CCT for Diabetic Elderly Veterans
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 55 - 99 |
| Updated: | 2/24/2019 |
| Start Date: | April 7, 2015 |
| End Date: | September 30, 2019 |
Computerized Cognitive Training to Improve Cognition in Diabetic Elderly Veterans
Computerized cognitive training (CCT) is an intervention has improved cognitive functioning
in the elderly with and without cognitive impairment. The investigators will study the effect
of a CCT program over an active control, "classic" computerized games. The outcomes will be
memory and executive functions/attention, diabetes elf-management and adherence to
medications, and glycemic and blood pressure control. Non-demented elderly Veterans with
diabetes mellitus, who are at high risk for cognitive impairment, will be from the James J.
Peters, Bronx, NY and Ann Arbor, MI VAMCs. This novel potential service fits the portfolio of
the Quality Enhancement Research Initiative for Diabetes Mellitus (QUERI-DM) for which the
Ann Arbor VAMC is a primary center. If successful, the VA National Center for Prevention and
MyHeatheVet will collaborate in disseminating results to encourage implementation throughout
the VA
in the elderly with and without cognitive impairment. The investigators will study the effect
of a CCT program over an active control, "classic" computerized games. The outcomes will be
memory and executive functions/attention, diabetes elf-management and adherence to
medications, and glycemic and blood pressure control. Non-demented elderly Veterans with
diabetes mellitus, who are at high risk for cognitive impairment, will be from the James J.
Peters, Bronx, NY and Ann Arbor, MI VAMCs. This novel potential service fits the portfolio of
the Quality Enhancement Research Initiative for Diabetes Mellitus (QUERI-DM) for which the
Ann Arbor VAMC is a primary center. If successful, the VA National Center for Prevention and
MyHeatheVet will collaborate in disseminating results to encourage implementation throughout
the VA
Project Background: Diabetes mellitus (DM) has consistently been associated with increased
risk for cognitive decline, mild cognitive impairment, and dementia in the elderly. Even
minor cognitive impairments in nondemented individuals dramatically affect disease
self-management. This, in turn, is associated with poor glycemic and blood pressure control
in diabetes, which by themselves increase the risk of dementia, provoking a reinforcing cycle
of disease. Thus, it is imperative to find interventions to delay or prevent cognitive
compromise in diabetic patients, that can be relatively easily and rapidly implemented, and
that are not cost prohibitive. This is especially true in the VA, in view of the high
incidence of both diabetes and dementia in the growing population of elderly Veterans.
Epidemiologic evidence suggests modifiable life-style factors, including cognitive activity,
may prevent or delay the onset of cognitive decline. Computerized cognitive training (CCT) is
an intervention that has shown promising results in the improvement of cognitive functioning,
more consistently in non-demented elderly, with additional benefits from booster training
sessions. To date, studies of CCT have typically only examined cognitive outcomes, and only
shortly after the intervention. The proposed CCT program, Personal Coach from Cognifit, is
designed to improve cognition of elderly persons by targeting their weak cognitive functions,
using a personally tailored training plan. The proposed study will provide the first
evaluation of the effects of CCT on DM self-management behavior and clinical outcomes, in
addition to cognition.
Project Objectives: Aim 1A: To determine whether the CCT, relative to the active control
games program, improves cognition (memory and executive functions/attention), DM-related
behavior (DM self-management and medication adherence), and clinical outcomes (glycemic and
blood pressure control), 6 and 12 months after the intervention. Aim 1B: To demonstrate
efficacy by improvement in behavioral outcomes (DM self-management and medication adherence)
6 months after the intervention. Aim 2: To document the effects of CCT on the successive
changes in memory and executive functions/attention, DM self-management and medication
adherence, and glycemic and blood pressure control. Aim 3: To explore the impact of
demographic (age, education, ethnicity, site) and health (ADL/IADL, health literacy,
depression, dementia family history, lifestyle factors) characteristics, on the intervention
effects.
