key: cord-1042903-8q4oh1tv
authors: Gray, Michelle; Gills, Joshua L.; Glenn, Jordan M.
title: Cognitive management in a digital world
date: 2021-07-13
journal: Aging (Albany NY)
DOI: 10.18632/aging.203324
sha: efe3eefebc2e5d624c4f5b5d98d5de2a25d52c38
doc_id: 1042903
cord_uid: 8q4oh1tv

nan

predicts current cognitive status [6, 7] . Remote cognitive screenings provide health care professionals with an additional tool when assessing cognitive decline, are time efficient, and allow for physicians to give information on various treatments to combat further abnormal decline. Interventions often use a single-domain (e.g., pharmacological, exercise, etc.) approach to improve cognitive function. Results from these interventions were ineffective after observing changes in physical activity, nutrition, cardiovascular health, or cognitive training on improving cognitive outcomes [8] . These results are not surprising considering the cause of ADRD is multifactorial. Thus, more recently longitudinal multi-domain interventions have resulted in positive changes in cognitive outcomes and risk of cognitive decline. It should be noted, however, that many of the primary outcome changes have been nonsignificant. One common thread of these interventions is the age of participants. Many have targeted older adults (>70 years) with existing underlying cognitive impairment and/or decline. At this point in a person's life, it may be too late for effective interventions to significantly impact cognitive outcomes. Therefore, interventions should target improving positive risk factors associated with cognitive decline rather than cognition as a singular outcome among high-risk individuals. Our group has recently begun a digital multi-domain intervention with the goal of reducing cognitive impairment risk of 45-75 year-old cognitively normal adults (NIH SBIR R44AG063672). We were intentional in our selection of research participants to examine changes in risk factors over a 2-year intervention. The project includes a digital multi-domain intervention with a personalized health coach providing direct counselling on physical activity practices, dietary habits, social engagement, and cognitive training. A personalized health coach model was chosen because not all individuals have the same needs. Accordingly, a multi-domain intervention providing individualized counselling is ideal for improving overall health outcomes and improving risk factors for future cognitive decline [8] . Additionally, focusing on lifestyle changes in mid-life and relating those changes to the improvements in cognitive performance in late life is an important and missing piece of the puzzle.

Behavior modification programs are difficult for individuals to adopt due to a myriad of reasons including insufficient time, perceived cost, and knowledge of specific changes. Virtual health coaching provides the knowledge to change various aspects of health, including focusing on healthy eating, physical activity participation, and social engagement. Doing so in a virtual environment is more cost effective than paying for a gym membership or personal training. In theory, this type of intervention is both efficacious and cost effective; however, has not been shown to significantly improve overall health outcomes or delay cognitive decline. Thus, further research is warranted, but results are promising.

Alzheimer's Association

Agency for Healthcare Research and Quality (US)