(39)维护你的大脑-Maintain your brain final audio-公开课-关爱惟士
(39)维护你的大脑-Maintain your brain final audio


Professor Perminder Sachdev

Perminder Sachdev 教授


So, the Maintain Your Brain trial is funded by the National Institute of Dementia Research, which is run by the NHMRC, the National Health and Medical Research Council of Australia. It's a $6.5 million study, grant over five years. What has happened as a result of the FINGER trial, is there are a number of kind of ‘children of FINGER’ so to speak, there are multiple FINGER trials that are happening around the world. Similar kinds of multipronged strategy to see whether you can fix everything and reduce your rate of dementia.

“维护你的大脑”试验是由国家认知症研究协会资助,由NHMRC(澳大利亚国家健康医疗研究协会)来进行研究。总资金650万美元,至今已有五年之久。作为“FINGER”试验的产物,出现了很多类似“FINGER”试验的“子女”,可以说,在世界各地都进行着大量的“FINGER”试验。类似一种多管齐下的策略,看看能否解决问题并降低认知症发病率。


Now what we wanted to do was see whether we could do this at a larger scale, at a population level. The problem with a study like that, is that if you do it at an individual level, bring everyone in, assess them, it's hugely expensive. You can actually - you will spend several million dollars just to do a few hundred people or a thousand people or so. But we thought can you upscale this to a large population level, within a reasonable budget, and that’s what we are trying to with this, in the Maintain your Brain trial. We thought okay, can we do this through the web and increasingly older people are connected to the web.  

现在我们想做的是看看能否在人群层面更大规模地做这项工作。问题在于,如果你在个体层面上做这个研究,让个体参与进来,评估他们,那需要巨大的花费。你其实做的是—花费数百万美元却只得到几百人或者一千人的研究数据。但是我们认为可以在合理预算范围里将其提升到更高人口水平,这正是我们在“维护你的大脑”这个试验里试图去做的。我们认为没有问题,我们可以通过互联网来做,并且越来越多的老年人也在使用网络。


Also, we don’t want to work necessarily with very old people, we want to work with people who are middle aged or getting in to that increased risk category. Because we want to work with people who have not yet developed cognitive problems, and middle age is probably the best time to catch them. In this trial, we said okay let's have a population of several thousand, in the age range of 55 to 75. We are recruiting them in New South Wales because there is already a study, a survey that’s happening, which is called the 45 and Up Study, which has a quarter of a million people enrolled in that study. They have already collected some health data over several waves in this population. So we know a little bit about their risk factors.

还有,我们不需要高龄者参与试验,我们想让中年人或者高风险的人来参与。因为我们想让那些认知还没有出现问题的人们参与到试验中来,能找到问题核心的最佳年龄段是中年。这个试验,我们计划募集几千名年龄在55至75岁之间的受试者。我们在新南威尔士进行招募,因为在新南威尔士已经进行了一个称为“45岁及以上”的研究,有25万人加入到这个研究中来。此研究已经收集了一些健康数据,这样我们对这些人群存在的风险因素有了先一步的了解。


We’re going to actually recruit them by email and then get them to sign up for the study, and all assessments will be done on the web. So, their detailed medical information will be obtained online, and they do cognitive testing online as well. There are cognitive batteries available that can be done online. Then they do three or four modules, and we have been developing these modules to deliver physical exercise, complex cognitive activity, diet and nutrition, and stress and depression management on the web. These are 12-week courses that we developed and there is some evidence that this can be done. Of course, we have some personalised interactions, so there are virtual coaches, there are some cut offs that we use for alerting feedback, we send messages, text messages, put them in to virtual groups to try to engage them. All those activities have been built in to the platform.

我们通过邮件的形式招募受试者,然后他们需要签字同意参与这个研究,并在网上完成所有的评估。这样我们通过网络获得他们详细的医疗信息,受试者也可在网上进行认知水平测试。我们在网上提供一系列的认知训练给受试者,他们完成三或四个模块,包括体育活动,高级认知活动,饮食和营养,以及压力和抑郁管理等,我们开发了为期12周的课程,证据显示这些课程是可以被完成的。当然,我们也有一些个性化的互动,像虚拟的指导员,如果有中断的情况,我们可以提醒受试者反馈信息,我们发送信件,短信,把他们放在一个虚拟的组群里,努力让他们参与进来。所有的这些活动都已经在这个平台建立完成。


They will have these three or four modules administered in the first year and then they'll have boosters happening every quarter, for each of those modules as they go forward. We assess them every year and we have funding for five years, so we’re hoping to at least have four years of assessment, to see whether we have reduced their rate of cognitive decline. We have enough numbers to see whether we actually cut down the incidence of dementia as well in this group. We have a control group, so they’re randomised via an active participant group and a control group, and the control group also logs in and they do some activities online, but usually they watch videos for example about health, about general, National Geographic videos, those kind of videos, which we previously used in control studies of this kind.

在第一年他们需要完成3或4个模块,并且随着向前逐渐推进,每个模块中每完成四分之一都会有加油的进程提示。每年我们都对受试者进行评估,我们已经开始这个研究5年,我们希望至少有四年的评估数据,来确定我们究竟有没有降低他们认知下降的速度。我们有足够的数据来证明我们是否真的降低了这个年龄组中认知症发病率。我们有一个对照组,他们被随机分配在积极参与组与对照组,对照组也登录网络并进行一些在线活动,但是通常他们只观看一些关于科普健康或者国家地理等内容的视频,这些我们都曾经在以前类似研究中的对照组中使用过。


We were funded in 2016 and in fact mid 2016 is when we started developing the platform. Later part of 2017, we did some of the pilot work and from that we've gone back and modified some of the modules, and now we are going through the pilot phase of running all the modules in a subgroup of people, to see what kind of difficulties we might get. If that runs smoothly, then of course we are hoping to start the trial in 2018.

