Kwan Rick Yiu Cho, Law Queenie Pui Sze, Tsang Jenny Tsun Yee, Lam Siu Hin, Wang Kam To, Sin Olive Shuk Kan, Cheung Daphne Sze Ki
School of Nursing, Tung Wah College, Hong Kong SAR, China (Hong Kong).
School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong SAR, China (Hong Kong).
JMIR Rehabil Assist Technol. 2024 Dec 13;11:e60155. doi: 10.2196/60155.
Cognitive frailty is known to be associated with both nutrition and cognitive training. However, effective treatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking.
This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitive frailty, focusing on Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition.
This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materials at home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomes included Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately.
A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=-0.606, P=.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=-0.728, P=.009), cognitive function (r=-0.752, P=.007), physical frailty (r=-0.668, P=.02), and walking speed (r=-0.587, P=.03), but no such improvements were seen in the control group.
GAHOCON is feasible in engaging older adults with cognitive frailty to regularly participate in the intervention. Preliminary evidence suggests that it can retain Mediterranean diet knowledge following nutritional education, improve adherence to the Mediterranean diet, and enhance global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects.
ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930.
认知衰弱已知与营养和认知训练均相关。然而，缺乏能让认知衰弱的老年人同时参与地中海饮食和认知训练的有效治疗方法。
本研究旨在探讨居家认知营养游戏化干预（GAHOCON）对认知衰弱老年人的可行性及初步效果，重点关注地中海饮食知识、对地中海饮食的依从性、认知功能、身体衰弱、握力、步行速度、记忆力和身体成分。
本研究采用2中心、评估者盲法、2平行组、非劣效性随机对照试验设计。符合条件的参与者为年龄在60岁及以上、患有认知衰弱且对地中海饮食依从性差的社区居住成年人。参与者按1:1比例随机分配至干预组或对照组。干预组参与者接受4周的中心培训（健康教育），随后进行8周的居家培训（GAHOCON）。对照组参与者仅接受4周的中心培训以及8周的在家自行复习健康教育材料。在干预期间，测量参与者在GAHOCON上花费的时间以及他们每周完成的难度水平，作为可行性指标。结局指标包括地中海饮食知识、对地中海饮食的依从性、认知功能、身体衰弱、握力、步行速度、记忆力和身体成分。在基线（T0）和干预后1周（T1）收集数据。采用Wilcoxon符号秩检验分别检验每组中结局变量的组内效应。
共招募了25名参与者，其中13名分配至干预组，12名分配至对照组。GAHOCON训练累计花费的中位数分钟数从117分钟增加到926分钟。游戏1完成的难度中位数水平从14级增加到20级，而游戏2从2级增加到24级。干预完成后，干预组的地中海饮食知识得以保留，而对照组则显著下降（r = -0.606，P = 0.04）。干预组在地中海饮食依从性（r = -0.728，P = 0.009）、认知功能（r = -0.752，P = 0.007）、身体衰弱（r = -0.668，P = 0.02）和步行速度（r = -0.587，P = 0.03）方面有显著改善，而对照组未观察到此类改善。
GAHOCON对于让认知衰弱的老年人定期参与干预是可行的。初步证据表明，它能在营养教育后保留地中海饮食知识，提高对地中海饮食的依从性，并增强整体认知功能、身体衰弱状况和步行速度。然而，游戏1后期的难度可能过高。未来研究应调整游戏1的难度水平。此外，需要更大样本量和更长随访期的试验来证实其效果。
ClinicalTrials.gov NCT05207930；https://clinicaltrials.gov/ct2/show/NCT05207930
