Cognitive Intervention to Improve Memory in Heart Failure Patients

摘要 这项申请是对NIH FOA PA-15-017调查削弱认知能力的干预措施的回应 有认知障碍的个体数量下降。这与改进的NINR优先顺序一致 管理慢性病症状，提高生活质量。从510万人中的23%到50% 患有慢性心力衰竭(HF)的美国人有包括衰弱在内的共病认知功能障碍 失忆的问题。我们发现心力衰竭患者的记忆力减退是12个月ALL的独立预测因子。 死因166例。我们测试了使用BrainHQ的计算机化认知训练干预 小规模研究(n=40；n=27)发现，与完成主动控制健康的心衰患者相比 教育干预，完成脑部智商的心力衰竭患者记忆力显著改善(延迟 回忆)(效应大小[ES]=0.75)、血清脑源性神经营养因子水平(ES=1.21)和工作 内存(ES=0.64)。我们提出了一项三臂随机对照试验，对264名心力衰竭患者在四个相等的范围内 根据基线认知功能(正常/低)和性别划分块大小。具体目标是：1)评估 脑总部计算机化认知训练干预改善记忆和血清脑源性神经营养因子的疗效 水平(主要结果)，工作记忆，日常生活的工具性活动，以及与健康相关的质量 心力衰竭患者的生活；2)评估在心力衰竭患者中使用BrainHQ的增量成本-效果；以及3) 检查抑郁症状、Val66Met多态的脑源性神经营养因子基因和载脂蛋白-ε4等位基因 作为大脑总部对初级和次级结果影响的调节因子。264名心力衰竭患者的样本将是 随机分配到：1)脑HQ；2)基于计算机的主动控制一般认知刺激干预 使用纵横字谜游戏；以及3)常规护理控制，没有特定的电脑认知干预。 BrainHQ是一种易于传播的、基于科学的干预措施，旨在通过以下方式改善记忆 提高信息处理的速度和准确性。这是一个为期8周，40小时的节目， 根据每个患者的表现进行个性化。主动控制干预(基于计算机的纵横字谜 拼图)将用作对计算机使用和认知活动的表现的比较，该认知活动可能提供 全身刺激。通常的护理控制组将作为与不接受护理的患者的比较 接受基于计算机的认知干预。数据收集将在基线和10点完成。 基线后3周、4个月和8个月。描述性统计、混合模型分析和成本效用 使用意向治疗方法的分析将被计算。这项研究将为我们提供关于 脑活素改善心力衰竭记忆和升高血清脑源性神经营养因子水平的疗效。如果有效，干预措施 将提供一种易于传播的新的治疗方法来治疗严重的合并症 高频。如果具有成本效益，保险公司将更有可能为干预提供保险，从而为健康提供保险 系统将更有可能将其作为一种治疗选项提供。

Abstract This application is in response to NIH FOA PA-15-017 investigating interventions to attenuate cognitive decline in individuals with cognitive impairment. It is consistent with the NINR priority of improving management of symptoms of chronic illness to improve quality of life. From 23% to 50% of the 5.1 million Americans with chronic heart failure (HF) have comorbid cognitive dysfunction including the debilitating problem of memory loss. We found that memory loss in HF was an independent predictor of 12-month all- cause mortality (n=166). We tested the computerized cognitive training intervention using BrainHQ in two small studies (n=40; n=27) and found that compared with HF patients who completed the active control health education intervention, HF patients who completed BrainHQ had significantly improved memory (delayed recall) (effect size [ES]=0.75), serum brain-derived neurotrophic factor (BDNF) levels (ES=1.21), and working memory (ES=0.64). We propose a three-arm randomized controlled trial of 264 HF patients within four equal sized blocks on baseline cognitive function (normal/low) and gender. Specific aims are to: 1) evaluate the efficacy of computerized cognitive training intervention using BrainHQ to improve memory and serum BDNF levels (primary outcomes), working memory, instrumental activities of daily living, and health-related quality of life among HF patients; 2) evaluate the incremental cost-effectiveness of BrainHQ among HF patients; and 3) examine depressive symptoms, BDNF genotype of the Val66Met polymorphism, and apolipoprotein-ε4 allele as moderators of BrainHQ effect on primary and secondary outcomes. A sample of 264 HF patients will be randomly assigned to: 1) BrainHQ; 2) active control computer-based general cognitive stimulation intervention using crossword puzzles; and 3) usual care control with no specific computerized cognitive intervention. BrainHQ is an easily disseminated, scientifically based intervention designed to improve memory by increasing speed and accuracy of information processing. It is an 8 week, 40-hour program that is individualized to each patient's performance. The active control intervention (computer-based crossword puzzles) will serve as a comparison for computer use and performance of a cognitive activity that may provide general stimulation. The usual care control group will serve as a comparison with patients who are not receiving computer-based cognitive interventions. Data collection will be completed at baseline and at 10 weeks, 4 months and 8 months after baseline. Descriptive statistics, mixed model analyses, and cost-utility analysis using intent-to-treat approach will be computed. This research will provide new knowledge about efficacy of BrainHQ to improve memory and increase serum BDNF levels in HF. If efficacious, the intervention will provide a new therapeutic approach that is easy to disseminate to treat a serious comorbid condition of HF. If cost-effective, insurers will be more likely to provide coverage for the intervention and therefore health systems will be more likely to offer it as a treatment option.