Conversational Engagement as a Means to Delay Alzheimer's Disease Onset

描述（由申请人提供）：面对人口老龄化和越来越多的痴呆症患者，关键是要找到有效的手段来延迟痴呆症的发作，更普遍的是要找到减缓认知能力下降过程的方法。心理学研究表明，谈话的任务是高度认知刺激。对话需要注意力、工作记忆、组织和控制思想（执行功能），以及理解他人意图和感受的社会认知。我们研究了基于对话的认知刺激是否会对目前报告社会参与和互动水平相对较低的老年人（AD的潜在高危人群）的一般和特定领域的认知功能产生积极影响。面对面的交流将通过使用个人电脑、网络摄像头和用户友好的简单交互式互联网程序（即，Skype），以使参与者在呆在家里的同时进行社交活动，并以具有成本效益的方式执行研究。为了考虑到可能发生在基于互联网的对话之外的日常对话，我们将使用一种名为MicroDot音频记录器（MAR）的可穿戴语音激活数字记录器，它可以不引人注目地记录参与者花费的时间。这项试点研究的目标包括：目标1。我们将评估75岁及以上人群的社会参与规范水平，以及社会参与的类型和频率以及与参与使用现代技术的试验和拟议预防试验的可能性相关的其他特征。我们将使用这些结果来评估我们随后发现的普遍性。目标2.在目标1的受访者中，我们将从社交参与频率的低端招募80名临床痴呆评定量表（CDR）= 0的受试者和80名CDR = 0.5的受试者。每个CDR组（CDR = 0和0.5）将在实验和对照亚组中代表。试验组将通过Skype与面试官进行为期4周或8周的日常对话。目标3。自动提取口语标记的算法开发（探索性研究）。从这项初步研究中获得的结果将用于假设生成，剂量/持续时间确定，功效计算和控制变量的细化，用于未来的预防研究，这些研究将基于对话的认知刺激作为一种潜在的保护手段，以防止认知下降和社交机会有限的老年人中AD的发病率。 公共卫生相关性：面对人口老龄化和阿尔茨海默病（AD）患者数量的不断增加，制定AD预防策略是公共卫生领域最重要和最紧迫的问题之一。这项拟议中的研究将探讨对话参与作为改善75岁及以上老年人认知功能的一种手段，这些老年人的社会参与机会有限。该项目具有很高的公共卫生意义，因为对这一弱势群体几乎没有有效、低成本的干预措施。

DESCRIPTION (provided by applicant): Faced with an aging population and a growing number of sufferers of dementia, it is critical to find effective means to delay the onset of dementia, and more generally to find ways to slow the process of cognitive decline. Psychological studies suggest that the task of conversation is highly cognitively stimulating. Conversations require attention, working memory and the organization and control of thought (executive functions), as well as social cognition to understand others' intentions and feelings. We examine whether conversation-based cognitive stimulations will have positive effects on general, and domain-specific cognitive functions among the elderly who currently report relatively low levels of social engagement and interaction (the potentially high risk group for getting AD). Face-to-face communication will be conducted through the use of personal computers, webcams, and user-friendly simple interactive Internet programs (i.e., Skype) to allow participants to have social engagement while staying at their home and also for the cost effective execution of the study. In order to take into account daily conversations that may occur outside of the internet-based conversations, we will utilize a wearable, voice activated digital recorder called the MicroDot Audio Recorder (MAR), which unobtrusively records the amount of time spent talking by the participants. The aims of this pilot study include: Aim 1. We will assess the normative levels of social engagement among persons aged 75 and older, and the types and frequencies of social engagement and other characteristics associated with the likelihood of participating in trials using modern technologies and the proposed prevention trial. We will use the results to assess the generalizability of our subsequent findings. Aim 2. Among those interviewed in Aim 1, we will recruit 80 subjects with Clinical Dementia Rating Scale (CDR) = 0 and 80 subjects with CDR = 0.5 from the lower end of the social engagement frequencies. Each CDR group (CDR = 0 and 0.5) will be represented in the experimental and control sub-groups. The trial group will be exposed to either 4 weeks or 8 weeks of daily conversational sessions with interviewers through Skype. Aim 3. Development of algorithms for automatically extracting spoken language markers (an exploratory study). The results obtained from this pilot study will be used for hypothesis generation, dose/duration determination, power calculations, and refinement of control variables for use in future prevention studies that examine conversation-based cognitive stimulation as a potential protective means against cognitive decline and the incidence of AD among the elderly with limited opportunities of social engagement. PUBLIC HEALTH RELEVANCE: Faced with an aging population and a growing number of people with Alzheimer's Disease (AD), developing a preventive strategy against AD is one of the most important and urgent issues in public health. The proposed study examines conversational engagement as a means to improve cognitive functions among the elderly aged 75 and older with limited opportunities of social engagement. The project is of high public health significance in that few effective, low-cost interventions exist for this vulnerable population.