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

项目概要/摘要 为认知完整的老年人（OA）开发有效的认知训练是一个主要的公共卫生目标， 降低与年龄相关的认知能力下降和阿尔茨海默病/痴呆症风险的潜力。执行 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，并且对于日常生活中的多任务处理至关重要。 针对OA的EC培训计划已被证明可以改善认知能力，但目前尚不清楚 它是否增强了多任务处理能力，并转移到不同的任务和环境中，如日常生活。最 EC训练方案未能采用生态任务，限制了其临床意义和推广。一 有前途的EC培训方法是重点改变（EmCh），这已被证明有利于年轻人和 OA。类似的方法也显示了OA的培训迁移，这表明EmCh可能是一个合适的方法。 方法诱导骨关节炎转移。到目前为止，EmCh尚未应用于模拟日常生活的生态任务中。 生活情况，也没有通过基于网络的界面远程实施。网络培训是 这是一个进步，因为它可以在家里交付，并且很容易扩展。最近，远程干预措施 由于COVID-19大流行，限制了亲自参与研究，因此与OA相关。当前 建议旨在透过早餐游戏（B-Game）， 基于网络的生态培训平台，模拟日常生活环境，在办公自动化中是可行的。目标1 和2（K99阶段）将基于认知健康OA的试点研究，以1） 研究基于Web 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 关于几个干预措施的特点和结果。这些数据对于优化 我计划在R 00期（目标3）进行的随机对照临床试验，以评价疗效 在OA中的EmCh/B-Game。R 00试验将通过阿尔茨海默病血液生物标志物来丰富， 将提高诊断的准确性，并允许我探索作为病理功能的干预反应。到 为了实现这些目标，我将发展先进的技能，以补充我在神经心理学方面的培训，因为我将： 1)丰富了我对认知老化/EC的概念性理解; 2）拓宽了我对认知训练的知识， 及其与技术和远程神经心理学的整合; 3）发展临床试验的专业知识; 4）获得 统计分析技能。此外，我将丰富我在阿尔茨海默病病理学方面的知识， 设计功能性磁共振成像实验的技巧，作为一名专注于衰老的未来试验者，我的独立性的相关目标。我 组建了一支优秀而全面的导师团队，拥有认知老化，EC/EmCh， 临床试验、技术干预、远程神经心理学和生物标志物。总体而言，K99/R 00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能力下降，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.