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

更大的社交网络和/或更频繁的社交互动与较低的AD发病率相关。在… 人口水平；增加社会互动可能是一种有希望的干预措施，以改善认知 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 训练有素的面试官通过以下途径提供基于对话的社交认知刺激方案 个人计算机、网络摄像头和带有触摸屏的用户友好的交互式互联网界面 (ClinicalTrials.gov：NCT01571427)。每天30分钟的面对面交流在6- 干预组试验期为一周，对照组每周一次电话联系。尽管有一个 样本量小，这项可行性研究表明老年人口(平均年龄80岁)的依从性很高 几年)，在基于语言的执行功能和精神运动速度方面也有一定的效果。基于这些 为了获得积极的结果，我们建议进行一项第一阶段试验，以促进这一干预措施的发展。主要目标(目标1) 是为了检查我们对目标群体--80岁老年人--认知功能的干预效果 年龄较大，患有MCI，社交机会有限。我们的两个主要结果是认知性的 在执行功能和情节记忆领域的功能的综合分数和次要的 结果是有针对性的IADL功能(药物管理)。心理健康(情绪、孤独) 而特定于个人的社交互动级别(即试验外的平均对话)将是 在分析中进行监测和控制。探索性目标2是检查干预是否可以 通过分析记录的日常对话会话来导致语音特征随时间的变化， 基于我们在这一领域有希望的横截面发现。探索性目标3是检查潜在的 通过评估试验前后杏仁核体积和其他感兴趣区的变化来评估疗效的机制 MRI和无偏全脑评估(基于体素的形态计量学)，以及结构和功能 磁共振弥散张量成像与静息状态下杏仁核与颞上沟的联系 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招募144名MCI受试者， 在两个地点与Meals on Wheels和Area Agency on AAA(AAA)合作，创造了一个 低收入者和少数民族的抽样框。大约一半的参与者将 被随机选择并被邀请参加脑成像研究。增加日常社交活动 通过通信技术可以提供具有成本效益的基于家庭的预防，这可能会减缓 认知能力下降，延缓阿尔茨海默病的发病，从而减轻痴呆症的整体社会负担。这个 在大多数发达国家，高龄老人是人口中增长最快的部分，面临的人口比例最高 罹患痴呆症和社会隔离的风险(不利健康后果的风险因素)。用户界面友好， 这里所寻求的可持续预防方法在这一人群中迫切需要。

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.