Project Methods: Non-demented DM elderly from the James J. Peters (Bronx, NY) and Ann Arbor
(MI) VAMCs will be randomized to CCT or games intervention and perform the respective program
3 days per week (every other day), for 20 minutes, for 24 total sessions. Four months after
the intervention, subjects will receive a 1-week booster training. Subjects will be assessed
at baseline; and immediately, 6 months, and 12 months after the intervention. At each time
point, assessments will be cognitive function, DM self-management, and blood pressure; blood
will be drawn for HbA1c measurement. VA records will be used to monitor medication adherence.
Longitudinal mixed model analyses will assess the effects of the intervention on change in
outcomes over time. Path analyses will evaluate the inter-relationships among changes in
cognition, DM self-management, and clinical outcomes for each intervention at 6 and 12
months.
risk for cognitive decline, mild cognitive impairment, and dementia in the elderly. Even
minor cognitive impairments in nondemented individuals dramatically affect disease
self-management. This, in turn, is associated with poor glycemic and blood pressure control
in diabetes, which by themselves increase the risk of dementia, provoking a reinforcing cycle
of disease. Thus, it is imperative to find interventions to delay or prevent cognitive
compromise in diabetic patients, that can be relatively easily and rapidly implemented, and
that are not cost prohibitive. This is especially true in the VA, in view of the high
incidence of both diabetes and dementia in the growing population of elderly Veterans.
Epidemiologic evidence suggests modifiable life-style factors, including cognitive activity,
may prevent or delay the onset of cognitive decline. Computerized cognitive training (CCT) is
an intervention that has shown promising results in the improvement of cognitive functioning,
more consistently in non-demented elderly, with additional benefits from booster training
sessions. To date, studies of CCT have typically only examined cognitive outcomes, and only
shortly after the intervention. The proposed CCT program, Personal Coach from Cognifit, is
designed to improve cognition of elderly persons by targeting their weak cognitive functions,
using a personally tailored training plan. The proposed study will provide the first
evaluation of the effects of CCT on DM self-management behavior and clinical outcomes, in
addition to cognition.
Project Objectives: Aim 1A: To determine whether the CCT, relative to the active control
games program, improves cognition (memory and executive functions/attention), DM-related
behavior (DM self-management and medication adherence), and clinical outcomes (glycemic and
blood pressure control), 6 and 12 months after the intervention. Aim 1B: To demonstrate
efficacy by improvement in behavioral outcomes (DM self-management and medication adherence)
6 months after the intervention. Aim 2: To document the effects of CCT on the successive
changes in memory and executive functions/attention, DM self-management and medication
adherence, and glycemic and blood pressure control. Aim 3: To explore the impact of
demographic (age, education, ethnicity, site) and health (ADL/IADL, health literacy,
depression, dementia family history, lifestyle factors) characteristics, on the intervention
effects.
Project Methods: Non-demented DM elderly from the James J. Peters (Bronx, NY) and Ann Arbor
(MI) VAMCs will be randomized to CCT or games intervention and perform the respective program
3 days per week (every other day), for 20 minutes, for 24 total sessions. Four months after
the intervention, subjects will receive a 1-week booster training. Subjects will be assessed
at baseline; and immediately, 6 months, and 12 months after the intervention. At each time
point, assessments will be cognitive function, DM self-management, and blood pressure; blood
will be drawn for HbA1c measurement. VA records will be used to monitor medication adherence.
Longitudinal mixed model analyses will assess the effects of the intervention on change in
outcomes over time. Path analyses will evaluate the inter-relationships among changes in
cognition, DM self-management, and clinical outcomes for each intervention at 6 and 12
months.
Inclusion Criteria:
- 55 years old or above
- A diagnosis of type 2 diabetes
- Home access to computer and internet
- Has an informant
- Self-management score 18 or below
Exclusion Criteria:
- Dementia or prescribed AD medications
- Major medical, psychiatric, or neurological conditions that affect cognitive
performance
- Severe impairment of vision, hearing or fine motor control necessary for computer
operation
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