A Remote Intervention to Prevent or Delay Cognitive Impairment in Older Adults: Design, Recruitment, and Baseline Characteristics of the Virtual Cognitive Health (VC Health) Study

Nicholas Bott, Shefali Kumar, Caitlyn Krebs, Jordan M Glenn, Erica N Madero, Jessie L Juusola, Nicholas Bott, Shefali Kumar, Caitlyn Krebs, Jordan M Glenn, Erica N Madero, Jessie L Juusola

Abstract

Background: A growing body of evidence supports the use of lifestyle interventions for preventing or delaying the onset of Alzheimer disease and other forms of dementia in at-risk individuals. The development of internet-delivered programs would increase the scalability and reach of these interventions, but requires validation to ensure similar effectiveness to brick-and-mortar options.

Objective: We describe the study design, recruitment process, and baseline participant characteristics of the sample in the Virtual Cognitive Health (VC Health) study. Future analyses will assess the impact of the remotely delivered lifestyle intervention on (1) cognitive function, (2) depression and anxiety, and (3) various lifestyle behaviors, including diet, exercise, and sleep, in a cohort of older adults with subjective memory decline. Additional analyses will explore feasibility outcomes, as well as the participants' engagement patterns with the program.

Methods: Older adults (aged 60-75 years) with subjective memory decline as measured by the Subjective Cognitive Decline 9-item (SCD-9) questionnaire, and who reported feeling worried about their memory decline, were eligible to participate in this single-arm pre-post study. All participants enrolled in the yearlong digital intervention, which consists of health coach-guided lifestyle change for improving diet, exercise, sleep, stress, and cognition. All components of this study were conducted remotely, including the collection of data and the administration of the intervention. We assessed participants at baseline, 12 weeks, 24 weeks, and 52 weeks with online surveys and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) test. We will conduct intention-to-treat analysis on all outcomes.

Results: A total of 85 participants enrolled in the intervention and 82 are included in the study sample (3 participants withdrew). The study cohort of 82 participants comprises 61 (74%) female, 72 (88%) white, and 64 (78%) overweight or obese participants, and 55 (67%) have at least a college degree. The average baseline RBANS score was 95.9 (SD 11.1), which is within age-adjusted norms. The average SCD-9 score was 6.0 (SD 2.0), indicating minor subjective cognitive impairment at the beginning of the study. The average baseline Generalized Anxiety Disorder 7-item scale score was 6.2 (SD 4.5), and the average Patient Health Questionnaire 9-item score was 8.5 (SD 4.9), indicating mild levels of anxiety and depression at baseline.

Conclusions: Internet-delivered lifestyle interventions are a scalable solution for the prevention or delay of Alzheimer disease. The results of this study will provide the first evidence for the effectiveness of a fully remote intervention and lay the groundwork for future investigations.

Trial registration: ClinicalTrials.gov NCT02969460; https://ichgcp.net/clinical-trials-registry/NCT02969460 (Archived by WebCite at http://www.webcitation.org/71LkYAkSh).

Registered report identifier: RR1-10.2196/11368.

Keywords: Alzheimer disease; cognitive dysfunction; cognitive impairment; dementia; digital health; health coaching; lifestyle intervention; risk reduction behavior.

Conflict of interest statement

Conflicts of Interest: Neurotrack makes and owns the eye-tracking assessment and behavior change program used in this study. NB, CK, JMG, and ENM are employed by Neurotrack and receive a salary and stock options. Evidation Health collected and analyzed all study data. JLJ and SK are employed by Evidation Health and have no financial interest in Neurotrack.

©Nicholas Bott, Shefali Kumar, Caitlyn Krebs, Jordan M Glenn, Erica N Madero, Jessie L Juusola. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 13.08.2018.

Figures

Figure 1
Figure 1
Flow for assessing and improving participant dietary habits.
Figure 2
Figure 2
Enrollment cascade and study timeline. RBANS: Repeatable Battery for the Assessment of Neuropsychological Status.
Figure 3
Figure 3
Geographic distribution of study participants. Each dot on the map corresponds to a study participant’s zip code. Larger dots represent multiple individuals from that zip code.

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