The Coaching for Cognition in Alzheimer's (COCOA) trial: Study design.

Comprehensive treatment of Alzheimer's disease (AD) requires not only pharmacologic treatment but also management of existing medical conditions and lifestyle modifications including diet, cognitive training, and exercise. We present the design and methodology for the Coaching for Cognition in Alzheimer's (COCOA) trial. AD and other dementias result from the interplay of multiple interacting dysfunctional biological systems. Monotherapies have had limited success. More interventional studies are needed to test the effectiveness of multimodal multi-domain therapies for dementia prevention and treatment. Multimodal therapies use multiple interventions to address multiple systemic causes and potentiators of cognitive decline and functional loss; they can be personalized, as different sets of etiologies and systems responsive to therapy may be present in different individuals. COCOA is designed to test the hypothesis that coached multimodal interventions beneficially alter the trajectory of cognitive decline for individuals on the spectrum of AD and related dementias (ADRD). COCOA is a two-arm prospective randomized controlled trial (RCT). COCOA collects psychometric, clinical, lifestyle, genomic, proteomic, metabolomic, and microbiome data at multiple timepoints across 2 years for each participant. These data enable systems biology analyses. One arm receives standard of care and generic healthy aging recommendations. The other arm receives standard of care and personalized data-driven remote coaching. The primary outcome measure is the Memory Performance Index (MPI), a measure of cognition. The MPI is a summary statistic of the MCI Screen (MCIS). Secondary outcome measures include the Functional Assessment Staging Test (FAST), a measure of function. COCOA began enrollment in January 2018. We hypothesize that multimodal interventions will ameliorate cognitive decline and that data-driven health coaching will increase compliance, assist in personalizing multimodal interventions, and improve outcomes for patients, particularly for those in the early stages of the AD spectrum. Highlights: The Coaching for Cognition in Alzheimer's (COCOA) trial tests personalized multimodal lifestyle interventions for Alzheimer's disease and related dementias.Dense longitudinal molecular data will be useful for future studies.Increased use of Hill's criteria in analyses may advance knowledge generation.Remote coaching may be an effective intervention.Because lifestyle interventions are inexpensive, they may be particularly valuable in reducing global socioeconomic disparities in dementia care.

Verbal fluency as a screening tool for mild cognitive impairment.

OBJECTIVES: The goal of this study was to evaluate the ability of semantic (animal naming) and phonemic (FAS) fluency in their ability to discriminate between normal aging, amnestic-Mild Cognitive Impairment (a-MCI), and Alzheimer's disease (AD). DESIGN: We used binary logistic regressions, multinomial regressions, and discriminant analysis to evaluate the predictive value of semantic and phonemic fluency in regards to specific diagnostic classifications. SETTING: Outpatient geriatric neuropsychology clinic. PARTICIPANTS: 232 participants (normal aging = 99, a-MCI = 90, AD = 43; mean age = 65.75 years). MEASUREMENTS: Mini-mental State Examination (MMSE), Controlled Oral Word Association Test. RESULTS: Results indicate that semantic and phonemic fluency were significant predictors of diagnostic classification, and semantic fluency explained a greater amount of the discriminant ability of the model. CONCLUSIONS: These results suggest that verbal fluency, particularly semantic fluency, may be an accurate and efficient tool in screening for early dementia in time-limited medical settings.

The effect of landscape photograph type on aesthetic judgments, attention, and memory in children with dyslexia.

Given the link between visual stimuli and memory, children with dyslexia could benefit from research discovering what visual stimuli they find more pleasing and memorable. People like natural landscapes (e.g.,forests) more than human-made (e.g.,cityscapes) or "combined" landscapes (i.e.,combination of human-made and natural components, e.g.,tires in a meadow). The purpose was to determine if the greater likability for natural generalized to children with dyslexia and age-equivalent controls and if photograph type impacted recognition rates after the short and long term. All children liked natural landscape photographs the most but paid longer attention to combined landscape photographs. Both groups recognized all photograph types at a high rate after the short retention interval, but after the long interval, the children with dyslexia had better memory, especially for combined photographs. On the basis of these results, we advise educators to incorporate images of natural landscapes into the learning context in order to create a more aesthetically pleasing environment or to infuse combined images for a more engaging and memorable environment.