Walking Interventions, cognitive remediation and mild cognitive impairment

步行干预、认知矫正和轻度认知障碍

• 批准号: 8399456
• 负责人: Jeffrey Neil Keller
• 金额: $ 22.2万
• 依托单位: LSU PENNINGTON BIOMEDICAL RESEARCH CTR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8399456
• 关键词: Alzheimer' s Disease; Area; Clinical; Clinical Research; Clinical Trials Design; Cognition; Cognitive; Cognitive remediation; Conflict (Psychology); Data; Data Set; Databases; Dementia; Development; Elderly; Equilibrium; Exhibits; Experimental Designs; Fall prevention; Funding; Future; Gait; Geriatrics; Impaired cognition; Individual; Intervention; Laboratories; Length; Life; Link; Literature; Lower Extremity; Measures; Mental Depression; Monitor; Neurosciences Research; Participant; Performance; Physical activity; Process; Publications; Randomized; Randomized Clinical Trials; Regimen; Registries; Reporting; Reproducibility; Research; Research Design; Resources; Short-Term Memory; Speed; Standardization; Technology; Testing; Therapeutic; Therapeutic Intervention; Training; United States National Institutes of Health; Ursidae Family; Visit; Walking; age effect; arm; cognitive change; cognitive function; design; efficacy trial; experience; fall risk; falls; frailty; geriatric depression; improved; insight; interest; lifestyle intervention; mental state; mild neurocognitive impairment; normal aging; pre-clinical; processing speed; programs; standard measure

DESCRIPTION (provided by applicant): This proposal outlines a tightly controlled efficacy trial designed to elucidate the potential therapeutic benefit of a walking intervention (WI), cognitive remediation therapy (CRT), as well as combined WI and CRT program towards specific aspects of gait and cognition in individuals with mild cognitive impairment (MCI). These studies are important clinically because they provide the framework for the implementation of a therapeutic program in the future which reduces falls and prevents/delays the development of dementia in the elderly. The design of the studies in this proposal significantly advance the field by providin much needed clarity to a research area that contains conflicting data on the reliability, reproducibility, robustness, and sustainability of the therapeutic benefit conferred by WI and CRT. To our knowledge this is the first study to examine the individual, and combined, effects of WI and CRT (particularly in the context of MCI). Our experimental design will contribute to the process of elucidating the mechanism(s) responsible for promoting the beneficial effects of WI and/or CRT, and contribute to designing the most effective therapeutic program in the future. Scientifically these studies are important because there is increasing interest in understanding the potential interactions between gait changes and cognitive decline during the development of dementia, and these studies are designed to examine the effects of each intervention towards cognition as well as multiple aspects of gait, under both laboratory and free-living conditions. The focus of this proposal is to test the hypothesis that implementation of a WI, CRT, or a combined WI/CRT program, will have significant and beneficial effects towards cognition and gait in elderly individuals with MCI. Additionally, we will test the related hypothesis that the combined WI/CRT program will provide synergistic benefit compared to the delivery of either WI or CRT alone. In Specific Aim 1 we will determine the effects of each intervention towards multiple gait parameters under both laboratory and free living conditions. In Specific Aim 2 we will determine the effects of each intervention towards multiple aspects of cognition. The current proposal brings to bear many of the latest technological advances, diverse clinical expertise, a powerful clinical registry, and strong clinical resources in order to understand the effects of a W, CRT, and a combined WI/CRT program using a randomized clinical trial approach. These efforts are a necessary first step for the eventual development of a therapeutic program that reduces falls/dementia in the elderly, and will significantly contribute to the understanding of th shared and selective effects of aging towards gait and cognitive decline. PUBLIC HEALTH RELEVANCE: This is a tightly controlled efficacy trial designed to understand the effects of a walking intervention, cognitive remediation therapy, and combined walking and cognitive remediation program towards aspects of dementia and fall risk in individuals with mild cognitive impairment. These findings will provide insight to links between cognitive function and gait, and have a significant impact in clinical research areas of dementia, geriatrics, frailty, lifestyle interventions, and neuroscience research.

描述（由申请人提供）：本提案概述了一项严格控制的疗效试验，旨在阐明步行干预 (WI)、认知矫正疗法 (CRT) 以及 WI 和 CRT 联合方案对轻度认知障碍 (MCI) 个体步态和认知特定方面的潜在治疗益处。这些研究在临床上很重要，因为它们为未来实施治疗计划提供了框架，以减少跌倒并预防/延缓老年人痴呆症的发展。本提案中的研究设计通过为研究领域提供急需的清晰度，显着推进了该领域的发展，该研究领域包含有关 WI 和 CRT 所带来的治疗益处的可靠性、可重复性、稳健性和可持续性的相互矛盾的数据。据我们所知，这是第一项检查 WI 和 CRT 的单独和组合影响（特别是在 MCI 背景下）的研究。我们的实验设计将有助于阐明促进 WI 和/或 CRT 有益效果的机制，并有助于设计未来最有效的治疗方案。从科学角度来看，这些研究很重要，因为人们越来越有兴趣了解痴呆症发展过程中步态变化和认知能力下降之间的潜在相互作用，并且这些研究旨在检查实验室和自由生活条件下每种干预措施对认知以及步态多个方面的影响。 该提案的重点是检验以下假设：实施 WI、CRT 或 WI/CRT 联合计划将对患有 MCI 的老年人的认知和步态产生显着且有益的影响。此外，我们将检验相关假设，即与单独使用 WI 或 CRT 相比，组合 WI/CRT 计划将提供协同效益。在具体目标 1 中，我们将确定实验室和自由生活条件下每种干预措施对多个步态参数的影响。在具体目标 2 中，我们将确定每种干预措施对认知多个方面的影响。当前的提案采用了许多最新的技术进步、多样化的临床专业知识、强大的临床注册中心和强大的临床资源，以便了解使用随机临床试验方法的 W、CRT 和组合 WI/CRT 计划的效果。这些努力是最终开发减少老年人跌倒/痴呆的治疗计划的必要的第一步，并将极大地有助于理解衰老对步态和认知能力下降的共同和选择性影响。 公共健康相关性：这是一项严格对照的疗效试验，旨在了解步行干预、认知矫正疗法以及步行和认知矫正相结合的计划对轻度认知障碍患者的痴呆和跌倒风险的影响。这些发现将深入了解认知功能和步态之间的联系，并对痴呆、老年医学、衰弱、生活方式干预和神经科学研究等临床研究领域产生重大影响。