Cognitive training to reduce incidence of cognitive impairment in older adults

认知训练可降低老年人认知障碍的发生率

• 批准号: 10589134
• 负责人: Jerri Edwards
• 金额: $ 1074.09万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589134
• 关键词: Activities of Daily Living; Address; Administrator; Advertisements; Age-associated memory impairment; Alzheimer' s Disease; Alzheimer' s disease related dementia; Amyloid; Apolipoprotein E; Attenuated; Categories; Certification; Classification; Clinical; Clinical Trials; Clinical assessments; Cognition; Cognitive; Communities; Control Groups; Critiques; Data; Dementia; Diagnosis; Diagnostic; Disease; Drops; Education; Effectiveness; Elderly; Enrollment; Evaluation; Exhibits; Experimental Designs; Failure; Funding; Genotype; Goals; Health; Impaired cognition; Incidence; Institutional Review Boards; Intervention; Knowledge; Life; Location; Marketing; Measurement; Media Campaign; Medical; Memory; Minority Recruitment; Mission; Monitor; Neuropsychological Tests; Neuropsychology; Outcome; Participant; Personal Satisfaction; Phase; Population; Positron-Emission Tomography; Prevalence; Prevention; Prevention trial; Preventive; Protocols documentation; Public Health; Randomized; Reporting; Research; Research Design; Research Personnel; Risk Reduction; Safety; Sampling; Telephone; Testing; Time; Training; Training Programs; Translations; United States National Institutes of Health; Visit; active control; active control group; amyloid pathology; apolipoprotein E-4; arm; bilingualism; clinical diagnosis; clinical practice; cognitive ability; cognitive function; cognitive training; computer game; computerized; cost; dementia risk; disability; effective intervention; effectiveness testing; efficacy evaluation; functional decline; genetic analysis; genetic testing; implementation facilitation; improved; innovation; instrumental activity of daily living; mild cognitive impairment; participant enrollment; prevent; primary endpoint; processing speed; randomized, clinical trials; recruit; screening; social media; theories; treatment arm; trial design; web page; β-amyloid burden

PROJECT SUMMARY Dementia is the most expensive medical condition in the US. There is an urgent need to intervene to curb the increasing prevalence of dementia in our population. Strong preliminary data from more than 18 ran- domized clinical trials demonstrate that computerized, cognitive speed of processing training (SPT) im- proves cognition and transfers to improved instrumental activities of daily living. Recent evidence further indicates that SPT may reduce dementia risk. Analyses of 10-year data from the ACTIVE trial revealed that older adults randomized to SPT were 29% less likely to develop dementia. Moreover, those who com- pleted additional training had a 48% reduced risk of dementia across 10 years. Two limitations of this study were a lack of clinical diagnosis of dementia and use of a no-contact control condition. Thus, an im- portant question is, “Can SPT be successfully implemented to reduce incidence of mild cognitive impair- ment (MCI) or dementia?”. Our primary goal is to test the effectiveness of SPT to reduce incidence of MCI or dementia. The Preventing Alzheimer's with Cognitive Training-PACT field trial advances prior research by rigorously implementing SPT in a large population of cognitively normal older adults and ex- amining the primary endpoint of MCI or dementia clinical diagnoses. Older adults are randomized to SPT or an active control arm of cognitive stimulation (i.e., computer games) and progression to MCI or demen- tia will be clinically assessed after 3 years. We further will explore if SPT effects are moderated by the de- gree of amyloid pathology or apolipoprotein E4 status. To demonstrate feasibility, our investigative team is implementing the study protocol in an R56 phase and successfully enrolled 744 older adults at the time of proposal submission. Three years after enrollment, we will re-assess study participants to identify those exhibiting cognitive decline. Such participants will be provided a thorough medical evaluation to clinically ascertain MCI or dementia diagnosis. Those classified as MCI or dementia will further complete an amy- loid PET scan and genetic testing. This non-pharmacological prevention trial is innovative with a highly efficient experimental design and optimized SPT training protocols including an active control group. The proposed research will determine if SPT successfully reduces incidence of MCI or dementia. This out- come will be significant in that if an intervention can delay the onset of dementia by only one year, there will be ~9.2 million fewer cases of the disease by 2050, substantially reducing cost. Positive results would support use of a relatively inexpensive and easy to apply intervention that could delay or prevent the on- set of Alzheimer’s disease and/or related dementias. Such an outcome would justify further research to identify mechanisms of action. Results will inform clinical practice of effective interventions to attenuate age-related cognitive and functional decline and thereby improve public health.

项目概要 痴呆症是美国最昂贵的医疗疾病。迫切需要进行干预以遏制 我国人口中痴呆症的患病率不断上升。来自超过 18 项研究的强有力的初步数据 大规模的临床试验表明，计算机化的认知处理速度训练（SPT）非常重要。 证明认知和转移可以改善日常生活的工具性活动。最近的证据进一步 表明 SPT 可以降低痴呆风险。对 ACTIVE 试验 10 年数据的分析显示 随机接受 SPT 的老年人患痴呆症的可能性降低了 29%。此外，那些 完成额外培训后 10 年内患痴呆症的风险降低了 48%。这有两个限制 研究缺乏痴呆症的临床诊断和使用非接触控制条件。因此，一个即时 重要的问题是，“SPT能否成功实施以减少轻度认知障碍的发生率？” （MCI）还是痴呆？”。我们的主要目标是测试 SPT 降低发病率的有效性 MCI 或痴呆症。通过认知训练预防阿尔茨海默病 - PACT 现场试验取得先期进展 通过在大量认知正常的老年人和前辈中严格实施 SPT 进行研究 确定 MCI 或痴呆症临床诊断的主要终点。老年人被随机分配接受 SPT 或认知刺激（即电脑游戏）的主动控制臂以及发展为 MCI 或痴呆的 tia 将在 3 年后进行临床评估。我们将进一步探讨 SPT 效应是否可以通过 de- 淀粉样蛋白病理学或载脂蛋白 E4 状态的程度。为了证明可行性，我们的调查团队正在 在 R56 阶段实施研究方案并成功招募了 744 名老年人 提案提交。入组三年后，我们将重新评估研究参与者，以确定那些 表现出认知能力下降。将为此类参与者提供全面的临床医学评估 确定 MCI 或痴呆症的诊断。那些被归类为 MCI 或痴呆症的人将进一步完成艾米- loid PET 扫描和基因检测。这项非药物预防试验具有创新性，具有高度 高效的实验设计和优化的 SPT 训练方案，包括主动对照组。这 拟议的研究将确定 SPT 是否成功降低 MCI 或痴呆症的发病率。这个出- 其意义重大，因为如果一项干预措施可以将痴呆症的发病时间推迟一年，那么 到 2050 年，该疾病的病例数将减少约 920 万例，从而大幅降低成本。积极的结果将 支持使用相对便宜且易于实施的干预措施，可以延迟或阻止 一组阿尔茨海默病和/或相关痴呆症。这样的结果将证明进一步的研究是合理的 确定行动机制。结果将告知临床实践有效的干预措施以减轻 与年龄相关的认知和功能下降，从而改善公众健康。