Interventions to Attenuate Cognitive Decline

项目概要 人们已经开发出不同的认知干预方法来减轻衰退（例如，认知参与 治疗、培训或刺激），但尚不清楚哪种方法有效。也不清楚什么时候， 沿着正常认知衰老到轻度认知障碍（MCI-之前的一个过渡阶段）的连续过程 痴呆发作），干预是最有效的。至关重要的是，有效认知的潜在机制 干预措施未知；这一领域取得进展的一个关键障碍。迫切需要找到有效的 遏制痴呆症日益流行的方法。总体目标是应用最佳认知 减轻认知和功能下降并遏制痴呆症患病率的干预措施。长期目标 旨在促进老年人保持健康和独立。 [这项随机临床试验将- 确定一种新颖的认知参与干预方法（强化钢琴训练）的有效性 与认知刺激（这将作为严格的主动控制）相比]。以理论为基础，中央 假设是干预措施增强了中枢听觉处理（CAP），这是一个强大的纵向预测因素 MCI 和痴呆症，会提高认知能力。音乐培训越来越被认为是实现以下目标的可行手段： 减轻与年龄相关的认知能力下降。先前的研究和我们的初步数据表明，激烈的钢琴训练- 认知刺激可能会增强 CAP，并且可能比认知刺激更有效。 [相关研究表明苏- 与接受过正规音乐训练的成年人相比，其早期 CAP、执行功能和其他认知能力 非音乐家。我们三项试点随机试验的结果表明，钢琴训练可以改善老年人的能力 CAP 和执行功能，包括 MCI 患者]。该研究的具体目的是检验效率 与认知刺激（主动控制）相关的强化钢琴训练的有效性，以提高 CAP、认知和 患有和不患有 MCI 的老年人的日常功能。钢琴培训的有效性将被确立 并将检查 MCI 状态的调节作用。拟议的研究进一步旨在阐明非 通过探索训练收益的中介因素来揭示有效认知干预方法的机制。 研究结果将是确定有效的干预方法来减弱与年龄相关的认知能力 以及功能衰退和机制的阐明。我们认为，拟议的研究具有创新性，因为 第一个钢琴训练增强老年人认知的二期随机试验。此外，这项研究是 通过纳入患有和不患有 MCI 的老年人并评估其对日常功能的影响来进行创新 性能。最重要的是，为了推进这一领域，我们将使用中介分析来阐明潜在的问题 干预效果机制。这些贡献将是巨大的，有助于加深我们对如何 认知干预会产生认知和功能改变。结果将有助于改进设计和改进 实施有效的干预措施以减轻认知能力下降并遏制痴呆症的患病率， 从而改善公共卫生。

PROJECT SUMMARY Different cognitive intervention approaches have been developed to attenuate decline (e.g., cognitive engage- ment, training, or stimulation), but it is not clear which approaches are efficacious. It is also not clear when, along the continuum of normal cognitive aging to mild cognitive impairment (MCI-a transitional stage before dementia onset), it is most effective to intervene. Crucially, the underlying mechanisms of effective cognitive in- terventions are not known; a critical barrier to progress in this field. There is an urgent need to identify effective approaches to curb the increasing prevalence of dementia. The overall objective is to apply the best cognitive interventions to attenuate cognitive and functional decline and curb dementia prevalence. The long-term goals are to promote maintained health and independence among older adults. [This randomized clinical trial will de- termine the efficacy of a novel cognitive engagement intervention approach (intense piano training) as com- pared to cognitive stimulation (which will serve as a stringent, active control)]. Grounded in theory, the central hypothesis is that interventions enhancing central auditory processing (CAP), a strong, longitudinal predictor of MCI and dementia, will improve cognition. Music training is increasingly recognized as a feasible means to at- tenuate age-related cognitive decline. Prior research and our preliminary data suggest that intense piano train- ing may enhance CAP and is likely more effective than cognitive stimulation. [Correlational studies indicate su- perior CAP, executive function, and other cognitive abilities for adults with formal music training compared to non-musicians. Our results across three pilot randomized trials show that piano training improves older adults' CAP and executive function, including those with MCI]. The specific aims of the study are to examine the effi- cacy of intense piano training relative to cognitive stimulation (active controls) to improve CAP, cognition, and everyday function among older adults with and without MCI. The efficacy of piano training will be established and moderating effects of MCI status will be examined. The proposed study further aims to elucidate the un- derlying mechanisms of effective cognitive intervention approaches by exploring mediators of training gains. Study outcomes will be identification of effective intervention approaches to attenuate age-related cognitive and functional decline and elucidation of the mechanisms. The proposed study is innovative, in our opinion, as the first phase II randomized trial of piano training to enhance older adults' cognition. Moreover, this study is innovative by including older individuals with and without MCI and assessing effects on everyday functional performance. Most importantly, to advance this field, we will use mediation analyses to elucidate the underlying mechanisms of intervention effects. The contributions will be significant, advancing our understanding of how cognitive interventions produce cognitive and functional change. Results will facilitate improved design and im- plementation of effective interventions to attenuate cognitive decline and curb the prevalence of dementia, thereby improving public health.