Improving Mood in Assisted Living Using a Cognitive Training Intervention

描述(申请人提供)：晚年抑郁症是一个巨大的、不断升级的公共健康问题，经常与其他健康状况相互作用，导致螺旋式残疾，同时威胁独立和与健康相关的生活质量，并增加医疗保健成本。在辅助生活(AL)环境中，24%的老年人患有抑郁症，但识别率和治疗率都很低，这突显了在AL中需要替代的抑郁症预防和治疗方法。一种新颖而有前景的干预措施是一种名为Road Tour的计算机化认知训练程序，该程序显示出偶然的好处，可以减少抑郁症状和疑似临床抑郁症的发作，与贝克的认知抑郁症模型一致。作为一个自我指导的、用户友好的“游戏”，公路之旅克服了阻碍AL治疗的常见态度和资源相关障碍，并有望阻止100万AL老年人抑郁症相关残疾的潜在螺旋式下降。本研究的目的是评估公路旅行对爱荷华州AL居民的处理速度、抑郁症状和疑似临床抑郁以及抑郁相关合并症的影响。我们将在300名60岁或以上的成年人中使用双臂平行RCT将公路旅行训练与使用计算机纵横字谜的注意力控制训练进行比较。我们将积极邀请15-30个AL机构作为研究伙伴，在其现场实施培训并协助评估过程。Re-AIM方法将用于制定AL特定的招募和登记方案，教育AL工作人员了解这项研究，并监督参与培训的住院医生及其家人和AL工作人员的计算机化培训。我们的三个具体目标是：(1)确定公路旅游对提高AL认知加工速度的效果；(2)评估公路旅游对缓解AL的抑郁症状和疑似临床抑郁症的风险的效果；以及(3)评估公路旅游对AL患者焦虑、疼痛和高分辨生活质量(HRQL)的抑郁相关健康结局的影响。参与者将在5-6周内接受10小时的计算机化训练，并在5个月和11个月接受4小时的强化训练。结果是关于处理速度的UFOV(目标1)，用于抑郁症状和疑似临床抑郁的CESD-12和PHQ-9(目标2)，以及用于HRQL的SF-36，用于疼痛的BPI和用于焦虑的GAD-7(目标3)。将在基线、培训后(6-8周)、26周和52周通过电话访谈收集数据。在线性面板分析中，每个人都将作为他们自己的对照，这些分析使用GEE来修正聚类，以及一般的线性混合效应模型。这项研究是评估在AL环境下使用公路旅行与抑郁相关的结果的第一步。随后，我们将重复这项研究，同时收集适当的生物标记物和FMRI，以确定确切的作用机制。

DESCRIPTION (provided by applicant): Late-life depression is a large, escalating public health problem that often interacts with other health conditions and leads to spiraling disability that simultaneously threatens independence and health-related quality of life (HRQoL), and increases health care costs. Depression affects 24% of older adults in assisted living (AL) settings, but rates of recognition and treatment are low and underscore the need for alternative depression prevention and treatment methods in AL. A novel and promising intervention is a computerized cognitive training program known as Road Tour, which has shown serendipitous benefits for reducing depression symptoms and the onset of suspected clinical depression consistent with Beck's model of cognitive depression. As a self-directed, user-friendly "game", Road Tour overcomes common attitudinal and resource-related barriers that impede treatment in AL settings, and holds considerable promise for interrupting the potential downward spiral of depression-related disability for 1 million AL elders. The purpose of this study is to evaluate th effect of Road Tour on processing speed, depression symptoms and suspected clinical depression, and depression-related comorbidities among AL residents in Iowa. We will use a two-arm, parallel, RCT comparing Road Tour training to attention control training using computerized crossword puzzles among 300 adults 60 years old or older. We will actively engage 15-30 AL facilities as study partners who implement the training at their sites and assist with the evaluation process. RE-AIM methods will be used to develop AL-specific recruitment and enrollment protocols, educate AL staff about the study, and oversee computerized training by participating residents, as well as their family members and AL staff. Our three specific aims are to: (1) establish the effect of Road Tour on improving cognitive processing speed in AL; (2) evaluate the effect of Road Tour on reducing depressive symptoms and the risk of onset of suspected clinical depression in AL; and, (3) evaluate the effect of Road Tour on the depression-related health outcomes of anxiety, pain, and HRQoL in AL. Participants will receive 10 hours of computerized training over 5-6 weeks, and 4 hours of booster training at months 5 and 11. Outcomes are the UFOV for speed of processing (Aim 1), the CESD-12 and PHQ-9 for depressive symptoms and suspected clinical depression (Aim 2), and the SF-36 for HRQoL, the BPI for pain, and GAD-7 for anxiety (Aim 3). Data will be collected using telephone interviews at baseline, post-training (6-8 weeks), and at 26- weeks and 52-weeks. Each person will serve as their own control in linear panel analyses that use GEE to correct for clustering, as well as general linear mixed effects models. This study is the first step in evaluating depression-related outcomes of using Road Tour in AL settings. Subsequently, we will replicate the study while collecting the appropriate biomarkers and fMRIs to identify the precise mechanisms of action.