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Alzheimers Dement. 2019 Mar 11. pii: S1552-5260(19)30028-7. doi: 10.1016/j.jalz.2019.01.007. [Epub ahead of print]

A randomized clinical trial to evaluate home-based assessment of people over 75 years old.

Author information

1
Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J Peters VAMC, Bronx, NY, USA. Electronic address: mary.sano@mssm.edu.
2
Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J Peters VAMC, Bronx, NY, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
3
Department of Neurology and Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
4
Wisconsin Department of Health Services, Division of Care and Treatment Services, Mauston, WI, USA.
5
Oregon Center for Aging and Technology, Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
6
Center for Cognitive Neurology, New York University Langone Medical Center, New York, NY, USA.
7
Department of Neurosciences, San Diego, CA, USA; Department of Family and Preventive Medicine, University of California, San Diego, CA, USA.
8
Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego, CA, USA.
9
Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
10
Department of Psychiatry, Alzheimer Disease Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
11
Department of Neurosciences, University of California, San Diego, CA, USA.

Abstract

INTRODUCTION:

There is an unmet need for effective methods for conducting dementia prevention trials.

METHODS:

Home-based assessment study compared feasibility and efficiency, ability to capture change over time using in-home instruments, and ability to predict cognitive conversion using predefined triggers in a randomized clinical trial in (1) mail-in questionnaire/live telephone interviews, (2) automated telephone/interactive voice recognition, and (3) internet-based computer Kiosk technologies. Primary endpoint was defined as cognitive conversion.

RESULTS:

Analysis followed a modified intent-to-treat principle. Dropout rates were low and similar across technologies but participants in Kiosk were more likely to dropout earlier. Staff resources needed were higher in Kiosk. In-home instruments distinguished conversion and stable groups. Cognitively stable group showed improvement in cognitive measures. Triggering was associated with higher likelihood of conversion but statistically significant only in mail-in questionnaire/live telephone interviews.

DISCUSSION:

Relatively low efficiency of internet-based assessment compared with testing by live-assessors has implications for internet-based recruitment and assessment efforts currently proposed for diverse populations.

KEYWORDS:

Alzheimer's disease; Dementia prevention; Home-based assessment; Randomized clinical trial

PMID:
30872114
DOI:
10.1016/j.jalz.2019.01.007

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