A Brain-based Approach to Enhancing Executive Control Functions in Healthy Aging

描述(由应聘者提供)：目标方向不佳，或者在令人分心的环境中失去集中注意力和‘专注于任务’的能力，是老年人常见的抱怨。这样的主观报告与认知老化研究文献中的一个新共识是一致的，即维持目标方向所需的执行控制过程特别容易随着年龄的增长而下降。遗憾的是，尽管执行控制缺陷对日常生活功能有重大影响，并在以后的生活中维持功能独立，但文献报道的执行控制缺陷的有效治疗方法很少。在这里，我们认为，由于我们对大脑中辅助执行控制处理的神经机制缺乏了解，这些治疗的有效性受到了阻碍。该提案的第一个目标是开发执行控制过程的强大生物标记物，以补充治疗疗效的神经认知和功能结果衡量标准。这些生物标志物将用于识别对治疗最敏感的神经过程，并预测神经认知和功能获得，从而为设计更有针对性和更有效的基于大脑的治疗提供信息。该提案的第二个目标是明确测试这种基于大脑的方法，使用集成的基于策略和有针对性的过程培训协议，以增强健康老龄化中的执行控制处理。通过这种综合治疗方法，我们打算通过在治疗师指导的、基于策略的目标管理计划中加强和结合目标培训来利用从有针对性的培训中实现的收获。这一计划是针对感兴趣的过程(执行控制)而标准化的，但指导战略应用到单独突出的、自我生成的目标和与个人相关的现实生活情况。结果将在神经、神经认知和功能结果层面进行评估。这种从大脑到行为再到持久功能变化的脚手架方法，通过推迟对家庭护理、疗养院或医院服务的需求，同时保持老龄化人口的功能独立性和尊严，确保认知补救努力直接造福老年人，并更广泛地惠及社会。 与公共健康相关：与正常衰老相关的认知衰退可能会对个人的生产力、身体健康和总体幸福感产生广泛影响。特别是随着预计未来几十年老龄化人口的增加，与年龄相关的认知能力下降是一个主要的公共卫生问题。该项目的目的是研究年龄相关性认知下降的神经机制，并开发干预措施和生物标记物来评估这些干预措施的效果。

DESCRIPTION (provided by applicant): Poor goal direction, or loss of ability to concentrate and 'stay on task' in a distracting environment, is a common complaint in advanced age. Such subjective reports are consistent with an emerging consensus in the cognitive aging research literature suggesting that the executive control processes necessary for maintaining goal direction are particularly susceptible to decline with advancing age. Unfortunately, there have been few efficacious treatments for executive control deficits reported in the literature despite their significant impact on daily life functions and the maintenance of functional independence into later life. Here we argue that the efficacy of such treatments is hindered by our poor understanding of the neural mechanisms subserving executive control processing in the brain. The first aim of the proposal is to develop robust biomarkers of executive control processes to complement neurocognitive and functional outcome measures of treatment efficacy. These biomarkers will serve to identify neural processes that are most responsive to treatment and predictive of neurocognitive and functional gain, thus informing the design of more targeted and efficacious brain-based treatments. A second aim of the proposal is to test this brain-based approach explicitly using an integrated strategy-based and targeted process training protocol to enhance executive control processing in healthy aging. Through this combined treatment approach we intend to leverage gains realized from targeted training by reinforcing and contextualizing them in a therapist-guided, strategy-based goal management program. This program is standardized for the process of interest (executive control), but guides strategy application to individually-salient, self-generated goals and personally-relevant real-life situations. Outcomes will be assessed at the neural, neurocognitive and functional outcome levels. Such a scaffolded approach, building from the level of brain to behavior to lasting functional change, ensures that cognitive remediation efforts benefit older adults directly, and society more generally, by delaying the need for home care, nursing home or hospital services while preserving the functional independence and dignity of an aging population. PUBLIC HEALTH RELEVANCE: Cognitive decline associated with normal aging can have a broad impact on an individual's productivity, physical health and general sense of well-being. Especially with the expected increase in the aging population in the next few decades, age-related cognitive decline is a major public health issue. The aim of this project is to investigate the neural mechanisms underlying age-related cognitive decline and to develop interventions and biomarkers to evaluate the efficacy of these interventions.