Web-based technology and cognitive training: improving executive control in cognitivelyhealthy older adults

项目摘要/摘要 为认知正常的老年人(OA)开发有效的认知训练是一个主要的公共卫生目标 它在减少与年龄相关的认知衰退和阿尔茨海默病/痴呆症风险方面的潜力。执行人员 控制(EC)是一个相关的训练目标，因为它随着年龄的增长而下降，并且对日常生活中的多任务处理至关重要。 欧共体的OA培训计划已被证明有助于认知能力的改善，但尚不清楚 它是否增强了多任务处理的能力，并转移到不同的任务和背景下，如日常生活。多数 EC培训方案未能采用生态任务，限制了其临床实用性和推广性。一个 很有前途的EC培训方法是重点改变(Emch)，事实表明，这种方法对年轻人和 骨关节炎。类似的方法也显示了OA的训练转移，这表明Emch可能是一种合适的 方法诱导骨性关节炎患者发生迁移。到目前为止，Emch还没有被应用于模拟日常生活的生态任务 它也不是通过基于网络的界面远程实施的。基于网络的培训是 这是一种进步，因为它可以在家里交付，并且很容易扩展。最近，远程干预已经 由于新冠肺炎大流行，限制了面对面研究的参与，因此与开放式学习相关。海流 一项提案寻求通过早餐游戏(B-Game)实施EMCH来弥合上述差距，a 基于Web的生态培训平台，模拟日常生活环境，在办公自动化中可行。《目标1》 该提案的2个阶段(K99阶段)将基于认知健康的骨性关节炎的试点研究，以便1) 调查基于网络B-Game的12节训练协议的可接受性/可用性和结构，以及2) 与对照干预相比，EMCH方法的效果。K99阶段将提供试点数据 关于若干干预措施的特点和结果。这些数据对于优化 我计划在R00阶段(目标3)进行随机对照临床试验，以评估疗效 Oa中的Emch/B-游戏。R00试验将得到阿尔茨海默病血液生物标记物的丰富， 将提高诊断的准确性，并使我能够探索作为病理功能的干预反应。至 为了实现这些目标，我将发展高级技能，以补充我在神经心理学方面的培训，正如我将： 1)丰富了我对认知老化/EC的概念理解；2)拓宽了我的认知训练知识， 以及它与技术和远程神经心理学的结合；3)开发临床试验方面的专业知识；4)获得 具有统计分析技能。此外，我还会充实我对阿尔茨海默氏症的病理和收获的知识 设计功能磁共振实验的技能，相关的目标是我作为一名未来专注于衰老的试验者的独立性。我 已经组建了一支优秀的、全面的导师团队，拥有认知老化方面的专业知识，EC/Emch， 临床试验、技术干预、远程神经心理学和生物标记物。总体而言，这份K99/R00提案 为专注于基于技术的OA干预的独立研究生涯奠定了基础 以减少与年龄相关的认知衰退，促进阿尔茨海默病/痴呆症的预防。

Project Summary/Abstract Developing efficient cognitive training for cognitively intact older adults (OA) is a major public health goal, due to its potential for reducing age-related cognitive decline and Alzheimer’s disease/dementia risk. Executive Control (EC) is a relevant training target since it declines with aging and is critical for multi-tasking in daily life. EC training programs for OA have been shown to lead to cognitive improvements, but it remains unclear whether it enhances multi-tasking ability and transfer to different tasks and context, such as everyday life. Most EC training protocols fail to adopt ecological tasks, which limit its clinical relevance and generalization. A promising EC training approach is Emphasis Change (EmCh), which has shown to benefit both younger and OA. Similar approaches have shown training-transfer in OA, suggesting that EmCh may be an appropriate method to induce transfer in OA. To date, EmCh has not been applied in ecological tasks that simulate a daily life situation, nor has it been implemented remotely through a web-based interface. The web-based training is an advancement since it can be delivered at home and is easily scalable. Recently, remote interventions have been relevant to OA due to the COVID-19 pandemic, which limits in-person research participation. The current proposal seeks to bridge the above gaps by implementing EmCh through the Breakfast Game (B-Game), a web-based ecological training platform that simulates a daily life environment and is feasible in OA. The Aims 1 and 2 (K99 phase) of this proposal will be based on a pilot study with cognitively healthy OA in order to 1) investigate acceptability/usability and structure of a 12-session training protocol based on web B-Game, and 2) the effects of EmCh approach, in comparison to a control intervention. The K99 phase will provide pilot data regarding several intervention features and outcomes. These data will be critical to optimize the design for the randomized controlled clinical trial I plan to conduct in the R00 phase (Aim 3), in order to evaluate the efficacy of EmCh/B-Game in OA. The R00 trial will be enriched by Alzheimer`s disease blood-based biomarkers, which will improve diagnostic accuracy and allow me to explore intervention response as a function of pathology. To accomplish these aims, I will develop advanced skills to supplement my training in neuropsychology, as I will: 1) enrich my conceptual understanding of cognitive aging/EC; 2) broaden my knowledge of cognitive training, and its integration with technology and teleneuropsychology; 3) develop expertise in clinical trials; and 4) gain skills in statistical analysis. Additionally, I will 5) enrich my knowledge on Alzheimer`s pathology and 6) gain skills in designing fMRI experiments, relevant aims for my independence as a future trialist focused on aging. I have assembled an excellent and well-rounded mentorship team with expertise in cognitive aging, EC/EmCh, clinical trials, technological interventions, teleneuropsychology, and biomarkers. Overall, this K99/R00 proposal lays the foundation for an independent research career focused on technology-based intervention for OA, in order to reduce age-related cognitive decline and promote Alzheimer’s disease / dementia prevention.