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

项目摘要/摘要 该研究计划的长期目标是创建和实现多模式生物行为 将预防或延缓老年人记忆力丧失的干预措施，但最初将重点放在患有 心血管疾病(CVD)，因为他们的风险高得不成比例。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急剧增加，女性比男性受到的影响更大， 严重程度和更快的下降。认知功能障碍的主要风险因素是心血管疾病，记忆力丧失是 一种早期出现的、特别令人痛苦的认知功能障碍，具有严重的公共健康 后果。有证据表明，体力活动干预和认知训练都能改善记忆 在健康的老年人中，当作为每个靶点结合在多模式干预中时，可能会协同作用 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 针对患有脑血管病的老年女性，尽管她们有不成比例的记忆丧失风险。此外，现有的 以记忆为目标的体力活动干预在很大程度上受到监督和结构化，这可能无法 产生长期的行为改变。相比之下，强调小行为改变的生活方式 到日常生活中更有可能得到维持。老年妇女和患有心血管疾病的成年人更喜欢生活方式干预 家庭和社区在健身房或实验室进行系统的运动干预。最后，几个人加在一起 干预措施包括血清生物标记物(例如脑源性神经营养因子[BDNF]、血管 内皮生长因子[血管内皮生长因子]、胰岛素样生长因子1[IGF-1])，可能是 干预效果。我们将基于我们两个研究领域的令人振奋的发现：(1)生活方式 针对患有心血管疾病的老年女性的体力活动干预，以及(2)易于传播的认知训练 在心力衰竭患者中使用BrainHQ计划。这项研究计划的下一步是分析 生活方式、体力活动干预(MOVE)和认知训练的独立和综合影响 65岁≥脑血管病患者的记忆力。在建议的研究中，我们会评估 24周联合MindMoves对24、48和48岁的记忆表现和记忆相关血清生物标志物的影响 患有心血管疾病的老年妇女72周。使用2x2析因设计，将招募254名患有心血管疾病的老年女性 来自两家女性心脏病诊所，随机分为四种情况之一：(1)移动，(2)心智，(3) 心动，(4)常规护理对照。目标是：(1)确定独立的和综合的效率 运动和心理干预对记忆表现的影响，(2)决定了独立和综合效应 运动和心理干预对记忆相关血清生物标记物(BDNF、VEGF、IGF-1)的影响，以及(3)检查 抑郁症状和遗传因素(载脂蛋白E-ε4等位基因，脑源性神经营养因子基因)作为潜在的调节因子 目标行为的变化与记忆之间的联系。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对患有脑血管病的老年妇女记忆的靶向能力。

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.