Wolfson Centre for Age-Related Diseases, King's College London, London, UK.
Department of Psychology, University of Western Ontario, Ontario, Canada.
J Am Med Dir Assoc. 2015 Nov 1;16(11):990-7. doi: 10.1016/j.jamda.2015.06.014.
Cognitive training (CT) offers a potential approach for dementia prevention and maintenance of cognitive function in older adults. Online delivery provides a cost-effective means of implementing CT compared with in-person interventions, with the potential of providing an effective public health intervention for risk reduction.
A double-blind 6-month online randomized controlled trial in adults older than 50 randomized to General CT, Reasoning CT, or control. The primary outcome was instrumental activities of daily living (IADL) in adults older than 60. Secondary outcomes were reasoning, verbal short-term memory, spatial working memory, verbal learning (VL), and digit vigilance in adults older than 50. Secondary analyses were performed with a group defined as showing age-associated impairment in reasoning according to baseline scores in this domain.
A total of 2912 adults older than 60 (6742 > 50) participated. General and reasoning packages conferred benefit to IADL (P = .008, P = .011), reasoning (P < 0.0001, P < .0001), and VL (P = .007, P = .008) at 6 months. Benefit in reasoning was evident from 6 weeks. Other benefits developed over 6 months. Analysis of participants with age-associated impairment also showed the same pattern of benefit. A clear dose-response effect was seen.
Online CT confers significant benefit to cognition and function in older adults, with benefit favoring the Reasoning package. Scale of benefit is comparable with in-person training, indicating its potential as a public health intervention. Impact on the group with age-associated impairment indicates a particular sensitivity to this at-risk group, which merits further investigation.
认知训练（CT）为预防痴呆症和维持老年人的认知功能提供了一种潜在的方法。与面对面干预相比，在线交付提供了一种具有成本效益的实施 CT 的方法，具有为降低风险提供有效公共卫生干预的潜力。
一项针对 50 岁以上成年人的为期 6 个月的双盲在线随机对照试验，随机分为常规 CT、推理 CT 或对照组。主要结局是 60 岁以上成年人的工具性日常生活活动（IADL）。次要结局是推理、言语短期记忆、空间工作记忆、言语学习（VL）和数字警戒在 50 岁以上成年人。使用根据该领域的基线分数定义为表现出推理年龄相关性损伤的组进行了二次分析。
共有 2912 名 60 岁以上的成年人（6742 名> 50 岁）参加了该研究。一般和推理包对 IADL（P =.008，P =.011）、推理（P < 0.0001，P <.0001）和 VL（P =.007，P =.008）有获益在 6 个月时。推理方面的益处从 6 周开始显现。其他益处则在 6 个月内发展。对有年龄相关性损伤的参与者的分析也显示出相同的获益模式。清楚地显示了剂量反应效应。
在线 CT 可显著改善老年人的认知和功能，推理包获益更大。获益规模与面对面培训相当，表明其具有作为公共卫生干预的潜力。对与年龄相关损伤的组的影响表明，该组对此类高危人群特别敏感，值得进一步研究。
