Efficacy of Adapted Tai Ji Quan to Slow Cognitive Decline in Older Adults

项目总结/摘要 背景运动通常被认为是一种非药物策略， 在保护老年人的认知功能或减缓认知障碍的进展方面具有保护作用 轻度认知障碍（MCI）。然而，大多数运动干预措施只关注 身体发育相对较少的干预措施结合了身体和认知训练 伴随地或明确地整合用于认知刺激的认知-物理组件。而且 运动改善MCI老年人认知功能的证据既有限又不确定， 因此很难推荐最佳实践。 Objective.本申请的主要目的是确定认知增强的 运动干预-太极拳：保持大脑健康（TJQMMBH）。TJQMMBH是建立在一个 一个经过全面研究的循证计划，已被证明具有多种健康结果 但现在明确整合了认知组件，旨在增加多任务成本和认知 需要进行日常运动任务。因此，基于我们有希望的试点数据，我们的 这项拟议研究的主要目的是确定新开发的TJQMMBH干预措施是否会 对患有遗忘型MCI的老年人的认知功能有积极影响。我们还有四个二级的 目的是检查（1）TJQMMBH是否可以减缓认知障碍的进展;（2） 整体认知功能的改善是通过运动信心的增加来介导的;（3） TJQMMBH对认知结果的干预在干预后随访期内持续存在;以及（4） 执行功能的改变和身体表现之间存在关联。 Approach.我们实现研究目标的核心方法是进行一项前瞻性、单盲、3组、 将评价认知增强TJQMMBH干预的随机（活性对照）试验 对一个标准的太极拳干预和一个伸展运动控制。我们的设计可以让我们测试 关于6个月TJQMMBH干预相对于标准太极拳的有效性的假设 和伸展控制，在改善全球认知功能和运动认知双重的主要成果， 任务步态表现和社区特定领域认知功能的次要结果- 根据已建立的临床标准诊断为遗忘型MCI的居住老年人。 意义和影响。这项工作意义重大，因为它解决了目前有限的选择， 社区和临床实践，为解决老年人认知能力下降提供最有效的策略。 成人MCI因此，如果拟议的干预措施被证明是有效的，科学影响可能会 在提供替代的、非药物性的认知训练干预方面， 改善患有MCI的美国老年人的认知能力下降，延迟或预防痴呆症的发作。

Project Summary/Abstract Background. Exercise is generally considered a non-pharmacological strategy that plays an important protective role in preserving cognitive function or mitigating the progression of cognitive impairment for older adults with mild cognitive impairment (MCI). Most exercise interventions, however, focus exclusively on physical development. Relatively few interventions have either combined physical and cognitive training concomitantly or explicitly integrated cognitive-physical components for cognitive stimulation. Moreover, the evidence that exercise improves cognitive function in older adults with MCI is both limited and inconclusive, making it difficult to recommend best practices. Objective. The primary objective of this application is to determine the efficacy of a cognitively enhanced exercise intervention - Tai Ji Quan: Moving to Maintain Brain Health (TJQMMBH). TJQMMBH is built on a comprehensively researched, evidence-based program that has been shown to have multiple health outcomes but now explicitly integrates a cognitive component aimed at increasing multitasking costs and cognitive demands on performing deliberate daily motor tasks. Accordingly, grounded on our promising pilot data, our primary aim in this proposed study is to determine whether the newly developed TJQMMBH intervention will have a positive effect on cognitive function in older adults with amnestic MCI. We also have four secondary aims that will examine whether (1) TJQMMBH can slow the progression of cognitive impairment; (2) improvement in global cognitive function is mediated through gains in movement confidence; (3) the benefits of the TJQMMBH intervention on cognitive outcomes persist over a post-intervention follow-up period; and (4) there is an association between change in executive function and physical performance. Approach. Our core approach to achieving our research aims is to perform a prospective, single-blind, 3-arm, randomized (active control) trial in which the cognitively enhanced TJQMMBH intervention will be evaluated against a standard Tai Ji Quan intervention and a stretching exercise control. Our design will allow us to test the hypothesis regarding the efficacy of a 6-month TJQMMBH intervention, relative to standard Tai Ji Quan and stretching control, in improving the primary outcomes of global cognitive function and motor-cognitive dual- task gait performance and the secondary outcomes of domain-specific cognitive functions in community- dwelling older adults who have been diagnosed with amnestic MCI per established clinical criteria. Significance and impact. This work is significant because it addresses the currently limited options in community and clinical practice for offering the most effective strategies that address cognitive decline in older adults with MCI. Therefore, if the proposed intervention proves to be effective, the scientific impact is likely to be high in terms of providing an alternative, non-pharmacological-based cognitive training intervention to ameliorate cognitive decline in older Americans with MCI and delay or prevent the onset of dementia.