Participating in regular online chats can help improve memory in isolated older adults, new research shows.
Results from the randomized, internet-based Conversational-Engagement Clinical Trial (I-CONECT) provide additional evidence that social interactions or engaging in conversations can have a significant effect on the brain health of patients, study investigator Hiroko H. Dodge, PhD, professor of neurology and co–associate director, Data Core Lead, Layton Aging and Alzheimer’s Disease Center, Oregon Health and Science University (OHSU), Portland, told Medscape Medical News.
“Doctors should encourage patients to talk with friends or relatives, and researchers and communities need to make sure that we create opportunities for these social interactions,” Dodge said.
The findings were presented at the Alzheimer’s Association International Conference (AAIC) 2022.
An Excluded Population
Previous studies have shown that a higher level of social engagement protects cognition. “Yet there’s a paucity of randomized controlled trials using social interactions as a means to enhance cognitive functions and delay onset of dementia,” said Dodge.
Octogenarians, who are the fastest growing segment of the population, are often excluded from intervention trials, she noted. “Slowing the cognitive decline in this age group for even just a few years could have significant impact on overall prevalence and incidence of dementia,” she said.
The I-CONECT trial included 186 socially isolated adults aged 75 and older (mean age, 81.1 years). Of the total study population, 53.8% had mild cognitive impairment (MCI), and the rest had normal cognition.
In addition, about 20% of the participants were Black, a proportion that was “higher than [in] most of the existing clinical trials,” Dodge noted.
To locate and enroll older isolated participants, the investigators collaborated with Meals on Wheels and the Area Agency on Aging (AAA) and used other volunteer registries to get referrals. They also used social media and churches.
All participants were randomly assigned to an experimental group or a control group. The two groups were similar in terms of demographic variables and cognitive test scores.
The experimental group engaged 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 check-ins to monitor social activities, health, and mood.
The conversations were semistructured to standardize interactions but were cognitively stimulating. They were based on differing themes, which prompted discussions on a range of topics and allowed participants to organize and convey their thoughts in a conversational setting.
The researchers tried to have the participants chat with a different staff person each week “to enhance the novelty of the experience,” said Dodge.
The program was very simple to operate, as the user needed only to touch the middle of the screen to start a conversation. This minimized the confounding effects of brain stimulation from learning a more complicated program, Dodge noted.
The control group received only the weekly check-ins by phone.
Because of the COVID-19 pandemic, planned in-home assessments were replaced with telephone assessments. For this reason, researchers conducted two separate analyses.
One analysis included only the 56 patients who completed month 6 assessments before the pandemic. Its primary 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 month 6 in the experimental group in comparison with the control group after adjusting for baseline score (P = .03; Cohen’s d = .73).
“To our pleasant surprise, we found a significant efficacy in MCI participants despite a small sample size,” said Dodge.
An intervention with a 1.75-point difference on MoCA is equivalent to 10 years of age difference, she said. “The intervention makes their brain 10 years younger,” although this interpretation is based on a “very rough yardstick of age, used cross-sectionally,” she added.
Dodge noted that the effect size was “relatively high.” However, there was not a similar effect among participants with normal cognition.
A post hoc analysis found a significant difference in memory, one of six domains in the MoCA, after controlling for baseline score (estimate, 1.69; P = .02).
“This indicates the efficacy in the MoCA score is driven mainly by the difference in the memory domain between the experimental and control groups,” said Dodge.
Psychosocial Effects, Brain Connectivity
The other analysis included all participants, was controlled for COVID-19 pandemic exposure, and included secondary and exploratory outcomes.
One secondary outcome was the Craft Story Immediate Recall (episodic memory/encoding) score. In participants with MCI, this score was 2.19 points higher at 12 months in the experimental group than in the control group. (P = .03)
Among those with normal cognition, the experimental group had a score on the Category Fluency (animals) test that was 2.56 points higher than the control group at 6 months (P = .03).
The question now is whether these gains extend the number of years these “older old” patients live “happily and independently,” said Dodge. “And if so, to what degree? Is it a few months, a year, more than a year?”
In a separate presentation, Kexin Yu, a PhD candidate and research assistant at the University of Southern California, Los Angeles, reported that the intervention had a positive psychosocial effect. Both the experimental group and the control group improved on the social satisfaction part of the National Institutes of Health Toolbox emotional battery, which measures factors such as friendship, loneliness, and emotional support.
This result suggests “weekly phone check-ins in the community might help improve social well-being among isolated older adults, Yu said.
One of the study’s exploratory outcomes was functional MRI brain connectivity. Results showed that among four large-scale cognitive brain networks, the intervention had a significant effect on Dorsal Attention Network connectivity, Patrick Pruitt, PhD, postdoctoral research fellow, OHSU, told meeting attendees.
Another exploratory outcome was change in speech patterns. Findings showed that participants with MCI in the experimental group used more coordinated phrasing in their speech after 6 months than those in the control group, reported another presenter, Meysam Asgari, PhD, assistant professor, Center for Spoken Language Understanding, School of Medicine, OHSU.
The investigators note that other elderly isolated patients can learn how to connect with a trained volunteer by visiting the I-CONNECT Foundation.
Commenting on the findings for Medscape Medical News, John Breitner, MD, professor in the Department of Psychiatry at McGill University, Montreal, Canada, and a participant in a panel discussion following the presentations, called the MoCA results “extraordinary.”
“It’s unusual for a short intervention to yield that much change in the MoCA,” said Breitner, who was not involved with the research.
That the scores actually improved and did not just indicate a slowing of cognitive decline is “striking,” he added.
“This trial, which was conducted rigorously under the most difficult circumstances, provides an important example of the potential benefits of social/environmental interventions that do not necessarily target the pathology of Alzheimer’s disease,” said Breitner.
The study was funded by the National Institute of Aging. The presenters and Breitner have disclosed no relevant financial relationships.
Alzheimer’s Association International Conference (AAIC) 2022: Presented August 1, 2022.