Cognitive training and dual-task ability in older adults

老年人的认知训练和双重任务能力

• 批准号: 8278192
• 负责人: COURTNEY HALL
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8278192
• 关键词: Address; Age; Age-Years; Age-associated memory impairment; Aging; Attention; Clinic; Cognition; Cognitive; Data; Drug usage; Economics; Effectiveness; Elderly; Equilibrium; Etiology; Exhibits; Future; Gait; Goals; Health Care Costs; Impairment; Incidence; Injury; Intervention; Intervention Studies; Measures; Mission; Morbidity - disease rate; Motor; Musculoskeletal; Outpatients; Participant; Patient Care; Physical therapy; Population; Publishing; Quality of life; Randomized; Recruitment Activity; Rehabilitation therapy; Research; Resources; Savings; Sensory; Speed; Task Performances; Testing; Therapeutic; Time; Training; Veterans; Visit; Walking; base; cognitive function; cognitive training; cost; effective intervention; equilibration disorder; executive function; fall risk; falls; high risk; human very old age (85+); improved; motor impairment; novel; novel strategies; primary outcome; processing speed; sensory system

DESCRIPTION (provided by applicant): The number of veterans over 85 years of age has tripled during this decade (US Dept of Veterans Affairs, 2007). It has been demonstrated that the rate of falls doubles after age 75 (Hausdorff, 2001). Given the increased incidence of falls with age and associated morbidity, this study has significance to aging veterans. Historically, degradation of balance control in older adults has been attributed to impairments of the motor and/or sensory systems. As a result, therapy has focused on motor and sensory impairments. However, evidence suggests that an impaired ability to allocate attentional resources to balance during dual-task situations is a powerful predictor of falls (Verghese, 2002). Despite this fact, few studies have examined whether interventions can improve older adults' dual-task ability. The goal of this study is to develop effective interventions to improve ability to allocate attention to balance and gait under dual-task conditions. Studies have shown that dual-task performance by older adults can be improved; however, the majority of research has been in non-balance related tasks (Rogers and Fisk, 2001). Interventions with small numbers provide the only evidence for the effectiveness of training to improve ability to divide attention in gait tasks. Silsupadol et al. (2009a, 2009b) foud that only participants trained under dual-task conditions showed improvements in gait under dual-task conditions. In contrast, Hall and Heusel-Gillig (2010) found that balance rehabilitation with no specific dual-task training resulted in improved gait under dual-task conditions. Further research is warranted to determine optimal balance rehabilitation parameters. Thus, the first aim of the study is to examine the extent to which the addition of dual-task practice improves gait under dual-task conditions. A novel approach to improving gait is through the enhancement of cognitive function. Pharmacologic interventions have demonstrated a positive effect on gait by the use of drugs that improve cognition (Auriel, 2006). Recent findings suggest that specific cognitive abilities (speed of processing, attention, and executive control) are associated with ability to walk under dual-task conditions (Hall, in press; Holtzer, 2006). There is substantial evidence that cognitive training can improve these specific cognitive abilities in older adults (Ball, 2002). It is unknown whether such improvements in cognition would enhance gait under dual-task conditions. Thus, another goal of the study is to examine the extent to which cognitive training benefits dual-task ability. Specific Aim 1 Examine the extent to which the inclusion of dual-task practice to standard balance rehabilitation results in greater benefits to dual-task ability. Hypothesis 1a: There will be greater improvement in walking under dual-task conditions following balance rehabilitation that includes dual-task activities. Hypothesis 1b: Improved motor abilities will explain a significant proportion of the variance of improved ability to walk under dual-task conditions. Specific Aim 2 Examine the extent to which the addition of cognitive training following balance rehabilitation results in greater benefits to dual-task ability. Hypotheis 2a: There will be additional improvements in the ability to walk under dual-task conditions following cognitive training. Hypothesis 2b: There will be greater benefits to walking under dual-task conditions following speed of processing training versus general cognitive training. Hypothesis 2c: Improved cognitive abilities will explain a significant proportion of the variance o further improvements in walking under dual-task conditions. Older adults (n = 44) who have been referred to physical therapy (PT) for gait or balance impairments who have dual-task impairment (based on published criteria for the timed up and go test with a subtraction task) will be randomized to receive either standard balance rehabilitation or balance rehabilitation with dual-task practice. Following PT, subjects will receive cognitive training (CT), either speed of processing or generalized cognitive training. Primary outcomes are ability to walk while performing four different cognitive tasks of varying difficulty. Assessment will occur at baseline, post-PT, post-CT. PUBLIC HEALTH RELEVANCE: Relevance of Proposed Research to VA Patient Care Mission This research directly addresses the mission of the VA by attending to quality-of-life mandates. The number of veterans age 85 years and older has tripled this decade (VetData, 2010). Older veterans, particularly those over 85, are among the most vulnerable of the veteran population and are at highest risk for suffering fall-related injuries. An estimate of outpatient costs to the VA in 2001 for fall-related injuries as nearly $3.3 million for the initial visit alone (Luther, 2005). The potential for large economic savings by reducing falls incidence, thus fall-related injuries, is evident. Given the increased incidence of falls with age and the morbidity associated with falls, the results of this study willbe relevant to a substantial number of veterans. The proposed study has the potential to develop novel rehabilitation approaches to reduce the risk of falls in older veterans. This project will contribute to improved management of fall risk, improved quality of life and to containing the cost of health care in the elderly.

