Compensation Training and Lifestyle Modifications to promote healthy aging in persons at risk for Alzheimer's disease: a digital application supported intervention

阿尔茨海默病和其他疾病(ADRD)的流行现在是一个公共卫生危机。在 缺乏有效的医疗，迫切需要行为干预来预防或拖延 症状出现。同时针对ADRD的多个可修改风险的多领域干预具有 展示了希望，但其他创新方法可以通过利用用户- 需要友好的数字应用程序来支持和加强行为修正。关于使用的培训 补充性辅助工具(如日历和笔记系统)可以提高日常独立性。这些是相同的 可以使用补偿工具来促进生活方式的改变，以支持大脑健康 (例如，锻炼、认知参与、压力管理)通过管理目标设置、行为 监测、跟踪和反馈。目前的项目将测试为期6个月的提供培训的干预 在补充性帮助和生活方式改变方面。一套全面的数字工具，封装在 数字记忆笔记本(DMN)是一种易于使用的交互式应用程序，将用于促进行为 改变和增强参与者的积极性。此外，DMN允许收集实时数据以跟踪 坚持干预。DMN已成功应用于提高以下人员的薪酬水平 有轻度认知障碍的个体。拟议中的工作利用了一个关键的建筑窗口 通过针对由于主观认知担忧(SCC)而出现ADRD风险但仍存在的个人进行恢复 认知正常。我们将在不同种族的老年人中进行随机对照试验(RCT) 患有SCC的成年人将我们的数字应用程序支持的薪酬培训和生活方式调整进行比较 对不使用DMN或向其提供指导的纯教育对照组的干预 如何将教材落实到他们的日常生活中。该项目的具体目标包括：1) 评估干预效果对初级结果(全球认知和日常功能)的影响；次级 结果关注幸福感、认知领域(记忆和执行功能)、日常生活活动 (IADLS)、身体功能、补偿和健康行为；2)评估治疗的特点 应答者；3)评估依从性并确定目标干预的有效组成部分 混合方法；以及4)设计实时使用变化模式的机器学习算法 DMN数据衡量标准，以确定治疗依从性的早期下降和健康状况的变化。这个 正在研究的干预措施是新颖的，因为它应用了补偿培训来支持生活方式的改变 以及使用数字应用程序的日常运作，该应用程序还可以监控对 实时干预。预计该项目将扩大对可能影响 预防性干预的坚持和结果导致可扩展干预的优化 降低适用于不同人群的痴呆症风险。

The prevalence of Alzheimer's Disease and other disorders (ADRDs) is now a public health crisis. In the absence of effective medical treatment, there is a critical need for behavioral interventions to prevent or delay symptom onset. Multidomain interventions simultaneously targeting multiple modifiable risks for ADRD have shown promise, but additional innovative approaches that could be highly accessible by capitalizing on user- friendly digital applications to support and strengthen behavior modification are needed. Training in the use of compensatory aids (e.g., calendars and note taking systems) can improve daily independence. These same compensatory tools can be employed to facilitate the adoption of lifestyle changes that support brain health (e.g., exercise, cognitive engagement, stress management) through management of goal-setting, behavioral monitoring, tracking and feedback. The current project will test a 6-month intervention that provides training in both compensatory aids and lifestyle modification. A comprehensive suite of digital tools encapsulated in the Digital Memory Notebook (DMN), an easy to use, interactive application, will be used to facilitate behavioral change and enhance participant motivation. Further, the DMN allows collection of real-time data to track intervention adherence. The DMN has been successfully applied to improving compensation among individuals with mild cognitive impairment. The proposed work capitalizes on a critical window for building resilience by targeting individuals at risk for ADRD due to a subjective cognitive concern (SCC) but who remain cognitively normal. We will conduct a randomized controlled trial (RCT) among ethnoracially diverse older adults with SCC to compare our digital app supported compensation training and lifestyle modification intervention to an education only control group that will not use the DMN or be provided with guidance on how to implement the educational material into their daily lives. Specific aims of the project include: 1) evaluate intervention efficacy on primary outcomes (global cognition and everyday function); secondary outcomes focus on well-being, cognitive domains (memory and executive function), activities of daily living (IADLs), physical function, compensation, and health behaviors; 2) evaluate characteristics of treatment responders; 3) evaluate adherence and identify the effective components of the target intervention using a mixed-method approach; and 4) design machine learning algorithms that use patterns of change in real-time DMN data metrics to identify incipient declines in treatment adherence and changes in health status. The intervention under study is novel because it applies training in compensation to support lifestyle modifications and everyday functioning using a digital app that also monitors adherence to each component of the intervention in real-time. The project is expected to expand understanding of factors that may impact adherence to and outcomes of a preventative intervention leading to optimization of a scalable intervention to reduce dementia risk applicable to diverse populations.