title: Web-enabled Conversational Interactions as a Means to Improve Cognitive Functions: Results of a 6-Week Randomized Controlled Trial.
abstract: BACKGROUND
  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 18thweek assessments. Among those with MCI, a trend (p=0.04) of improved psychomotor speed was observed in the intervention group.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, NIA-Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR ; Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR ; Department of Neurology, Michigan Alzheimer's Disease Center, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Hiroko H
authors.initials: HH
authors.lastname: Dodge
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Neurology, NIA-Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR ; Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR.
authors.forename: Nora
authors.initials: N
authors.lastname: Mattek
authors.affiliation: Department of Neurology, NIA-Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR ; Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR.
authors.forename: Molly
authors.initials: M
authors.lastname: Bowman
authors.affiliation: Department of Psychology, University of Michigan, Ann Arbor, MI.
authors.forename: Oscar
authors.initials: O
authors.lastname: Ybarra
authors.affiliation: Department of Neurology, NIA-Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR ; Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR.
authors.forename: Katherine
authors.initials: K
authors.lastname: Wild
authors.affiliation: Department of Psychiatry & Behavioral Sciences and Center on Aging, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: David A
authors.initials: DA
authors.lastname: Loewenstein
authors.affiliation: Department of Neurology, NIA-Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR ; Oregon Center for Aging and Technology, Oregon Health & Science University, Portland, OR ; Portland VA Medical Center, Portland, OR.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kaye
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