描述（由申请人提供）： 在这十年中，85 岁以上退伍军人的数量增加了两倍（美国退伍军人事务部，2007 年）。研究表明，75 岁以后跌倒率会翻倍（Hausdorff，2001）。鉴于跌倒发生率随着年龄的增长和相关发病率的增加而增加，这项研究对老年退伍军人具有重要意义。从历史上看，老年人平衡控制能力的下降被归因于运动和/或感觉系统的损伤。因此，治疗的重点是运动和感觉障碍。然而，有证据表明，在双重任务情况下分配注意力资源以保持平衡的能力受损是跌倒的有力预测因素（Verghese，2002）。尽管如此，很少有研究探讨干预措施是否可以提高老年人的双重任务能力。本研究的目标是开发有效的干预措施，以提高双任务条件下分配注意力到平衡和步态的能力。研究表明，老年人的双重任务表现可以得到改善；然而，大多数研究都是在非平衡相关任务上（Rogers 和 Fisk，2001）。少量干预提供了训练有效性的唯一证据，以提高步态任务中分散注意力的能力。西苏帕朵等。 (2009a, 2009b) 发现只有在双任务条件下接受训练的参与者在双任务条件下表现出步态改善。相比之下，Hall 和 Heusel-Gillig (2010) 发现，在没有特定双任务训练的情况下进行平衡康复可以改善双任务条件下的步态。需要进一步的研究来确定最佳的平衡康复参数。因此，该研究的首要目的是检查双任务练习在双任务条件下改善步态的程度。改善步态的一种新方法是通过增强认知功能。药物干预已证明通过使用改善认知的药物对步态有积极影响（Auriel，2006）。最近的研究结果表明，特定的认知能力（处理速度、注意力和执行控制）与双任务条件下的行走能力相关（Hall，正在出版；Holtzer，2006）。有大量证据表明认知训练可以提高老年人的这些特定认知能力（Ball，2002）。目前尚不清楚这种认知能力的提高是否会增强双任务条件下的步态。因此，该研究的另一个目标是检验认知训练在多大程度上有利于双任务能力。具体目标 1 检查将双任务练习纳入标准平衡康复对双任务能力带来更大益处的程度。假设 1a：在进行包括双任务活动在内的平衡康复后，双任务条件下的行走将会有更大的改善。假设 1b：运动能力的提高可以解释双任务条件下行走能力提高的很大一部分差异。具体目标 2 检查平衡康复后添加认知训练对双任务能力产生更大益处的程度。假设 2a：认知训练后，双任务条件下的行走能力将会进一步提高。假设 2b：与一般认知训练相比，在处理速度训练之后的双任务条件下步行会带来更大的好处。假设 2c：认知能力的提高可以解释双任务条件下步行进一步改善的很大一部分差异。因步态或平衡障碍而接受物理治疗 (PT) 并患有双任务障碍（基于已发布的减法任务计时开始测试标准）的老年人 (n = 44) 将被随机分配接受标准平衡康复或双任务练习平衡康复。 PT 之后，受试者将接受认知训练 (CT)，无论是处理速度还是广义认知训练。主要结果是在执行四种不同难度的不同认知任务时行走的能力。评估将在基线时进行， PT后、CT后。 公共卫生相关性： 拟议研究与 VA 患者护理使命的相关性 这项研究通过关注生活质量要求直接解决 VA 的使命。十年来，85 岁及以上退伍军人的数量增加了两倍（VetData，2010）。老年退伍军人，特别是 85 岁以上的退伍军人，是退伍军人群体中最脆弱的群体之一，遭受跌倒相关伤害的风险最高。据估计，2001 年退伍军人管理局因跌倒相关伤害而仅初次就诊的门诊费用就接近 330 万美元（Luther，2005）。通过减少跌倒发生率（从而减少跌倒相关伤害）来节省大量经济的潜力是显而易见的。鉴于跌倒发生率随着年龄的增长以及与跌倒相关的发病率的增加而增加，这项研究的结果将与大量退伍军人相关。拟议的研究有可能开发出新的康复方法，以降低老年退伍军人跌倒的风险。该项目将有助于改善跌倒风险的管理、提高生活质量并控制老年人的医疗费用。