diffusion tensor imaging (DTI) and resting state fMRI (R-fMRI). A total of 144 MCI subjects will be recruited 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. Approximately 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 faces the highest risk of developing dementia and social isolation (risk factors of adverse health outcomes). User-friendly, sustainable prevention approaches, as sought here, are urgently needed in this population.

较大的社交网络和/或更频繁的社交互动与较低的 AD 发病率相关。在 人口水平；增加社交互动可能是改善认知能力的一种有希望的干预措施 老年人的福祉。在我们之前的随机对照行为临床试验中，我们开发了一种 由训练有素的访谈员通过以下方式提供基于对话的社交互动认知刺激协议 个人电脑、网络摄像头以及带有触摸屏的用户友好型交互式互联网界面 （ClinicalTrials.gov：NCT01571427）。每天进行 30 分钟的面对面交流，为期 6 至 干预组的试验期为一周，而对照组则每周接受一次电话联系。尽管有 样本量较小，这项可行性研究表明老年人群（平均年龄 80 岁）的依从性很高 年）以及对基于语言的执行功能和精神运动速度的一些功效。基于这些 积极的结果，我们建议进行一期试验来推进这种干预措施的发展。主要目标（目标 1） 目的是检验我们的干预措施对目标群体（80 岁）认知功能的效果 患有 MCI 的老年人和社交互动机会有限。我们的两个主要结果是认知 使用综合分数和辅助分数在执行功能和情景记忆领域发挥作用 结果是有针对性的 IADL 功能（药物管理）。心理健康（情绪、孤独感） 以及特定于个人的社交互动水平（即试验之外的平均对话）将 在分析中进行监测和控制。探索性目标 2 是检验干预措施是否可以 通过分析记录的日常对话会话，导致语音特征随时间的变化， 基于我们在该领域有希望的横截面研究结果。探索性目标 3 是检查潜在的 通过评估试验前和试验后杏仁核体积和其他 ROI 的变化来评估疗效机制 MRI 和无偏见的全脑评估（基于体素的形态测量）以及结构和功能 使用扩散张量成像 (DTI) 和静息状态观察杏仁核和颞上沟之间的连接 状态功能磁共振成像（R-fMRI）。俄勒冈州波特兰和密歇根州底特律将总共招募 144 名 MCI 受试者， 与 Meals on Wheels 和地区老龄化机构 (AAA) 合作，创建了一个大型 低收入群体和少数民族群体的抽样框架。大约一半的参与者将 被随机选择并邀请参加脑成像研究。增加日常社交接触 通过通信技术可以提供具有成本效益的家庭预防措施，从而减缓 认知能力下降，延缓AD的发病，从而减轻痴呆症的整体社会负担。这 在大多数发达国家，最年长的老年人是人口中增长最快的部分，面临着最高的压力。 患痴呆症和社会孤立的风险（不良健康结果的风险因素）。方便使用的， 这一人群迫切需要采取本文所寻求的可持续预防方法。