Yeo Pei Shi, Nguyen Tu Ngoc, Ng Mary Pei Ern, Choo Robin Wai Munn, Yap Philip Lin Kiat, Ng Tze Pin, Wee Shiou Liang
Geriatric Education and Research Institute, Singapore, Singapore.
Khoo Teck Puat Hospital, Singapore, Singapore.
JMIR Form Res. 2021 Apr 27;5(4):e25462. doi: 10.2196/25462.
Cognitive training can improve cognition in healthy older adults.
The objectives are to evaluate the implementation of community-based computerized cognitive training (CCT) and its effectiveness on cognition, gait, and balance in healthy older adults.
A single-blind randomized controlled trial with baseline and follow-up assessments was conducted at two community centers in Singapore. Healthy community-dwelling adults aged 55 years and older participated in a 10-week CCT program with 2-hour instructor-led group classes twice a week. Participants used a mobile app to play games targeting attention, memory, decision making, visuospatial abilities, and cognitive flexibility. Implementation was assessed at the participant, provider, and community level (eg, reach, implementation, and facilitators and barriers). Effectiveness measures were the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Color Trails Test 2 (CTT-2), Berg Balance Scale, and GAITRite walkway measures (single and dual task gait speed, dual task cost, and single and dual task gait variability index [GVI]).
A total of 94 healthy community-dwelling adults participated in the CCT program (mean age 68.8 [SD 6.3] years). Implementation measures revealed high reach (125/155, 80.6%) and moderate adherence but poor penetration of sedentary older adults (43/125, 34.4%). The effectiveness data were based on intention-to-treat (ITT) and per-protocol (PP) analysis. In the ITT analysis, single task GVI increased (b=2.32, P=.02, 95% CI [0.30 to 4.35]) and RBANS list recognition subtest deteriorated (b=-0.57, P=.01, 95% CI [-1.00 to -0.14]) in both groups. In the PP analysis, time taken to complete CTT-2 (b=-13.5, P=.01, 95% CI [-23.95 to -3.14]; Cohen d effect size = 0.285) was faster in the intervention group. Single task gait speed was not statistically significantly maintained in the intervention group (b=5.38, P=.06, 95% CI [-0.30 to 11.36]) and declined in the control group (Cohen d effect size = 0.414). PP analyses also showed interaction terms for RBANS list recall subtest (b=-0.36, P=.08, 95% CI [-0.75 to 0.04]) and visuospatial domain (b=0.46, P=.08, 95% CI [-0.05 to 0.96]) that were not statistically significant.
CCT can be implemented in community settings to improve attention and executive function among healthy older adults. Findings help to identify suitable healthy aging programs that can be implemented on a larger scale within communities.
ClinicalTrials.gov NCT04439591; https://clinicaltrials.gov/ct2/show/NCT04439591.
认知训练可改善健康老年人的认知能力。
评估基于社区的计算机化认知训练（CCT）的实施情况及其对健康老年人认知、步态和平衡的影响。
在新加坡的两个社区中心进行了一项单盲随机对照试验，包括基线和随访评估。年龄在55岁及以上的健康社区居民参加了为期10周的CCT项目，每周有两次由教师指导的2小时小组课程。参与者使用一款移动应用程序玩针对注意力、记忆力、决策能力、视觉空间能力和认知灵活性的游戏。在参与者、提供者和社区层面（如覆盖面、实施情况以及促进因素和障碍）对实施情况进行评估。有效性指标包括用于评估神经心理状态的可重复性成套测验（RBANS）、色线试验2（CTT - 2）、伯格平衡量表以及GAITRite步道测量指标（单任务和双任务步态速度、双任务成本以及单任务和双任务步态变异性指数[GVI]）。
共有94名健康社区居民参加了CCT项目（平均年龄68.8[标准差6.3]岁）。实施情况评估显示覆盖面高（125/155，80.6%）且依从性中等，但久坐不动的老年人参与率低（43/125，34.4%）。有效性数据基于意向性分析（ITT）和符合方案分析（PP）。在ITT分析中，两组的单任务GVI均增加（b = 2.32，P = 0.02，95%置信区间[0.30至4.35]），且RBANS列表识别子测验恶化（b = -0.57，P = 0.01，95%置信区间[-1.00至-0.14]）。在PP分析中，干预组完成CTT - 2的时间更快（b = -13.5，P = 0.01，95%置信区间[-23.95至-3.14]；科恩d效应量 = 0.285）。干预组的单任务步态速度未在统计学上显著保持（b = 5.38，P = 0.06，95%置信区间[-0.30至11.36]），而对照组下降（科恩d效应量 = 0.414）。PP分析还显示RBANS列表回忆子测验（b = -0.36，P = 0.08，95%置信区间[-0.75至0.04]）和视觉空间领域（b = 0.46，P = 0.08，95%置信区间[-0.05至0.96]）的交互项无统计学显著性。
CCT可在社区环境中实施，以改善健康老年人的注意力和执行功能。研究结果有助于确定可在社区内大规模实施的合适的健康老龄化项目。
ClinicalTrials.gov NCT04439591；https://clinicaltrials.gov/ct2/show/NCT04439591。
