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，同时威胁独立性和健康相关的生活质量（HRQoL），并增加医疗保健费用。抑郁症影响24%的老年人在辅助生活（AL）设置，但识别率和治疗率很低，并强调需要替代抑郁症的预防和治疗方法在AL。一个新颖的和有前途的干预是一个计算机化的认知训练计划被称为公路之旅，它已经显示出减少抑郁症症状和疑似临床抑郁症发作的意外益处，这与Beck的认知模型一致。萧条作为一个自我导向的，用户友好的“游戏”，巡回赛克服了共同的态度和资源相关的障碍，阻碍了在AL设置治疗，并持有相当大的承诺，中断潜在的螺旋式下降的抑郁症相关的残疾为100万AL老人。 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症以及抑郁相关合并症的影响。我们将使用一项双臂平行RCT，在300名60岁或60岁以上的成年人中比较Road Tour训练和使用电脑填字游戏的注意力控制训练。我们将积极与15-30家AL机构合作，作为研究合作伙伴，在其研究中心实施培训并协助评估过程。RE-AIM方法将用于制定AL特定的招募和入组方案，对AL工作人员进行研究教育，并监督参与居民及其家庭成员和AL工作人员的计算机化培训。我们的三个具体目标是：（1）确定公路旅行对改善AL认知加工速度的作用;（2）评估公路旅行对减轻AL抑郁症状和疑似临床抑郁发作风险的作用;以及（3）评估公路旅行对抑郁相关的焦虑，疼痛，参与者将在5-6周内接受10小时的计算机化培训，并在第5个月和第11个月接受4小时的强化培训。结果为UFOV（处理速度）（目标1）、CESD-12和PHQ-9（抑郁症状和疑似临床抑郁）（目标2）、SF-36（HRQoL）、BPI（疼痛）和GAD-7（焦虑）（目标3）。将在基线、培训后（6-8周）、26周和52周时通过电话访谈收集数据。每个人都将在使用GEE校正聚类的线性面板分析以及一般线性混合效应模型中作为自己的对照。这项研究是评估在AL环境中使用Road Tour的抑郁相关结果的第一步。随后，我们将重复这项研究，同时收集适当的生物标志物和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.