Interventions to Attenuate Cognitive Decline

项目摘要 已经开发了不同的认知干预方法来减弱衰退（例如，认知参与， 教育、培训或刺激），但尚不清楚哪些方法有效。也不清楚何时， 沿着正常认知老化到轻度认知损害（MCI-之前的过渡阶段）的连续体， 痴呆发作），干预是最有效的。重要的是，有效认知的潜在机制- 干预措施尚不清楚;这是这一领域进步的关键障碍。迫切需要确定有效的 以遏制痴呆症日益增加的患病率。总体目标是应用最好的认知 干预措施，以减轻认知和功能下降，并遏制痴呆症的患病率。远景目标 是为了促进老年人的健康和独立。[This随机临床试验将 确定一种新的认知参与干预方法（密集的钢琴训练）的有效性， 认知刺激（将作为严格的主动控制）。从理论上讲，中央 一个假设是，干预措施增强了中枢听觉处理（CAP），这是一个强有力的纵向预测因素， 轻度认知障碍和痴呆症，将改善认知能力。音乐训练越来越被认为是一种可行的手段， 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，高强度的钢琴训练- 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， 与接受过正规音乐训练的成年人相比， 非音乐家我们在三个试点随机试验中的结果表明，钢琴训练可以改善老年人的 CAP和执行功能，包括MCI患者]。研究的具体目的是检查效果- 与认知刺激（主动控制）相关的高强度钢琴训练对改善CAP、认知和 日常生活中有无MCI的老年人。钢琴训练的功效将被确立 和MCI状态的调节作用将被检查。拟议的研究进一步旨在阐明联合国- 通过探索训练增益的中介物，探索有效的认知干预方法的机制。 研究结果将确定有效的干预方法，以减轻与年龄相关的认知功能障碍。 和功能衰退的机制。我们认为，拟议的研究是创新的，因为 第一个二期随机试验的钢琴训练，以提高老年人的认知。此外，这项研究是 通过纳入有和没有MCI的老年人并评估对日常功能的影响， 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 干预效果的机制。这些贡献将是重大的，将促进我们对如何实现这些目标的理解。 认知干预产生认知和功能变化。研究结果将有助于改进设计和改进- 实施有效的干预措施，以减缓认知能力下降和遏制痴呆症的流行， 从而改善公众健康。

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.