Improving Mood in Assisted Living Using a Cognitive Training Intervention

描述（由申请人提供）：晚年抑郁症是一个巨大的，不断升级的公共卫生问题，经常与其他健康状况相互作用，导致螺旋式残疾，同时威胁到独立性和健康相关的生活质量（HRQoL），并增加医疗保健费用。在辅助生活（AL）环境中，24%的老年人患有抑郁症，但识别率和治疗率很低，这强调了在AL中需要替代抑郁症预防和治疗方法。一种新颖而有前途的干预措施是计算机化的认知训练计划，称为Road Tour，它在减少抑郁症状和疑似临床抑郁症发作方面显示出意外的好处，这与Beck的认知抑郁症模型一致。作为一个自我导向的、用户友好的“游戏”，Road Tour克服了在人工智能环境中阻碍治疗的常见态度和资源相关障碍，并有望中断100万人工智能老年人抑郁症相关残疾的潜在恶性循环。本研究旨在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随机对照试验，比较公路旅行训练和使用电脑填字游戏的注意力控制训练。我们将积极邀请15-30家人工智能机构作为研究合作伙伴，在他们的场所实施培训，并协助评估过程。RE-AIM方法将用于制定特定的AL招募和注册协议，教育AL工作人员有关研究，并监督参与的居民及其家人和AL工作人员的计算机培训。我们的三个具体目标是：(1)建立公路旅行对提高人工智能认知加工速度的影响；(2)评价公路旅行对减轻AL患者抑郁症状和疑似临床抑郁发病风险的影响；(3)评估公路旅行对AL患者焦虑、疼痛和HRQoL的抑郁相关健康结果的影响。参与者将在5-6周内接受10小时的计算机化训练，并在第5个月和第11个月接受4小时的强化训练。结果是UFOV用于处理速度（Aim 1）， csd -12和PHQ-9用于抑郁症状和疑似临床抑郁（Aim 2）， SF-36用于HRQoL， BPI用于疼痛，GAD-7用于焦虑（Aim 3）。数据将在基线、训练后（6-8周）、26周和52周时通过电话访谈收集。每个人都将在线性面板分析中作为自己的控制，使用GEE来纠正聚类，以及一般的线性混合效应模型。本研究是评估在人工智能环境下使用Road Tour的抑郁相关结果的第一步。随后，我们将复制该研究，同时收集适当的生物标志物和功能磁共振成像，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.