The Adherence Promotion with Person-centered Technology (APPT) Project: Promoting Adherence to Enhance the Early Detection and Treatment of Cognitive Decline

许多老年人的认知能力可能会严重下降，包括轻度认知障碍、阿尔茨海默病和 AD 相关痴呆症。人口老龄化，加上与年龄相关的认知障碍，包括阿尔茨海默病和其他痴呆症，构成了前所未有的挑战。早期发现认知障碍是一个至关重要的目标。这将使有轻度认知障碍和/或 AD/ADRD 风险的个体能够改变生活方式，以尽量减少认知障碍和获得性认知障碍的风险。然而，认知训练和纵向评估在检测和预防与年龄相关的认知障碍和痴呆方面的巨大潜力不太可能实现，除非个人愿意并且能够长期参与这些方案。对认知评估和培训的依从性往往很差。随着人口老龄化，解决早期发现和预防认知障碍的潜在效益和已实现效益之间的差距是一个紧迫的目标。以人为本的技术促进依从性 (APPT) 项目的目标是通过 1) 加强对认知干预和评估方案的依从性，2) 提高对长期依从性障碍的理解，以及 3) 协助开发用于预测和预防依从性失败的算法，从而促进与年龄相关的认知障碍和痴呆症的早期发现和治疗。该项目旨在调查有或没有认知障碍的老年人样本中的这些问题。两项随机对照试验将测试一种自适应、定制和集成的技术支持系统，该系统预计将在 6 个月内提高对认知协议的遵守程度，超过更简单的日程安排和提醒系统。研究不仅将为遵守支持的好处提供有价值且普遍的见解，而且还将提供影响方案遵守的个体差异因素（例如态度、认知能力、痴呆状况、健康状况、个性、技术熟练程度）。数据将为识别可从额外支持中受益的个人的过程提供信息，并在发生之前预测和预防长期遵守失败的情况。通过提高依从性，这些研究将有助于改善认知障碍的早期发现和治疗，最终将延长老年人的功能独立性，改善他们及其家人的生活，并减少解决与阿尔茨海默病和AD相关痴呆相关的独立性丧失所需的护理和支持资源。此外，通过工具识别可能在严重认知障碍发生之前经历衰退的个体，可以使痴呆症和阿尔茨海默病的干预研究更加有效。结果的影响远远超出了认知障碍的范围。所发现的方法和机制对于以技术为媒介的评估和协议具有广泛的影响，以增强总体健康和福祉。该项目由两项大型随机对照试验和较小的需求评估和可用性研究组成，这些研究将指导其开发和部署。

Many older adults experience declines in cognitive ability that can be substantial, including mild cognitive impairment and Alzheimer’s disease and AD-related dementia. Population aging, coupled with age-related cognitive impairment, including Alzheimer’s disease and other dementias, represents an unprecedented challenge. Early detection of cognitive impairment is a crucial goal. This would allow individuals at risk for mild cognitive impairment and/or AD/ADRD to adopt lifestyle changes to minimize decrements and the risk for acquired cognitive impairment. However, the massive potential of cognitive training and longitudinal assessment to detect and prevent age-related cognitive impairment and dementia are unlikely to be realized unless individuals are willing and able to engage with these protocols for an extended period of time. Adherence to cognitive assessment and training is often poor. Addressing the gap between potential and realized benefits of early detection and prevention of cognitive impairment is an urgent goal as the population ages. The aims of the Adherence Promotion with Person-centered Technology (APPT) project are to promote early detection and treatment of age-related cognitive impairment and dementia by 1) enhancing adherence to cognitive intervention and assessment protocols, 2) improving understanding of barriers to long-term adherence, and 3) assisting in the development of algorithms for predicting and preventing adherence failures. Projects aim to investigate these issues within samples of older adults with and without cognitive impairment. Two randomized controlled trials will test an adaptive, tailored, and integrated technology support system predicted to boost adherence to cognitive protocols, over and above a simpler scheduling and reminder system over 6 months. Studies will provide valuable and generalizable insight into not only the benefits of adherence support, but also the individual difference factors that shape protocol adherence (e.g., attitudes, cognitive ability, dementia status, health status, personality, technology proficiency). Data will inform the process of identifying individuals who would benefit from additional support, and predicting and preventing extended adherence failures before they happen. By increasing adherence, these studies will help improve early detection and treatment of cognitive impairment, which will ultimately extend older adults' functional independence, improving their lives and the lives of their families, and reducing care and support resources needed to address lost independence like that associated with Alzheimer’s disease and AD-related dementia. Further, intervention studies for dementia and Alzheimer’s disease can be made more efficient through tools for identifying individuals likely to experience decline before substantial cognitive impairment has occurred. Results have implications that extend far beyond cognitive impairment; the methods and mechanisms uncovered have broad implications for technology-mediated assessment and protocols to enhance health and well-being in general. The project consists of two large randomized controlled trials and smaller needs assessment and usability studies that will guide their development and deployment.