Virtual Reality and Computerized Cognitive Intervention for Mild Cognitive Impairment in Heart Failure

项目摘要/摘要 心力衰竭(HF)和轻度认知障碍(MCI)在美国老年人中很普遍。 患有心力衰竭的患者患MCI的可能性是没有心力衰竭的患者的两倍。心力衰竭患者的认知功能障碍与 照顾自己的能力显著下降，12个月死亡率较高。一小部分 认知干预在改善心力衰竭患者认知功能方面已显示出初步疗效。然而， 这项工作受到一些主要限制：1)缺乏对已经有认知障碍的患者的关注 和更高的痴呆症风险；2)专注于单一成分的干预；3)缺乏对 包括遗传生物标志物在内的反应性变量；以及4)缺乏长期随访。郑美妍博士， RN博士建议通过进行一项随机对照试验来估计 基于虚拟现实的认知修复(VITA)与计算机化认知功能相结合的初步疗效 172名老年心力衰竭患者的培训干预(COM)与每项干预的单独和护理标准 和MCI一起。该项目的具体目标是评估VITA和COM干预措施的效果 单独或联合提高：1)注意力和记忆力(目标1)；2)高频自理，工具性 日常生活活动和与健康有关的生活质量(目标2)；和3)无痴呆症生存(目标3)超过1 年。此外，她还将探讨可能影响干预效果的缓和因素(即基线 认知功能、抑郁症状、心力衰竭严重程度、载脂蛋白Eε4和BDNFMet等位基因的存在)。 Jung博士建议开展职业发展/培训活动，以发展诊断MCI的专业知识 在K76颁奖典礼上从正常认知和痴呆症中脱颖而出。她的多学科指导团队包括 神经学、阿尔茨海默病和相关痴呆症领域的非常成功的领导者(LG Apostolova，MD，MSc，初级导师和痴呆症专家)，心血管护理和心力衰竭(SJ Pressler，PhD， 心力衰竭认知和健康相关生活质量专家；DK Moser博士，心力衰竭自我护理和老龄化专家)， 心脏病学专业为心衰(医学博士)，生物统计学专业为临床试验专业(S，博士)，以及 以人为中心的技术(RJ Holden，博士)。Jung博士将通过导师-学员互动接受培训 小组和个人环境，参与授课课程、研讨会和专业会议，以及 开展拟议的研究研究。计划的培训活动将支持Jung博士：1)发展 诊断认知障碍的专业知识；2)在老年人中测试Vita Com干预的初步效果 患有心力衰竭和MCI的成年人；3)发展领导技能，成为进行多学科研究的领导者 团队和未来几代研究人员的导师；以及4)成为成功的R01资助的独立公司 调查员。总而言之，荣格博士将开发和测试有效的干预措施来改善认知功能 在患有心力衰竭和MCI的老年人中。有效的认知干预最终将有助于保留 患者功能独立，提高相关生活质量。

PROJECT SUMMARY/ABSTRACT Heart failure (HF) and mild cognitive impairment (MCI) are prevalent among older adults in the U.S. Patients with HF are twice as likely to have MCI than people without HF. Cognitive impairment in HF is associated with significant decline in one’s ability to take care of one’s self and higher 12-month mortality. A small number of cognitive interventions have demonstrated preliminary efficacy in improving cognitive function in HF. However, this work suffers from some major limitations: 1) lack of focus on patients who already have cognitive impairments and at higher risk of dementia; 2) focus on single-component interventions; 3) lack of evaluation of responsiveness variables including genetic biomarkers; and 4) lack of long-term follow-up. Dr. Miyeon Jung, PhD, RN proposes to address this gap by conducting a randomized controlled pilot trial to estimate the preliminary efficacy of a virtual reality-based cognitive restoration (Vita) combined with a computerized cognitive training intervention (Com) relative to each intervention alone and standard of care among 172 older HF patients with MCI. The Specific aims of the project are to estimate the effects of the Vita and Com interventions individually and in combination to improve: 1) attention and memory (Aim 1); 2) HF self-care, instrumental activities of daily living, and health-related quality of life (Aim 2); and 3) dementia free survival (Aim 3) over 1 year. In addition, she will explore moderating factors that may influence intervention efficacy (i.e., baseline cognitive function, depressive symptoms, HF severity, and presence of apolipoprotein E ε4 and BDNF Met allele). Dr. Jung proposes career development/training activities to develop expertise in diagnosing MCI from normal cognition and dementia during this K76 award. Her multidisciplinary mentoring team consists of highly successful leaders in the fields of neurology and Alzheimer’s disease and related dementias (LG Apostolova, MD, MSc, primary mentor and dementia expert), cardiovascular nursing and HF (SJ Pressler, PhD, expert in cognition and health-related quality of life in HF; DK Moser, PhD, expert in HF self-care and aging), cardiology with HF specialty (I Gradus-Pizlo, MD), biostatistics with expertise in clinical trials (S Gao, PhD), and human-centered technology (RJ Holden, PhD). Dr. Jung will receive training via mentor-mentee interactions in group and individual settings, engaging in didactic coursework, workshops, and professional meetings, and conduct of the proposed research study. The planned training activities will support Dr. Jung to: 1) develop expertise in diagnosing cognitive impairment; 2) test preliminary efficacy of Vita+Com intervention among older adults with HF and MCI; 3) develop leadership skills to become a leader who runs multidisciplinary research teams and mentors future generations of researchers; and 4) become a successful R01-funded independent investigator. In summary, Dr. Jung will develop and test efficacious interventions to improve cognitive function among older adults with HF and MCI. Efficacious cognitive interventions will ultimately contribute to retaining the patients’ functional independence and promoting related quality of life.