New research suggests that engaging in regular online chats may help improve memory in isolated older adults.
Findings from the Randomized Online Clinical Trial of Conversational Interaction (I-CONECT) provide additional evidence that social interactions or participation in conversations can have a significant impact on patients’ brain health, researcher Hiroko H. Dodge, Ph.D., professor. from Neurology and Co-Associate Director, Head of Data Core, Leyton Center for Aging and Alzheimer’s Disease, Oregon Health and Science University (OHSU), Portland, told Medscape Medical News.
“Physicians should encourage patients to talk to friends or relatives, and researchers and communities should make sure we create opportunities for these social interactions,” Dodge said.
The results were presented at the Alzheimer’s Association International Conference (AAIC) 2022.
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Previous research has shown that higher levels of social engagement are protective of cognition. “However, there are few randomized controlled trials that have used social interactions as a means of improving cognition and delaying the onset of dementia,” Dodge said.
She noted that octogenarians, the fastest growing segment of the population, are often excluded from intervention trials. “Slowing down cognitive decline in this age group even by a few years could have a significant impact on the overall prevalence and incidence of dementia,” she said.
The I-CONECT study included 186 socially isolated adults aged 75 years and older (mean age 81.1 years). Of the entire study population, 53.8% had mild cognitive impairment (MCI) and the rest had normal cognitive function.
In addition, about 20% of the participants were black, and this proportion was “higher than [in] most existing clinical trials,” Dodge said.
To find and enroll older isolated participants, the researchers partnered with Meals on Wheels and the Local Aging Agency (AAA) and used other volunteer registries to obtain referrals. They also used social media and churches.
All participants were randomly assigned to the experimental or control group. Both groups were similar in terms of demographics and cognitive test scores.
The experimental group participated in 30-minute video chats with trained interviewers four times a week for 6 months, then twice a week for an additional 6 months. They also received weekly 10-minute phone calls to track social activity, health, and mood.
Conversations were partly structured to standardize interaction but stimulated cognition. They were based on different topics, which sparked discussions on a range of topics and allowed the participants to organize and convey their thoughts in a conversational setting.
The researchers tried to have participants talk to a different collaborator each week “to reinforce the novelty of the experience,” Dodge said.
The program was very easy to use, as the user only had to touch the middle of the screen to start a conversation. This minimized the distorting effects of brain stimulation when learning a more complex program, Dodge noted.
The control group received only weekly phone reports.
A pleasant surprise
Due to the COVID-19 pandemic, scheduled home assessments have been replaced by telephone assessments. For this reason, the researchers conducted two separate analyses.
One analysis included only 56 patients assessed 6 months before the pandemic. Its main outcome was global cognition as measured by the Montreal Cognitive Assessment (MoCA).
Among participants with MCI, the MoCA score was 1.75 points higher at 6 months in the treatment group compared to the control group after adjusting for baseline score (P = 0.03; Cohen’s d = 0.73).
“To our pleasant surprise, we found significant efficacy in MCI participants despite the small sample size,” Dodge said.
An intervention with a difference of 1.75 MoCA points is equivalent to a 10-year difference in age, she says. “The intervention makes their brains 10 years younger,” although this interpretation is based on “a very rough age criterion used in the cross section,” she added.
Dodge noted that the effect size was “relatively high”. However, among participants with normal cognitive abilities, no such effect was observed.
Post hoc analysis found a significant difference in memory, one of the six domains in MoCA, after adjusting for baseline (score 1.69; P = 0.02).
“This indicates that the performance on the MoCA scale is mainly determined by the difference in memory area between the experimental and control groups,” Dodge said.
Another analysis included all participants, controlled for exposure to the COVID-19 pandemic, and included secondary and exploratory outcomes.
One of the secondary outcomes was an assessment of the immediate recall of the Craft Story (episodic memory/coding). In participants with MCI, this indicator was 2.19 points higher after 12 months in the experimental group than in the control group. (P = 0.03)
Among those with normal cognition, the experimental group had a category fluency test score (animals) that was 2.56 points higher than the control group at 6 months (P = 0.03).
Now the question is whether these advances increase the number of years these “old old” patients live “happily and independently,” Dodge said. “And if so, to what extent? A few months, a year, more than a year?
In a separate presentation, Keksin Yu, Ph.D. and researcher at the University of Southern California at Los Angeles, reported that the intervention had a positive psychosocial effect. Both the experimental group and the control group improved the social satisfaction portion of the National Institutes of Health Toolbox emotional battery, which measures factors such as friendship, loneliness, and emotional support.
This result suggests that “weekly community phone checks can help improve the social well-being of isolated older adults,” Yu said.
One of the results of the study was the functional MRI brain connection. The results showed that among four large-scale cognitive networks in the brain, the intervention had a significant effect on connecting the dorsal attention network, Patrick Pruitt, Ph.D., an OHSU postdoctoral fellow, told meeting participants.
Another research result was the change in speech patterns. The results showed that participants with MCI in the treatment group used more coordinated phrases in their speech after 6 months than participants in the control group, said another moderator, Meisam Asgari, PhD, assistant professor at the Center for Spoken Language Understanding, School of Medicine, OHSU. .
The researchers note that other elderly isolated patients can learn how to contact a trained volunteer by visiting the I-CONNECT Foundation.
Commenting on the results to Medscape Medical News, John Breitner, MD, professor in the Department of Psychiatry at McGill University, Montreal, Canada, and panellist following the presentations, called the MoCA results “extraordinary.”
“It is unusual for a short intervention to result in such significant changes in MoCA,” said Breitner, who was not involved in the study.
He added that the scores have indeed improved, and do not just indicate a slowdown in cognitive decline.
“This study, which was conducted in the most challenging environments, provides an important example of the potential benefits of social/environmental interventions that do not necessarily target the pathology of Alzheimer’s disease,” Breitner said.
The study was funded by the National Institute on Aging. The hosts and Breitner have not disclosed any relevant financial relationship.
Alzheimer’s Association International Conference (AAIC) 2022: Submitted August 1, 2022
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