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: 8548957
• 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/8548957
• 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 ability; cognitive function; cognitive task; 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 input; 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.

描述（由申请人提供）： 85岁以上的退伍军人人数在这十年中增加了两倍（美国退伍军人事务部，2007年）。研究表明，75岁以后，福尔斯跌倒的几率会加倍（Hausdorff，2001）。鉴于福尔斯的发病率随着年龄的增长和相关的发病率增加，这项研究对老年退伍军人具有重要意义。从历史上看，老年人平衡控制的退化归因于运动和/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，在双重任务的情况下，分配注意力资源的平衡能力受损是福尔斯的一个强有力的预测因素（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。本研究的目的是开发有效的干预措施，以提高在双重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的任务中（Rogers和菲斯克，2001年）。少数干预措施提供了训练有效性的唯一证据，以提高在步态任务中分配注意力的能力。Silsupadol等人（2009 a，2009 b）发现，只有在双重任务条件下训练的参与者在双重任务条件下表现出步态改善。相比之下，Hall和Heusel-Gillig（2010）发现，没有特定双任务训练的平衡康复可以改善双任务条件下的步态。需要进一步研究以确定最佳平衡康复参数。因此，本研究的第一个目的是检查在何种程度上增加双任务的做法，改善步态下的双任务条件。改善步态的一种新方法是通过增强认知功能。通过使用改善认知的药物，药物干预已证明对步态有积极影响（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）与在双重任务条件下行走的能力有关（Hall，出版中; Holtzer，2006）。有大量证据表明，认知训练可以改善老年人的这些特定认知能力（Ball，2002）。目前还不清楚这种认知能力的提高是否会在双重任务条件下提高步态。因此，本研究的另一个目的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检查在何种程度上包括双任务的做法，以标准的平衡康复结果在更大的好处，双任务的能力。假设1a：在包括双任务活动的平衡康复之后，在双任务条件下的行走将有更大的改善。假设1b：运动能力的提高可以解释在双重任务条件下行走能力提高的显著差异。具体目标2检查在平衡康复后增加认知训练对双重任务能力的益处。假设2a：认知训练后，在双重任务条件下行走的能力会有额外的改善。假设2b：与一般认知训练相比，在处理速度训练后的双任务条件下行走会有更大的好处。假设2c：认知能力的提高将解释在双任务条件下行走的进一步改善的方差的显著比例。因步态或平衡障碍而接受物理治疗（PT）的老年人（n = 44）有双重任务障碍（基于已发表的减法任务定时启动测试标准），将随机接受标准平衡康复或双任务练习平衡康复。PT后，受试者将接受认知训练（CT），包括处理速度或广义认知训练。主要结果是在执行不同难度的四种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