Variability and Volume of Day-to-Day Lifestyle Activity in Sustaining Cognitive Function among Insufficiently Active Older Adults at Risk for Alzheimer's Disease and Related Dementias

日常生活方式活动的变异性和活动量对有阿尔茨海默病和相关痴呆风险的活动不足的老年人维持认知功能的影响

• 批准号: 10662088
• 负责人: Chih-Hsiang Yang
• 金额: $ 21.68万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662088
• 关键词: Accelerometer; Adult; Aerobic Exercise; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Behavioral; Behavioral Model; Cellular Phone; Cognition; Cognitive; Data; Data Set; Dementia; Devices; Dimensions; Distal; Economic Burden; Elderly; Enrollment; Ethnic Origin; Exercise; Expenditure; Family; Foundations; Funding; Future; Gender; Goals; Guidelines; Health; Health Care Costs; Heterogeneity; Impaired cognition; Incidence; Individual; Intervention; Joints; Knowledge; Life Style; Light; Literature; Masks; Measurement; Measures; Medical; Medicine; Mental Health; Methodology; Methods; Modeling; Monitor; Motivation; Noise; Older Population; Outcome; Participant; Pattern; Persons; Phase; Physical activity; Population; Prevention strategy; Prospective, cohort study; Public Health; Race; Recommendation; Reliability of Results; Reporting; Research; Resources; Risk; Role; Sampling; Sex Differences; Sleep; Societies; Statistical Methods; Stress; Subgroup; Surveys; Testing; Time; Uncertainty; United States National Institutes of Health; Variant; Walking; age difference; cognitive benefits; cognitive function; cognitive testing; dementia risk; demographic disparity; demographics; disease registry; efficacy trial; eligible participant; ethnic difference; ethnic diversity; evidence base; experience; follow-up; gender difference; high risk; light intensity; longitudinal design; mobile computing; novel; pedometer; pre-clinical; prevent; programs; prospective; racial difference; recruit; sex; sleep quality; social; social engagement; statistics; success; therapy development; tool

The escalating incidence of Alzheimer’s disease and related dementias (ADRD) places a tremendous economic burden on society and families, making up the largest healthcare cost expenditure in the US. To date, medical approaches for preventing and treating ADRD have yielded limited success. Non-pharmacological preventive strategies, such as physical activity, hold promise for sustaining cognition and thus reducing ADRD risks in older adults. Unfortunately, it is not feasible and practical for many older adults to engage in the recommended higher- intensity physical activities (or aerobic exercise), especially for those with mobility limitations, physical barriers, and predisposing health conditions. Existing evidence suggests that even engaging in lower-intensity lifestyle activities, such as walking, may benefit cognitive health. However, this literature has exclusively focused on the total amount or mean volume of light-intensity physical activity (LPA) or steps and identified small-to-moderate effects on cognition. Beyond the total volume performed, the day-to-day variability (or stability) of LPA or steps also represents a behavioral target that potentially can amplify the cognitive benefits, but this variable has not been tested in the literature. Using an experimental medicine approach, this proposal will bridge the knowledge gap by determining whether older adults’ daily variability and volume of LPA/steps jointly predict their proximal and distal cognitive function. This study will recruit ethnically diverse older adults (ages 60+) who are insufficiently active and have higher risks for developing ADRD. Eligible participants will wear an accelerometer for 30 days to estimate each person’s typical variability and volume of their daily LPA/steps. They will complete daily e-surveys during the same 30-day period to assess their daily stress, sleep, and social engagements. These factors influence older adults’ daily physical activity and cognition, so they will be considered (modeled) when estimating each person’s typical LPA and step patterns. After the 30-day monitoring period, participants will complete three follow-up cognitive measures on Day 31, at 2.5 months, and 4 months. These cognitive measures involve validated in-lab and smartphone-based tools (MoCA, scales, NIH-funded M2C2 app). Lastly, this study will examine whether subgroup differences (based on demographics) exist in the proposed associations between daily lifestyle activity patterns (variation and volume of LPA/steps) and cognitive function. To enhance the rigor of our study findings, we will apply the novel MixWILD statistical program in our analysis. This program accounts for uncertainties in unbalanced datasets, which can enhance estimation precision and provide reliable results. The first study aim is to determine if both variation and volume of daily LPA/steps are joint targets for sustaining proximal and distal cognitive function in older adults at risk for ADRD. The second aim is to investigate if there are sex, gender, age, and race/ethnicity differences in the associations between LPA/step patterns and cognitive function. Findings have the potential to identify achievable and scalable behavioral targets that can be engaged in future efficacy trials to reduce ADRD risks in older adults’ daily lives.

阿尔茨海默病和相关痴呆症（ADRD）发病率的不断上升给人类带来了巨大的经济损失。 对社会和家庭的负担，构成了美国最大的医疗保健成本支出。到目前为止，医疗 用于预防和治疗ADRD的方法取得了有限的成功。非药物预防 策略，如体力活动，有望维持认知，从而降低老年人的ADRD风险。 成年人了不幸的是，对于许多老年人来说，参加推荐的更高级别的活动是不可行和不实际的。 高强度的身体活动（或有氧运动），特别是对于那些行动不便，身体障碍， 和易患病的健康状况现有的证据表明，即使从事低强度的生活方式， 活动，如散步，可能有益于认知健康。然而，这篇文献只关注 轻度体力活动（LPA）或步数的总量或平均量，以及确定的小到中度 对认知的影响除了执行的总体积外，LPA或步骤的每日变异性（或稳定性） 也代表了一个潜在的可以放大认知益处的行为目标，但这个变量没有 在文献中进行了测试。使用实验医学的方法，这个建议将桥梁的知识 通过确定老年人的日常变异性和LPA/步数是否共同预测他们的 近端和远端认知功能。这项研究将招募不同种族的老年人（60岁以上）， 缺乏足够的积极性，并有更高的风险发展ADRD。合资格的参加者将佩戴 使用加速度计测量30天，以估计每个人的日常LPA/步数的典型可变性和体积。他们 将在同一30天内完成每日电子调查，以评估他们的日常压力，睡眠和社交 订婚这些因素会影响老年人的日常身体活动和认知能力， 在估计每个人的典型LPA和步伐模式时考虑（建模）。经过30天的监测 期间，参与者将在第31天、2.5个月和4个月时完成三项随访认知测量。 这些认知测量涉及经过验证的实验室内和基于智能手机的工具（莫卡、量表、NIH资助的 M2C2 app）。最后，本研究将检查是否存在亚组差异（基于人口统计学）， 日常生活方式活动模式（LPA/步数的变化和体积）与认知能力之间的拟议关联 功能为了提高我们研究结果的严谨性，我们将在我们的研究中应用新的MixWILD统计程序。 分析.该程序考虑了不平衡数据集中的不确定性，这可以增强估计 精确度和可靠的结果。第一个研究目的是确定是否每天的变化和数量 LPA/steps是维持ADRD风险老年人近端和远端认知功能的联合靶点。 第二个目的是调查是否有性别，性别，年龄和种族/民族差异的协会 LPA/步伐模式和认知功能之间的关系。调查结果有可能确定可实现和可扩展的 行为目标，可以参与未来的疗效试验，以减少老年人日常生活中的ADRD风险。