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)一直与老年人认知功能减退、轻度认知障碍和痴呆症的风险增加有关。即使是非痴呆者的轻微认知障碍，也会极大地影响疾病自我管理。这反过来又与糖尿病患者血糖和血压控制不佳有关，这本身就增加了患痴呆症的风险，引发了一个不断加强的疾病循环。因此，必须找到干预措施来延迟或防止糖尿病患者的认知妥协，这些干预措施可以相对容易和快速地实施，并且不会造成成本过高。考虑到我们日益增长的老年退伍军人人口中糖尿病和痴呆症的高发病率，退伍军人中的情况尤其如此。流行病学证据表明，可改变的生活方式因素，包括认知活动，可能会防止或推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，在非痴呆症老年人中表现得更一致，并从助推器训练课程中获得额外好处。到目前为止，对CCT的研究通常只检查认知结果，而且只是在干预后不久。拟议的CCT计划，来自Cognifit的个人教练，旨在通过针对老年人较弱的认知功能，使用个人定制的培训计划来改善他们的认知。这项拟议的研究将首次评估CCT对DM自我管理行为和临床结果的影响，以及认知方面的影响。项目目标：目标1A：确定与积极控制性游戏计划相比，CCT是否在干预后6个月和12个月改善认知(记忆和执行功能/注意力)、糖尿病相关行为(糖尿病自我管理和服药依从性)以及临床结果(血糖和血压控制)。目的1B：通过干预6个月后行为结局(DM自我管理和服药依从性)的改善来证明疗效。目的：研究CCT对糖尿病患者记忆和执行功能/注意力、糖尿病自我管理和服药依从性、血糖和血压控制的影响。目的：探讨人口学特征(年龄、教育程度、民族、地点)和健康特征(日常生活能力/日常生活能力、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：来自纽约布朗克斯的James J.Peter和Ann Arbor(MI)VAMC的非痴呆型DM老年人将随机接受CCT或游戏干预，并在8周内每周执行各自的计划3次，每次20分钟。干预四个月后，受试者将接受为期一周的助推器训练。受试者将在基线时、干预后立即、6个月和12个月进行评估。在每个时间点，将评估认知功能、糖尿病自我管理和血压；将抽取血液进行糖化血红蛋白测量。退伍军人管理局的记录将用于监测服药依从性。纵向混合模型分析将评估干预对结果随时间变化的影响。路径分析将评估认知变化、糖尿病自我管理和每个干预措施在6个月和12个月的临床结果之间的相互关系。

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.