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

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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.