2016年我们收到资助,事实上2016年中我们就开始开发这个平台。2017年后半年,我们开展了部分试点工作,随后我们对一些模块进行了修改调整,现在我们计划完成不同小组全部模块的试点工作,来观察我们可能会遇到的各种困难。如果运行顺利,那么当然我们希望可以在2018年开始这个试验。


There has not been an online trial which actually has - which is multimodal of this kind really. There have been a lot of online trials now, which have looked at one or other aspect of say, for example, with physical exercise there have been some online trials, there have been online trails for cognitive activity, for nutrition there have been online trials, certainly for depression and stress management there have been many trials. But trying to put them all together, I don’t think there has been any trial like that, and certainly this will be one of the largest. The other aspect is I think the testing, we are doing online testing and we’re not doing face to face assessments in any of these people. Most other trials have done face to face assessments at baseline and follow up. They've been short trials really, not of this duration. So, this is a very ambitious trial in that sense, to see whether this can be delivered at a population level, at a large scale level, remotely and at low cost.

在这之前并没有真正意义在网络上进行过这样的试验—实际上是个多模式试验。现在网络上的很多试验只观察某个方面,举例说,很多在线试验是关于体力锻炼的,关于认知活动的也有,营养学方面的也不少,当然对抑郁症和压力管理的试验也不胜枚举。但是把它们放在一起,我认为目前还没有,当然这也一定是一个大型试验。另一方面,我认为我们所做的是全在线测试的形式,没有对任何人做过面对面评估。大多数的其他试验会在基线状态及随访时进行面对面评估。那些都是短期试验,不像我们的周期这么长。所以从这个意义上说这是一个很有雄心的试验,让我们看看能否在人口水平,大规模地用低成本去实现它。


I think there are a number of concerns that we do have. The first concern of course is that there are many older people who are not online, and that can be about a third perhaps of very old people who are not online. Although that number is shrinking gradually, but still there are many people. Then there are other people who are online but they're very limited in their connectivity, in how comfortable they are with online activities, so they will need some extra help, some instruction. The third thing is that engaging people online, because interpersonal engagement, that face to face engagement is a different thing to engagement online. Certainly, younger people are easy to engage online, they've grown up with technology. But older people are somewhat more difficult, because they relate better to a person rather than to a virtual person in a way. That’s something that I think still we are working through and there’s not enough data, to convincingly show that yes, it’s as good as having a person there.

我们的确有一些担忧。首当其冲的担忧就是很多老年人他们不使用网络,大约有三分之一的高龄老人都不使用网络。尽管这些数字在逐渐缩小,但是还是有很多人。而那些使用网络的老人,他们上线的时间又非常有限,以及对于线上活动在多大程度能够适应,他们会需要一些额外的帮助和指导。第三个担忧就是如何使受试者能够有参与感,参与感是在人与人之间实现的,网络参与同现实中面对面参与是完全不同的。当然年轻人生在科技年代,进行线上活动对他们相当容易。但是老人却截然不同,相比虚拟交际他们更容易接受真实的人际交往。这就是我认为我们仍需努力的事情,没有足够的数据来非常信服的告诉我们,虚拟网络和现实中与人相处是一样的。


Previously in many of our trials, we have actually brought people in, for example for physical exercise. In the last trial we did, we brought them in to a gym and there was a gym instructor who worked with a group. That seems to work quite well, but it’s very expensive and it’s time consuming for everybody. Those are the concerns and there is some evidence that yes, you may be able to engage people initially, but then there’ll be a big drop out, and we don’t know how big that drop out is going to be over the course of the trial, which is running for several years.

早期的很多试验,我们把受试者带到试验里比如进行体力锻炼。在上一个试验中我们把受试者带到健身房,每组有一个健身教练来指导他们。看起来一切进行得很好,但是成本却很高,并且很浪费时间。这些就是我们的担忧,有证据显示,开始时一些受试者参与进来,但接着有很多人退出,我们不知道在这个周期这么长的试验期间退出的人到底会有多少。


I think once we have a platform, that it can be scaled up to a population level, to the whole population really. Because finally I think the ultimate objective would be that everybody at risk - and all of us are at risk of dementia. As we know by the time we reach our 90s, one in three people will have dementia and by the time - if you reach the age of 100, you have more than 50% chance of having dementia, so all of us are at risk for dementia. In fact, these risk factors apply to some degree to all of us in a way, so everyone should be doing what we are doing in this trial. But how we reach everybody in the population is the challenge, and if we have a platform like that, the objective would be to reach the whole population. It could be scaled up quite easily if it works. So, let’s hope the trial runs smoothly and that we’re able to recruit the number of people that we want to.

我想一旦我们有这样一个平台,那就是把规模增加到人口水平,甚至是全人类水平。因为我认为最终我们的目标是知道每个人的风险,我们所有人患认知症的风险。我们知道, 90岁时三分之一的人将会患上认知症—如果你活到100岁,你患认知症的几率将超过50%,所以说,我们所有人都面临患有认知症的风险。事实上,这些风险因素都不同程度地以特定的方式影响每一个人,所以每个人都应该做我们在试验中所做的事。但是如何覆盖到每一个人是我们面临的挑战,如果我们有了这样一个平台,那这个试验就可以覆盖到整个人类。如果有效的话,它会很容易的扩大延展。所以我们真心希望这个试验可以顺利进行下去,我们能够尽可能的招募到我们希望的人数。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

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