Smartphone-Based Solutions for Prospective Memory in Mild Cognitive Impairment and Dementia

摘要： 阿尔茨海默病和相关的痴呆症导致日常功能、独立性和 生活质量。在这些情况下，最早的认知变化之一是前瞻记忆障碍， 或者记忆未来意图的能力，比如在给定的时间服药。事先干预 针对前瞻记忆的研究使用了助记策略或认知训练，但这些 这些方法在临床人群中产生了适度的增长。相比之下，我们的第一阶段试点试验表明， 基于智能手机的记忆辅助(提醒应用)可供轻度认知障碍和 轻度痴呆症可以改善主观和客观的前瞻性记忆表现。已经确立了 可行性和可接受性在第一阶段的试点研究中，我们现在将测试有效性、耐用性和普适性 在第二阶段随机对照试验中对不同样本的益处进行比较。我们将招募200名参与者 患有轻度认知障碍或轻度痴呆症的人，其中一半将来自数字弱势背景 (社会经济地位低、农村或历史上代表性不足的群体)。这些人很好地- 由我们的临床集水区捕获。参与者将完成基线评估，然后 随机分配到智能手机提醒应用程序干预或使用纸张的主动控制条件- 基于内存的支持系统。在为期4周的干预期内，参与者将完成患者- 选定和实验者指定的前瞻性记忆评估和接受助推器培训课程 通过干预/控制系统提高自我效能感。我们将在3个月和3个月后评估效果的持久性 6个月的随访期。目前还不清楚是基于智能手机的方法还是基于纸张的方法 在认知障碍和数字化的老年人中更好地支持6个月的前瞻性记忆 劣势。然而，根据试点数据，我们预计提醒应用程序将特别有益 到预期记忆，因为它提供自动提醒，允许护理伙伴“推送”提醒 和事件，它包括使用该应用程序的日常提醒。作为次要目标，我们将同时招收家庭 或朋友研究伙伴收集线人评级，跟踪研究伙伴对参与者的帮助程度，以及 确定改善患者的前瞻性记忆是否改善了研究伙伴的生活质量(例如，通过 减少为自己和护理接受者记住的双重待办事项清单负担)。作为第三个目标， 我们将整合定量和定性数据，以确定智能手机干预的障碍和促进者 在历史上在技术和痴呆症方面代表不足的数字弱势群体中 研究。这项研究将促进对老年人使用技术的理解，告知 与传统的纸质提醒相比，基于智能手机的提醒应用程序是有效和耐用的 前瞻记忆，为个性化认知医学干预提供了基础。

Abstract: Alzheimer’s disease and related dementias lead to marked declines in daily functioning, independence, and quality of life. One of the earliest cognitive changes in these conditions is impairment in prospective memory, or the ability to remember future intentions such as taking medications at a given time. Prior intervention studies that targeted prospective memory used mnemonic strategies or cognitive training, but these approaches resulted in modest gains in clinical populations. By contrast, our Stage I pilot trial indicated that smartphone-based memory aids (reminder apps) can be used by persons with mild cognitive impairment and mild dementia to improve both subjective and objective prospective memory performance. Having established feasibility and acceptability in the Stage I pilot study, we will now test for efficacy, durability, and generalizability of benefits across diverse samples in a Stage II randomized controlled trial. We will recruit 200 participants with mild cognitive impairment or mild dementia, half of whom will be from digitally-disadvantaged backgrounds (low socioeconomic status, rural, or historically underrepresented groups). These populations are well- captured by our clinical catchment areas. Participants will complete baseline assessments and then be randomly assigned to a smartphone reminder app intervention or an active control condition that uses a paper- based memory support system. Across a 4-week intervention period, participants will complete both patient- selected and experimenter-assigned prospective memory assessments and receive booster training sessions to promote self-efficacy with the intervention/control system. We will assess durability of effects at 3-month and 6-month follow-up sessions. It is unknown whether smartphone-based or paper-based approaches will be better at supporting prospective memory across 6 months in older adults with cognitive impairment and digital disadvantages. However, based on pilot data, we anticipate that the reminder app will be especially beneficial to prospective memory because it provides automated reminders, allows care partners to “push” reminders and events, and it includes daily alerts to use the app. As a secondary aim, we will simultaneously enroll family or friend study partners to collect informant ratings, track how much study partners assist the participants, and determine whether improving prospective memory in patients improves quality of life in study partners (e.g., by reducing the double to-do list burden of remembering for themselves and for care recipients). As a third aim, we will integrate quantitative and qualitative data to identify barriers and facilitators to smartphone interventions in digitally-disadvantaged individuals who have historically been underrepresented in technology and dementia research. This research will advance understanding of technology usage in older adults, inform whether smartphone-based reminder apps are effective and durable relative to established paper-based approaches for prospective memory, and provide the foundation for personalized cognitive medicine interventions.