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

项目总结/摘要 心力衰竭（HF）和轻度认知障碍（MCI）在美国的老年人中很普遍。 HF患者发生MCI的可能性是非HF患者的两倍。HF中的认知障碍与 照顾自己的能力显著下降，12个月死亡率更高。少数 的认知干预已初步证明在改善HF患者的认知功能方面的疗效。然而，在这方面， 这项工作有一些主要的局限性：1）缺乏对已经有认知障碍的患者的关注 痴呆症的风险较高; 2）专注于单一成分干预; 3）缺乏对 反应性变量，包括遗传生物标志物;和4）缺乏长期随访。郑美妍医生， RN博士建议通过进行随机对照试点试验来估计 基于虚拟现实的认知恢复（Vita）与计算机化认知恢复相结合 在172例老年HF患者中，相对于单独的每种干预和标准治疗的培训干预（Com） 关于MCI该项目的具体目标是评估Vita和Com干预措施的效果 单独和组合，以改善：1）注意力和记忆力（目标1）; 2）HF自我护理，工具 日常生活活动和健康相关生活质量（目标2）; 3）无痴呆生存期（目标3）超过1 年此外，她将探讨可能影响干预效果的调节因素（即，基线 认知功能、抑郁症状、HF严重程度以及载脂蛋白E ε4和BDNF Met等位基因的存在）。 Jung博士提出职业发展/培训活动，以发展诊断MCI的专业知识 从正常认知和痴呆中恢复过来她的多学科指导团队包括 在神经病学和阿尔茨海默病及相关痴呆症领域非常成功的领导者（LG Apostolova，医学博士，理学硕士，主要导师和痴呆症专家），心血管护理和HF（SJ Pressler，博士， HF认知和健康相关生活质量专家; DK Moser，PhD，HF自我护理和衰老专家）， 心脏病学与HF专业（I Gradus-Pizlo，MD），生物统计学与临床试验专业（S Gao，PhD），以及 以人为本的技术（RJ霍尔顿，博士）。Jung博士将通过导师与学员的互动接受培训， 小组和个人设置，参与教学课程，研讨会和专业会议，以及 开展拟议的研究。计划中的培训活动将支持荣格博士：1）开发 诊断认知障碍的专业知识; 2）测试Vita+Com干预在老年人中的初步疗效 患有HF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 团队和导师的未来几代研究人员;和4）成为一个成功的R 01资助的独立 调查员总之，荣格博士将开发和测试有效的干预措施，以改善认知功能 老年心衰和轻度认知功能障碍患者中。有效的认知干预最终将有助于保持 患者的功能独立性和提高相关生活质量。

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.