Lifestyle Physical Activity and Cognitive Training Interventions: Preventing Memory Loss in Older Women with Cardiovascular Disease

项目概要/摘要 该研究计划的长期目标是创建和实施多模态生物行为 干预措施将预防或延迟老年人的记忆丧失，但最初将集中在女性， 心血管疾病（CVD），由于其不成比例的高风险。这一点很重要，因为 65岁以后，认知功能障碍随着年龄的增长而急剧增加，对女性的影响大于男性， 严重性和更快的下降。认知功能障碍的一个主要危险因素是心血管疾病，记忆丧失是 这是一种早期出现的，特别令人痛苦的认知功能障碍， 后果有证据表明，身体活动干预和认知训练都能提高记忆力 在健康的老年人中，当在多模式干预中组合作为每个目标时， 不同的机制。到目前为止，还没有测试身体活动干预和/或认知训练的研究， 目标是患有心血管疾病的老年妇女，尽管她们有不成比例的记忆丧失风险。此外，现有 针对记忆的身体活动干预在很大程度上是监督和结构化的，这可能无法 产生长期的行为改变。相反，生活方式方法强调小的行为变化， 日常生活中，更有可能保持。老年女性和成年CVD患者更喜欢生活方式干预， 家庭和社区在健身房或实验室进行有组织的锻炼干预。最后，很少有人 干预包括血清生物标志物（例如，血管性脑源性神经营养因子 内皮生长因子[VEGF]，胰岛素样生长因子1 [IGF-1]），可能是 干预效果。我们将建立在我们两条研究路线的有希望的发现之上：（1）生活方式 针对心血管疾病老年妇女的体力活动干预，以及（2）易于传播的认知训练 在心力衰竭患者中进行BrainHQ项目。这项研究计划的下一步是分析 生活方式体育活动干预（Move）和认知训练的独立和综合效应 （精神）对≥ 65岁CVD女性记忆力的影响。在拟议的研究中，我们将评估 24-在24、48和49周时，MindMoves对记忆性能和记忆相关血清生物标志物的影响 72周的老年女性CVD。采用2x2析因设计，将招募254名患有CVD的老年女性 从两个妇女的心脏病诊所，并随机分为四个条件之一：（1）移动，（2）思想，（3） MindMoves，（4）常规护理控制。目的是：（1）确定以下药物的独立和联合疗效： 移动和思维干预对记忆表现的影响，（2）确定独立和联合功效 对记忆相关的血清生物标志物（BDNF，VEGF，IGF-1）的移动和思维干预，以及（3）检查 抑郁症状和遗传因素（APOE-ε4等位基因，BDNF基因型）作为潜在的调节因子， 目标行为变化与记忆之间的关联。调查结果将提供有关 实用和可扩展的多模式生活方式干预的能力，以针对老年女性心血管疾病的记忆。

Project Summary/Abstract The long-term goal of this program of research is to create and implement multimodal biobehavioral interventions that will prevent or delay memory loss in older adults but will initially focus on women with cardiovascular disease (CVD) due to their disproportionately higher risk. This is important as the prevalence of cognitive dysfunction steeply increases with age after 65 years, affecting women more than men, with greater severity and more rapid decline. A leading risk factor for cognitive dysfunction is CVD, and loss of memory is an early-emerging and particularly distressing type of cognitive dysfunction with serious public health consequences. Evidence shows that both physical activity interventions and cognitive training improve memory in healthy older adults and may synergize when combined in a multimodal intervention as each targets different mechanisms. To date, no study testing physical activity interventions and/or cognitive training has targeted older women with CVD despite their disproportionate risk for memory loss. Moreover, existing physical activity interventions that target memory are largely supervised and structured, which can fail to generate long-term behavior change. In contrast, lifestyle approaches emphasizing small behavioral changes to daily life are more likely to be maintained. Older women and adults with CVD prefer lifestyle interventions in the home and community over structured exercise interventions in a gym or lab. Finally, few combined interventions have included serum biomarkers (e.g., brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF], insulin-like growth factor 1 [IGF-1]) that may be early indicators of intervention effects. We will build upon the promising findings of our two lines of research: (1) a lifestyle physical activity intervention targeting older women with CVD, and (2) easily disseminated cognitive training with the BrainHQ program in patients with heart failure. The next step of this research program is to analyze the independent and combined effects of a lifestyle physical activity intervention (Move) and cognitive training (Mind) on memory in women ≥ 65 years with CVD. In the proposed study, we will evaluate the efficacy of the 24-week combined MindMoves on memory performance and memory-related serum biomarkers at 24, 48, and 72 weeks in older women with CVD. Using a 2x2 factorial design, 254 older women with CVD will be recruited from two women’s cardiology clinics and randomized to one of four conditions: (1) Move, (2) Mind, (3) MindMoves, (4) usual care control. Aims are to: (1) determine the independent and combined efficacies of Move and Mind interventions on memory performance, (2) determine the independent and combined efficacies of Move and Mind interventions on memory-related serum biomarkers (BDNF, VEGF, IGF-1), and (3) examine depressive symptoms and genetic factors (APOE-ε4 allele, BDNF genotype) as potential moderators of the association between changes in target behaviors and memory. Findings will provide key knowledge about the ability of practical and scalable multimodal lifestyle interventions to target memory in older women with CVD.