interventions Flashcards
Factors to consider in intervention studies
- Group being tested (e.g., healthy older adults, MCI, mild/moderate dementia)
- Outcome measures (e.g., IADL, QOL, cognition)
- Control condition (what is the intervention being compared to?)
- Timeline of intervention & when outcomes are measured
- Generalizability
cognitive interventions
(1) cognitive training,
(2) cognitive rehabilitation, and
(3) cognitive stimulation
cognitive outcome measures
- Cognitive performance - e.g., on memory tests
- Instrumental activities of daily living (IADL)
ACTIVE
Advanced Cognitive Training for Independent and Vital Elderly
what did the active trial test?
memory, reasoning, and visual speed of processing in maintaining cognitive health
what was the MMSE score on the participants
> 22 (dementia cutoff is 24)
ACTIVE trial: major findings
- Immediate improvement in the trained cognitive ability
- Significant improvements in IADL
- less QOL decline
- driving effects
- reduced traffic accidents
overall conclusion ACTIVE
“Results support the effectiveness of cognitive intervention in maintaining cognitive health over the long-term and indicate modest but detectable far transfer to instrumental activities of daily living, health-related quality of life, and driving outcomes.”
Challenges With Studies Of Physical Activity
- definitions vary
findings physical activity studies
reduced risk of cognitive decline & dementia
- mixed results aerobic vs resistance training
WHO recommendations physical activity
For adults aged 65+, the WHO recommends:
* 150 minutes or more of moderate- intensity aerobic physical activity/week, OR
* 75 minutes or more of vigorous- intensity aerobic physical activity/week, OR
a combo
Diet and cognition: what are the findings?
associated with larger brain volumes and better cognitive performance
- Memory (delayed recognition, long-term and working memory), executive function, and visual constructs
MeDi, fish, meat
higher brain activation in MeDi on scans
Diet and cognition: WHO Recommendations
- recommends a Mediterranean-like diet
- does not recommend taking supplements
social factors
Social isolation and low social participation
Epidemiological/Cohort Studies advantages
- Large number of subjects
- Data on multiple factors
- Longitudinal follow-up over many years
Epidemiological/Cohort Studies disadvantages
- association not causation
- hard determination of ‘direction’ of cause/effect for exposure/outcome (reverse causality problem)
- influence of unidentified factors
- Uncertainty about whether an intervention aimed at an identified factor would have an impact on biological or
clinical outcome
Basic science/animal studies advantages
- highly controlled conditions
- Determination of underlying mechanisms
- Identification of intervening variables that help explain clinical outcomes (e.g., changes in brain structure, neurotransmitters, growth factors, inflammatory markers, etc.)
Basic science/animal studies disadvantages
- Reduction of complex issues into simple ones
- Need to translate to humans
- Elucidating underlying mechanisms does not signify that manipulating an identified factor will alter clinical outcome
Human “Proof-of- Concept” Studies advantages
- Opportunity to examine markers of cerebral plasticity, reserve, efficiency, and neural compensation
- utilization of tools of cognitive neuroscience to elucidate underlying mechanism
- Opportunity for further hypothesis testing and generation
- Often considered the “gold standard”
Human “Proof-of- Concept” Studies disadvantages
- similar to limitations of basic science/animal studies noted above
what is sleep hygiene?
- sleep ritual before you fall asleep
Additional factors: what is the evidence?
- Avoid medications with anticholinergic properties
- Limit alcohol use
- Protect the brain from physical and toxic injuries
Sense of purpose: what is it?
refers to the feeling that one’s life is goal- oriented & has a direction
Sense of purpose: what is associated with?
It is associated with:
* better cognitive function
* less age-related cognitive decline
* lower risk of incident dementia
Sense of purpose: what are the findings in SCD?
Sense of purpose was negatively related to SCD
* Conclusion: sense of purpose may help mitigate the cognitive decrements associated with loneliness
Depression and loneliness were ______ related to SCD
positively
For loneliness, this association was ________ by sense of purpose:
moderated
