Computerized Cognitive Training to Improve Cognition in Diabetic Elderly Veterans

描述（由申请人提供）： 项目背景：糖尿病（DM）一直与老年人认知能力下降、轻度认知障碍和痴呆症的风险增加有关。即使是轻微的认知障碍，在非痴呆症的个人显着影响疾病的自我管理。反过来，这与糖尿病患者血糖和血压控制不良有关，这本身会增加痴呆症的风险，引发疾病的强化循环。因此，迫切需要找到干预措施来延迟或预防糖尿病患者的认知损害，这些干预措施可以相对容易和快速地实施，并且成本不高。这在退伍军人事务部尤其如此，因为在我们不断增长的老年退伍军人中，糖尿病和痴呆症的发病率很高。流行病学证据表明，可改变的生活方式因素，包括认知活动，可以预防或延迟认知能力下降的发生。计算机化认知训练（CCT）是一种干预措施，在改善认知功能方面显示出有希望的结果，在非痴呆老年人中更为一致，并从强化训练课程中获得额外益处。到目前为止，CCT的研究通常只检查认知结果，并且只在干预后不久。建议的CCT计划，Cognifit的私人教练，旨在通过针对老年人的认知功能薄弱，使用个人定制的培训计划来提高他们的认知能力。这项研究将首次评估CCT对DM自我管理行为和临床结局以及认知的影响。项目目标：目标1A：在干预后6个月和12个月，确定相对于主动控制游戏计划，CCT是否改善了认知（记忆和执行功能/注意力）、DM相关行为（DM自我管理和药物依从性）和临床结局（血糖和血压控制）。目的1B：通过干预后6个月行为结果（DM自我管理和药物依从性）的改善来证明疗效。目标二：记录CCT对记忆和执行功能/注意力、DM自我管理和药物依从性以及血糖和血压控制的连续变化的影响。目标3：探讨人口学特征（年龄、文化程度、种族、居住地）和健康特征（ADL/IADL、健康素养、抑郁、痴呆家族史、生活方式因素）对干预效果的影响。项目方法：来自James J. Peters（布朗克斯，NY）和安阿伯（MI）VAMC的非痴呆DM老年人将被随机分配至CCT或游戏干预组，并在8周内每周进行3次相应的程序，每次20分钟。干预后4个月，受试者将接受为期1周的强化训练。将在基线、干预后即刻、6个月和12个月对受试者进行评估。在每个时间点，评估将是认知功能、DM自我管理和血压;将抽血测量HbA 1c。VA记录将用于监测药物依从性。纵向混合模型分析将评估干预措施对结果随时间变化的影响。路径分析将评估6个月和12个月时每种干预的认知变化、DM自我管理和临床结局之间的相互关系。

DESCRIPTION (provided by applicant): Project Background: Diabetes mellitus (DM) has consistently been associated with increased risk for cognitive decline, mild cognitive impairment, and dementia in the elderly. Even minor cognitive impairments in nondemented individuals dramatically affect disease self-management. This, in turn, is associated with poor glycemic and blood pressure control in diabetes, which by themselves increase the risk of dementia, provoking a reinforcing cycle of disease. Thus, it is imperative to find interventions to delay or prevent cognitive compromise in diabetic patients, that can be relatively easily and rapidly implemented, and that are not cost prohibitive. This is especially true in the VA, in view of the high incidence of both diabetes and dementia in our growing population of elderly Veterans. Epidemiologic evidence suggests modifiable life-style factors, including cognitive activity, may prevent or delay the onset of cognitive decline. Computerized cognitive training (CCT) is an intervention that has shown promising results in the improvement of cognitive functioning, more consistently in non-demented elderly, with additional benefits from booster training sessions. To date, studies of CCT have typically only examined cognitive outcomes, and only shortly after the intervention. The proposed CCT program, Personal Coach from Cognifit, is designed to improve cognition of elderly persons by targeting their weak cognitive functions, using a personally tailored training plan. The proposed study will provide the first evaluation of the effects of CCT on DM self-management behavior and clinical outcomes, in addition to cognition. Project Objectives: Aim 1A: To determine whether the CCT, relative to the active control games program, improves cognition (memory and executive functions/attention), DM-related behavior (DM self-management and medication adherence), and clinical outcomes (glycemic and blood pressure control), 6 and 12 months after the intervention. Aim 1B: To demonstrate efficacy by improvement in behavioral outcomes (DM self-management and medication adherence) 6 months after the intervention. Aim 2: To document the effects of CCT on the successive changes in memory and executive functions/attention, DM self-management and medication adherence, and glycemic and blood pressure control. Aim 3: To explore the impact of demographic (age, education, ethnicity, site) and health (ADL/IADL, health literacy, depression, dementia family history, lifestyle factors) characteristics, on the intervention effects. Project Methods: Non-demented DM elderly from the James J. Peters (Bronx, NY) and Ann Arbor (MI) VAMCs will be randomized to CCT or games intervention and perform the respective program 3 times/week, for 20 minutes, during eight weeks. Four months after the intervention, subjects will receive a 1-week booster training. Subjects will be assessed at baseline; and immediately, 6 months, and 12 months after the intervention. At each time point, assessments will be cognitive function, DM self-management, and blood pressure; blood will be drawn for HbA1c measurement. VA records will be used to monitor medication adherence. Longitudinal mixed model analyses will assess the effects of the intervention on change in outcomes over time. Path analyses will evaluate the inter-relationships among changes in cognition, DM self- management, and clinical outcomes for each intervention at 6 and 12 months.