Web-enabled Conversational Interactions as a Means to Improve Cognitive Functions: Results of a 6-Week Randomized Controlled Trial

Hiroko H Dodge, Jian Zhu, Nora Mattek, Molly Bowman, Oscar Ybarra, Katherine Wild, David A Loewenstein, Jeffrey A Kaye, Hiroko H Dodge, Jian Zhu, Nora Mattek, Molly Bowman, Oscar Ybarra, Katherine Wild, David A Loewenstein, Jeffrey A Kaye

Abstract

Introduction: Increasing social interaction could be a promising intervention for improving cognitive function. We examined the feasibility of a randomized controlled trial to assess whether conversation-based cognitive stimulation, through personal computers, webcams, and a user-friendly interactive Internet interface had high adherence and a positive effect on cognitive functions among older adults without dementia.

Methods: Daily 30 minute face-to-face communications were conducted over a 6-week trial period in the intervention group. The control group had only a weekly telephone interview. Cognitive status of normal and MCI subjects was operationally defined as Global Clinical Dementia Rating (CDR) = 0 and 0.5, respectively. Age, sex, education, Mini-Mental State Exam and CDR score were balancing factors in randomization. Subjects were recruited using mass-mailing invitations. Pre-post differences in cognitive test scores and loneliness scores were compared between control and intervention groups using linear regression models.

Results: Eighty-three subjects participated (intervention: n=41, control: n=42). Their mean (std) age was 80.5 (6.8) years. Adherence to the protocol was high; there was no dropout and mean % of days completed out of the targeted trial days among the intervention group was 89% (range: 77%-100%). Among the cognitively intact participants, the intervention group improved more than the control group on a semantic fluency test (p=0.003) at the post-trial assessment and a phonemic fluency test (p=0.004) at the 18th week assessments. Among those with MCI, a trend (p=0.04) of improved psychomotor speed was observed in the intervention group.

Discussion: Daily conversations via user-friendly Internet communication programs demonstrated high adherence. Among cognitively intact, the intervention group showed greater improvement in tests of language-based executive functions. Increasing daily social contacts through communication technologies could offer cost-effective home-based preventions. Further studies with a longer duration of follow-up are required to examine whether the intervention slows cognitive declines and delays the onset of dementia.

Keywords: Communication Technology; Conversational Interaction; Internet; Mild Cognitive Impairment (MCI); Oregon Center for Aging and Technology (ORCATECH); Randomized controlled clinical trial (RCT); Social Engagement; prevention study.

Figures

Fig. 1
Fig. 1
Study flow chart. CDR, clinical dementia rating.
Fig. 2
Fig. 2
Letter fluency test results at baseline, post-trial, and final assessments among clinical dementia rating (CDR) 0 group. Among the CDR 0 group, the intervention group kept improving the test score after the trial, but the control group experienced a decline at the final assessment, leading to a significant difference between the two groups in the gain in scores from baseline to the final assessment (P = .004).

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