Shlomit Rotenberg, Department of Occupational Science and Occupational Therapy, University of Toronto, Canada,
J Prev Alzheimers Dis. 2024;11(6):1534-1548. doi: 10.14283/jpad.2024.166.
Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) can lead to functional and cognitive decline, increasing dementia risk. There is a pressing need for interventions that prevent this deterioration. The ASPIRE (Adult Strategies Put Into Real-world Environments) intervention was developed to improve performance of daily activities.
The primary objective was to determine whether ASPIRE was more effective than a Brain Education control intervention in improving performance and satisfaction with daily life activities that were not specifically trained in the intervention. Secondary objectives were to explore: 1) whether ASPIRE was more effective in improving self-reported health and quality of life, and performance on cognitive tests; and 2) maintenance of change over six-months.
Double-blind, two-armed, parallel randomized controlled trial, with a six-month follow-up period.
Community based, Greater Toronto Area.
Two-hundred sixty-four older adults (aged 70.8 ± 6.6 years) with SCD or MCI, randomized to ASPIRE (n=131) or a Brain Education active control arm (n= 133).
ASPIRE is a 10-week meta-cognitive group intervention focusing on strategy acquisition and application to improve performance of individualized daily activity identified by each participant as important. It involves setting goals, creating tailored plans, and iteratively modifying these plans with support from the group members and facilitator.
Performance of and satisfaction with daily activities was rated on a 10-point Likert scale using the Canadian Occupational Performance Measure (COPM). Secondary outcome were subjective cognition, depression, anxiety, self-efficacy, quality of life, and cognitive tests of memory and executive functions.
Post-intervention, clinically significant improvement of untrained activities (two points or more on the COPM) was found in 32.5% in ASPIRE; and 30.6% in the control arm, with no significant between group differences (Performance: (exp(β ̂) =0.96, z=-0.15, p=.879); Satisfaction: (exp(β ̂) =0.94, z=-0.29, p=.775). The improvements remained stable over six months in both arms. No significant group effects were found on the secondary outcomes, but improvements were found on subjective cognition and self-efficacy in both arms post intervention.
Both a meta-cognitive strategy approach and an adult learning activity resulted in positive changes in subjective cognition, self efficacy, and, to a certain extent, engagement in daily activities.
主观认知衰退（SCD）和轻度认知障碍（MCI）可导致功能和认知能力下降，增加痴呆风险。目前迫切需要预防这种恶化的干预措施。ASPIRE（成人策略应用于现实环境）干预措施旨在提高日常活动的表现。
主要目的是确定 ASPIRE 是否比大脑教育对照干预更能有效提高未在干预中专门训练的日常活动的表现和对日常生活活动的满意度。次要目标是探讨：1）ASPIRE 是否更能有效改善自我报告的健康和生活质量，以及认知测试的表现；2）维持六个月的变化。
双盲、双臂、平行随机对照试验，随访期为六个月。
基于社区的大多伦多地区。
264 名年龄在 70.8±6.6 岁之间的 SCD 或 MCI 老年人，随机分为 ASPIRE 组（n=131）或大脑教育主动对照组（n=133）。
ASPIRE 是一项为期 10 周的元认知小组干预措施，重点是获取和应用策略，以提高每个参与者确定为重要的个性化日常活动的表现。它涉及设定目标、制定量身定制的计划，并在小组成员和促进者的支持下迭代修改这些计划。
使用加拿大职业表现量表（COPM）对日常活动的表现和满意度进行 10 分李克特量表评分。次要结果是主观认知、抑郁、焦虑、自我效能、生活质量以及记忆和执行功能的认知测试。
干预后，ASPIRE 组中有 32.5%的患者在未训练的活动中出现了临床显著改善（COPM 得分为 2 分或以上）；对照组中有 30.6%的患者出现了这种情况，两组之间无显著差异（表现：（exp(β ̂)=0.96，z=-0.15，p=.879）；满意度：（exp(β ̂)=0.94，z=-0.29，p=.775）。在两个手臂中，六个月时的改善都保持稳定。在次要结果中，没有发现组间的显著效果，但在干预后，两个手臂的主观认知和自我效能都有了提高。
元认知策略方法和成人学习活动都能在一定程度上对主观认知、自我效能以及日常生活活动的参与产生积极的变化。
