Walking Interventions, cognitive remediation and mild cognitive impairment

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)、认知补救疗法(CRT)以及步行干预和CRT联合计划对轻度认知障碍(MCI)患者步态和认知的特定方面的潜在治疗益处。这些研究具有重要的临床意义，因为它们为未来实施减少跌倒和预防/延缓老年痴呆症发展的治疗计划提供了框架。这项建议中的研究设计大大推进了该领域的发展，因为它为一个研究领域提供了亟需的清晰度，该研究领域包含了关于放射治疗和CRT所提供的治疗益处的可靠性、重复性、稳健性和可持续性的相互矛盾的数据。据我们所知，这是第一次研究放射治疗和CRT(特别是在MCI的情况下)的个体效应和联合效应。我们的实验设计将有助于阐明促进放疗和/或CRT有益效果的机制(S)，并有助于设计未来最有效的治疗方案。从科学上讲，这些研究很重要，因为人们越来越有兴趣了解痴呆发展过程中步态变化和认知衰退之间的潜在相互作用，这些研究旨在考察在实验室和自由生活条件下，每种干预措施对认知以及步态的多个方面的影响。这项建议的重点是验证这样一种假设，即实施WI、CRT或联合WI/CRT计划将对患有MCI的老年患者的认知和步态产生显著和有益的影响。此外，我们还将检验相关假设，即与单独实施放射治疗或放射治疗相比，联合放射治疗/放射治疗计划将提供协同效益。在具体目标1中，我们将确定在实验室和自由生活条件下每次干预对多个步态参数的影响。在具体目标2中，我们将确定每次干预对认知的多个方面的影响。目前的提案利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和联合WI/CRT计划的效果。这些努力是最终开发减少老年人跌倒/痴呆症的治疗计划的必要的第一步，并将大大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。 公共卫生相关性：这是一项严格控制的疗效试验，旨在了解步行干预、认知补救治疗以及步行和认知补救相结合的计划对轻度认知障碍患者的痴呆症和跌倒风险的影响。这些发现将为认知功能和步态之间的联系提供洞察力，并对痴呆症、老年病、虚弱、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。

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.