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，请访问 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1周。尽管样本量很小，但这项试点研究(2014年6月30日完成) 在老年人群(平均年龄80岁)中证明了可行性、高依从性和有效性 干预组与对照组的语言执行功能比较。 基于这些积极的结果，我们建议进行第一阶段的试验，以促进这方面的发展 干预。主要目标(目标1)是检查我们对以下人群认知功能的干预效果 目标群体-80岁及以上患有MCI且社交机会有限的人群。我们的 主要结果是语言、注意力、执行和记忆领域的认知功能 功能和次要结果是有针对性的IADL功能(用药和依从性)和总体 情绪幸福感(情绪，自评健康)。特定于个人的社交互动级别(即平均 试验以外的对话)将在分析中进行监测和控制。探索性目标2是 检查干预是否会导致言语和语言特征随着时间的推移而发生变化 根据我们在这一领域有希望的横断面发现，分析记录的日常对话。 探索性目标3通过评估试验前和试验后的变化来检查潜在的疗效机制。 用MRI和无偏全脑检查抑制海马区、背外侧前额叶皮质、杏仁核和其他ROI 评估(基于体素的形态测量)以及使用扩散张量的结构和功能连通性 成像(DTI)和静息状态功能磁共振(R-fMRI)。总共将招募144名MCI科目，并 在俄勒冈州波特兰和密歇根州底特律随机进行，与Meals on Wheels和Area Agency合作 在两个地点的老龄化(AAA)，创造了一个低收入和种族的大样本框架 少数族裔。一半的参与者将被随机挑选并被邀请参与大脑成像研究。 通过通信技术增加日常社交联系可以提供一个经济实惠的家- 以预防为基础，可以减缓认知衰退，推迟AD的发病，从而降低整体 痴呆症的社会负担。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 国家，并面临患痴呆症和社会孤立的最高风险(不利健康的风险因素 结果)。在这一人群中迫切需要方便用户的可持续预防方法。

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. Despite a small sample size, this pilot study (completed 6/30/2014) demonstrated feasibility, high adherence in an elderly population (mean age 80 years) and efficacy in language-based executive functions among the intervention group in comparison to the control group. 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 primary outcomes are cognitive functions in the domains of language, attention, executive and memory functions, and secondary outcomes are a targeted IADL function (medication use and adherence) and overall emotional well-being (mood, self-rated health). 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 and language 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 inhippocampal, dorsolateral prefrontal cortex, amygdala and other ROIsusing MRI and unbiased whole brain assessment (voxel-based morphometry), and structural and functional connectivity using diffusion tensor imaging (DTI) and resting state functional MRI (R-fMRI). A total of 144 MCI subjects will be recruited and randomized 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. 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 face the highest risk of developing dementia and social isolation (risk factors of adverse health outcomes). User-friendly sustainable prevention approaches are urgently needed in this population.