The Effect Of Difficulty-adaptive Computerized Cognitive Training On The Cognitive Function Of Cognitively Healthy Elderly In The Community

Objective:To explore the effects of difficulty-adaptive computerized cognitive training(CCT)on the cognitive function of cognitively healthy older in the community.To explore in-depth the awareness of cognitively healthy elderly in the community on cognitive training and facilitators and barriers among elderly to persistently participate in CCT,in order to improve the age-related decline of the elderly’s cognitive function,increase the cognitive function reserve and provide reference measures to improve the compliance of the elderly to participate in CCT.Methods:This study was a mixed method research.According to the inclusion and exclusion criteria,we conveniently recruited cognitively healthy elderly people living in Dadong,Heping and Shenbei communities in Shenyang from Nov.2019 to Dec.2020.1.All elderly people who met the inclusion criteria were randomly allocated into difficultyadaptive CCT group(intervention group)or difficulty-fixed CCT group(control group).The frequency of intervention was 3 times a week,30 minutes/time,for a total of 10 weeks.Before the intervention,immediately after the intervention,and one month after the intervention,the Mo CA scale,Auditory Verbal Learning Test(AVLT),Digital Span Test(DST),Stroop Color-word Test(SCWT)and Shape Trail Test(STT)were used to evaluate the global cognitive function,memory,attention and executive function.2.After the quantitative research,the descriptive qualitative research method was adopted to interview elderly adults who participated in the previous intervention study.13 elderly people were sampled by purpose to conduct semi-structured in-depth interviews to understand the feelings of the elderly during CCT and facilitators and barriers among elderly to persistently participate in CCT.All interviews were recorded and transcribed into Word manuscripts.Content analysis technique was utilized for data analysis.Nvivo11 also was used to sort,code,and summarize the data.3.Data was analyzed using SPSS version 23 and was interpreted by using descriptive method like frequency,mean,and standard deviation.Independent sample t test,Chisquare and Mann-Whitney U rank sum test were used to compare the differences in general demographic data between the intervention group and the control group.Repeated measures analysis of variance or Friedman M test of multiple related samples was used to analyze the differences in indicators of global cognitive function,memory,executive function,and attention between the intervention group and the control group at three time points.Results:A total of 36 elderly were recruited in this study,including 18 in the intervention group and 18 in the control group.The results of Intention-To-Treat(ITT)showed that:1.The average age of elderly in the intervention group was 69.11±8.17,and in the control group was 74.22±7.86.There were 12 females and 6 males in the intervention group and7 females and 11 males in the control group.There were 12 people with high school education or above in the intervention group and 15 people in the control group.The baseline results showed that there was no statistical difference between two groups in general demographic data and cognitive function(P>0.05).2.The scale in global cognitive function of intervention group was improved one month after intervention(P<0.05).Compared with the control group,the elderly people in the intervention group with Mo CA one month after the intervention was significantly improved(P<0.05).3.The scale in DST-forward of intervention group was improved one month after intervention(P<0.05).There was no statistically significant difference in DST-forward and DST-backward scores between the intervention group and the control group at the three time points(P>0.05).4.The scales in the AVLT-04,AVLT-cued,AVLT-recall and total points of intervention group were improved immediately and one month after the intervention in intervention group.Immediately and one month after the intervention,the AVLT-cued score of the intervention group was significantly higher than that of the control group(P<0.05).5.Immediately after the intervention,STT-A in the intervention group was significantly shorter than that in the control group(P<0.05).Compared with before,the STT-B of the intervention group was significantly shorter immediately after the intervention(P<0.05).Immediately and one month after the intervention,the STT-B and SCWT-B of the intervention group were significantly shorter than those of the control group(P<0.05).6.Qualitative interviews found that the factors that affect the willingness of the elderly to participate in CCT included: a)personal traits(including social responsibility and free time);b)awareness of cognitive training;c)professional support.Facilitators to persistently participate in CCT included: a)personal traits(including free time,emotions,and persistent personality);b)external motivation(including group motivation and staff supervision);c)positive feelings(including improvement of cognitive function and mood);d)Awareness of the importance of cognitive training.Barriers to persistently participate in CCT included: a)unskilled computer operation;b)imperfect training settings(including longer training time settings,vague training instructions,boring training,and too fast individual training tempo)and c)the low awareness of cognitive training.7.From the preparation of hardware equipment,training system support and subjective use experience,it was shown that CCT had certain application feasibility in the cognitively healthy elderly in the community.Conclusion:1.This study found that compared with difficulty-fixed CCT,difficultyadaptive CCT can significantly improve the global cognitive function,cue recall,recognition recall and executive function of cognitively healthy elderly,and there may have a certain continuation effect.However,there was limited effect of difficulty-adaptive CCT in attention,and further research is needed in the future.It is feasible to apply computerized cognitive training to the healthy elderly in the community.2.The elderly had insufficient awareness of cognitive training,and lack of cognitive training methods.They need more information support and health education.At the same time,individualized cognitive training should be developed to gradually increase the difficulty of training,so as to ensure the compliance of participants.