Dodge Hiroko H, Zhu Jian, Mattek Nora, Bowman Molly, Ybarra Oscar, Wild Katherine, Loewenstein David A, Kaye Jeffrey A
Department of Neurology, NIA-Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR ; Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR ; Department of Neurology, Michigan Alzheimer's Disease Center, University of Michigan Health System, Ann Arbor, MI.
Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI.
Alzheimers Dement (N Y). 2015 May;1(1):1-12. doi: 10.1016/j.trci.2015.01.001.
Increasing social interaction could be a promising intervention for improving cognitive function. We examined the feasibility of a randomized controlled trial to assess whether conversation-based cognitive stimulation, through personal computers, webcams, and a user-friendly interactive Internet interface had high adherence and a positive effect on cognitive functions among older adults without dementia.
Daily 30 minute face-to-face communications were conducted over a 6-week trial period in the intervention group. The control group had only a weekly telephone interview. Cognitive status of normal and MCI subjects was operationally defined as Global Clinical Dementia Rating (CDR) = 0 and 0.5, respectively. Age, sex, education, Mini-Mental State Exam and CDR score were balancing factors in randomization. Subjects were recruited using mass-mailing invitations. Pre-post differences in cognitive test scores and loneliness scores were compared between control and intervention groups using linear regression models.
Eighty-three subjects participated (intervention: n=41, control: n=42). Their mean (std) age was 80.5 (6.8) years. Adherence to the protocol was high; there was no dropout and mean % of days completed out of the targeted trial days among the intervention group was 89% (range: 77%-100%). Among the cognitively intact participants, the intervention group improved more than the control group on a semantic fluency test (p=0.003) at the post-trial assessment and a phonemic fluency test (p=0.004) at the 18 week assessments. Among those with MCI, a trend (p=0.04) of improved psychomotor speed was observed in the intervention group.
Daily conversations via user-friendly Internet communication programs demonstrated high adherence. Among cognitively intact, the intervention group showed greater improvement in tests of language-based executive functions. Increasing daily social contacts through communication technologies could offer cost-effective home-based preventions. Further studies with a longer duration of follow-up are required to examine whether the intervention slows cognitive declines and delays the onset of dementia.
增加社交互动可能是改善认知功能的一种有前景的干预措施。我们研究了一项随机对照试验的可行性，以评估通过个人电脑、网络摄像头和用户友好的交互式互联网界面进行的基于对话的认知刺激是否具有高依从性，以及对无痴呆症的老年人认知功能是否有积极影响。
在为期6周的试验期内，干预组每天进行30分钟的面对面交流。对照组仅进行每周一次的电话访谈。正常和轻度认知障碍（MCI）受试者的认知状态在操作上分别定义为总体临床痴呆评定量表（CDR）=0和0.5。年龄、性别、教育程度、简易精神状态检查表和CDR分数是随机分组中的平衡因素。通过大规模邮寄邀请函招募受试者。使用线性回归模型比较对照组和干预组在认知测试分数和孤独感分数上的前后差异。
83名受试者参与（干预组：n = 41，对照组：n = 42）。他们的平均（标准差）年龄为80.5（6.8）岁。对方案的依从性很高；没有受试者退出，干预组完成的天数占目标试验天数的平均百分比为89%（范围：77%-100%）。在认知功能完好的参与者中，干预组在试验后评估的语义流畅性测试（p = 0.003）和18周评估的音素流畅性测试（p = 0.004）中比对照组改善更多。在患有MCI的受试者中，干预组观察到心理运动速度改善的趋势（p = 0.04）。
通过用户友好的互联网通信程序进行的日常对话显示出高依从性。在认知功能完好的人群中，干预组在基于语言的执行功能测试中显示出更大的改善。通过通信技术增加日常社交接触可以提供具有成本效益的居家预防措施。需要进行更长随访期的进一步研究，以检查该干预措施是否能减缓认知衰退并延迟痴呆症的发病。
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