Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA.
Department of Neurology and Plummer Movement Disorders Center, Baylor Scott and White Health, Temple, Texas, USA.
J Am Geriatr Soc. 2022 Feb;70(2):459-469. doi: 10.1111/jgs.17551. Epub 2021 Nov 17.
BACKGROUND: A decline in the ability to perform daily intentions-known as prospective memory-is a key driver of everyday functional impairment in dementia. In the absence of effective pharmacological treatments, there is a need for developing, testing, and optimizing behavioral interventions that can bolster daily prospective memory functioning. We investigated the feasibility and efficacy of smartphone-based strategies for prospective memory in persons with cognitive impairment. METHODS: Fifty-two older adults (74.79 ± 7.20 years) meeting diagnostic criteria for mild cognitive impairment or mild dementia were enrolled in a 4-week randomized controlled trial. Participants were trained to use a digital voice recorder app or a reminder app to off-load prospective memory intentions. Prospective memory was assessed using experimenter-assigned tasks (e.g., call the laboratory on assigned days), standardized questionnaires, and structured interviews. Secondary dependent measures included days of phone and app usage, acceptability ratings, quality of life, and independent activities of daily living. RESULTS: Participant ratings indicated that the intervention was acceptable and feasible. Furthermore, after the four-week intervention, participants reported improvements in daily prospective memory functioning on standardized questionnaires (p < 0.001, η = 0.285) and the structured interview (p < 0.001, d = 1.75). Participants performed relatively well on experimenter-assigned prospective memory tasks (51.7% ± 27.8%), with performance levels favoring the reminder app in Week 1, but reversing to favor the digital recorder app in Week 4 (p = 0.010, η = 0.079). Correlational analyses indicated that greater usage of the digital recorder or reminder app was associated with better prospective memory performance and greater improvements in instrumental activities of daily living (completed by care partners), even when controlling for condition, age, baseline cognitive functioning, and baseline smartphone experience. CONCLUSIONS: Older adults with cognitive disorders can learn smartphone-based memory strategies and doing so benefits prospective memory functioning and independence.
背景:执行日常意图的能力下降,即前瞻性记忆下降,是痴呆患者日常功能障碍的主要原因。由于缺乏有效的药物治疗方法,因此需要开发、测试和优化能够增强日常前瞻性记忆功能的行为干预措施。我们研究了基于智能手机的策略对认知障碍患者前瞻性记忆的可行性和疗效。
方法:52 名年龄在 74.79±7.20 岁的符合轻度认知障碍或轻度痴呆诊断标准的老年人参加了一项为期 4 周的随机对照试验。参与者接受了使用数字语音记录器应用程序或提醒应用程序来卸载前瞻性记忆意图的培训。前瞻性记忆使用实验者分配的任务(例如,在指定日期给实验室打电话)、标准化问卷和结构化访谈进行评估。次要依赖指标包括电话和应用程序的使用天数、可接受性评分、生活质量和独立日常生活活动。
结果:参与者的评分表明干预措施是可接受和可行的。此外,在四周的干预后,参与者在标准化问卷(p<0.001,η=0.285)和结构化访谈(p<0.001,d=1.75)上报告了日常前瞻性记忆功能的改善。参与者在实验者分配的前瞻性记忆任务中表现相对较好(51.7%±27.8%),在第 1 周,提醒应用程序表现较好,但在第 4 周,数字记录器应用程序表现较好(p=0.010,η=0.079)。相关分析表明,数字记录器或提醒应用程序的使用量与前瞻性记忆表现的提高和工具性日常生活活动(由护理人员完成)的改善呈正相关,即使在控制了条件、年龄、基线认知功能和基线智能手机使用经验的情况下也是如此。
结论:认知障碍的老年人可以学习基于智能手机的记忆策略,这样做可以提高前瞻性记忆功能和独立性。
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