I‐CONECT: Efficacy in Primary and Secondary outcomes. (20th December 2022)

• Record Type: Journal Article
• Authors: Dodge, Hiroko H; Wu, Chao‐Yi; Albin, Roger L.; Hampstead, Benjamin M.; Kaye, Jeffrey A; Wild, Katherine; Silbert, Lisa C
• Is Part Of: Alzheimer's & dementia. Volume 18(2022)Supplement 11
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-12-20
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.059655
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: Octogenarians are the fastest growing segment of the population worldwide, but are often excluded from pharmacological intervention trials. Slowing cognitive decline and delaying the onset of dementia even for a few years among this age group could reduce prevalent dementia significantly. Behavioral intervention targeting the older old, which can be easily started and sustained even among the homebound, is needed. Method: Based on the epidemiological findings and promising results in our previous pilot project, we developed Internet‐based Conversational‐Engagement Clinical Trial (I‐CONECT)" (ClinicalTrial.gov: NCT02871921). I‐CONECT is a multi‐site, assessor‐blind, randomized controlled behavioral intervention trial intended to enhance cognitive reserve by increasing social interactions, specifically conversational interactions, using video conferencing. Through community outreach and mass‐mailing, 29, 664 contacts were attempted, resulting in 1, 139 telephone screenings. Ultimately 186 socially isolated participants aged 75 and older (mild cognitive impairment (MCI) or normal cognition (NC)) were randomized (mean age = 81.1, 20% African Americans). The experimental group engaged in 30‐minute video chats 4 times per week for 6 months, followed by twice per week for an additional 6 months, and weekly 10‐minute phone check‐ins. The control group received only the weekly phone check‐ins. Due to the COVID‐19 pandemic, we replaced in‐home assessments with telephone assessments (T‐COG) during the intervention. Accordingly, we conducted two separate analyses: one using only those who completed Month 6 assessments before the COVID pandemic (n = 56, N56Analysis) and another using all randomized participants (n = 186, N186Analysis) with the latter analysis controlling for COVID‐19 pandemic exposure using mixed models for repeated measures. Result: Among MCI participants, global cognition as measured by the Montreal Cognitive Assessment (MoCA) (primary outcome) was 1.76 points higher at Month 6 assessments among the experimental group compared with the control group (M56analysis) (p = 0.03, Cohen's d = 0.73). At Month 12, we also observed 2.19 points higher score (p = 0.03) in Craft Story Immediate Recall (episodic memory/encoding, secondary outcome) in M186Analysis. Conclusion: Despite the reduced sample size, we demonstrated efficacy in our primary and secondary outcomes and feasibility of executing methods to enhanced social engagement in isolated older adults using a virtual platform. Long term effects of this intervention will be examined in a future Phase III trial.