Elucidating the Necessary Components and Mechanisms of Cognitive Training

丧失独立性、日常功能障碍、认知功能下降、轻度认知障碍(MCI)、阿尔茨海默病(AD)和阿尔茨海默病相关痴呆(ADRD)是老年人及其家人非常关注的领域。从公共卫生的角度来看，与养老院相比，成功的让老年人在家中养老的努力每年将节省约800亿美元。认知训练是一种低成本、非侵入性的干预措施，已反复证明对维持认知、日常功能、健康有可靠的转移效果，最近，ADRD的发生率减少了29%。重要的是，这些日常功能的许多影响在五到十年内保持不变，包括：保持驾驶机动性，减少50%的故障车辆碰撞，以及保持日常生活的工具性活动(IADL)。尽管有这些令人振奋的证据，但这个项目背后的主持人和机制尚不清楚。我们在这项计划拨款中的总体目标是奠定概念和方法基础，以确定两种形式的概念驱动的认知训练的认知、心理社会、生活方式行为、生物标记物和神经机制。此外，我们将研究日常生活中的认知和心理社会因素如何解释认知训练向日常功能的转移。我们将使用析因设计将45-90岁的成年人随机分为10、20、30或40小时两种形式的认知训练、组合训练或主动控制条件。这项研究将使我们能够为未来的多点临床试验测试我们的登记、评估和培训方案的可行性。这项探索性研究是此类研究的第一次，将被用来提供与未来更大规模的随机对照试验相关的重要数据，该试验在具有代表性的成年人样本中检查认知训练的中介因素。这些信息将指导未来开发和评估负担得起、更有效的以家庭和社区为基础的干预措施，以维持日常功能，并降低轻度认知障碍(MCI)、阿尔茨海默病(AD)和阿尔茨海默病相关痴呆(ADRD)的风险。

Loss of independence, difficulties in everyday function, cognitive decline, Mild Cognitive Impairment (MCI), Alzheimer’s Disease (AD) and Alzheimer’s Disease Related Dementias (ADRD) are areas of great concern for older adults and their families. From a public health perspective, successful efforts that enable older adults to age within their homes, as compared to nursing homes, will save an estimated $80 billion dollars per year. Cognitive training is a low cost, noninvasive intervention that has repeatedly demonstrated reliable transfer effects to maintained cognition, everyday function, health, and most recently, a 29% reduction in incident ADRD. Importantly, many of these everyday function effects are maintained across five to ten years including: maintained driving mobility, 50% reduction in at-fault vehicle crashes, and maintained Instrumental Activities of Daily Living (IADL). Despite this promising evidence, the moderators and mechanisms underlying this program are unknown. Our overall objective in this planning grant is to lay the conceptual and methodological foundation to identify cognitive, psychosocial, lifestyle behaviors, biomarker, and neural mechanisms of two forms of conceptually driven cognitive training. Additionally, we will examine how cognitive and psychosocial factors within daily life account for the transfer of cognitive training to everyday function. We will use a factorial design to randomize adults ages 45-90 to 10, 20, 30, or 40 hours of two forms of cognitive training, a combined training, or an active control condition. This study will allow us to test the feasibility of our enrollment, assessment and training protocols for a future multisite clinical trial. This exploratory study is the first of its kind and will be used to provide important data relevant to a future larger randomized controlled trial examining mediators of cognitive training in a representative sample of adults. This information will guide future development and evaluation of affordable and more effective home- and community-based interventions that maintain everyday function and reduce the risk of Mild Cognitive Impairment (MCI), Alzheimer’s Disease (AD) and Alzheimer’s Disease Related Dementias (ADRD).