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

描述(申请人提供)：面对人口老龄化和越来越多的痴呆症患者，关键是找到有效的方法来延缓痴呆症的发病，更广泛地说，找到方法来减缓认知能力下降的过程。心理学研究表明，谈话的任务对认知有很强的刺激作用。对话需要注意力、工作记忆、思维的组织和控制(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老年人的一般和特定领域的认知功能产生积极影响，这些老年人目前报告的社交参与和互动水平相对较低(患AD的潜在高危群体)。将通过使用个人电脑、网络摄像头和用户友好的简单交互互联网程序(即Skype)进行面对面的交流，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进行研究。为了考虑到在基于互联网的对话之外可能发生的日常对话，我们将使用一种名为MicroDot Audio Recorder(MAR)的可穿戴、语音激活的数字录音机，它可以不引人注目地记录参与者花费的交谈时间。这项试点研究的目的包括：目标1.我们将评估75岁及以上老年人的社会参与标准水平，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的预防试验的可能性有关的其他特征。我们将使用这些结果来评估我们后续发现的概括性。目的2.在目标1的访谈对象中，我们将从社会参与频率的低端招募80名临床痴呆评定量表(CDR)=0和80名CDR=0.5的受试者。每个CDR组(CDR=0和0.5)将在试验组和控制子组中代表。试验组将通过Skype与面试官进行为期4周或8周的每日对话。目的3.口语标记自动提取算法的发展(探索性研究)。这项先导性研究的结果将用于假设生成、剂量/持续时间的确定、能量计算和控制变量的改进，以便在未来的预防研究中使用，该研究考察基于对话的认知刺激作为潜在的保护手段，防止认知能力下降和社交机会有限的老年人中AD的发生。 公共卫生意义：面对人口老龄化和越来越多的阿尔茨海默病(AD)患者，制定预防AD的策略是公共卫生中最重要和最紧迫的问题之一。这项拟议的研究考察了会话参与作为一种手段来改善75岁及以上社交参与机会有限的老年人的认知功能。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.