Elucidating the Necessary Components and Mechanisms of Cognitive Training

独立性丧失、日常功能困难、认知能力下降、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，使老年人能够在家中养老的成功努力估计每年将节省800亿美元。认知训练是一种低成本、无创的干预措施，已多次证明其在维持认知、日常功能和健康方面具有可靠的转移效果，最近的一项研究表明，其可将ADRD发生率降低29%。重要的是，许多这些日常功能的影响可以在5到10年内保持，包括：保持驾驶机动性，减少50%的故障车辆碰撞，以及维持日常生活的工具性活动（IADL）。尽管有这些有希望的证据，但这个程序背后的调节者和机制是未知的。我们在这个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、生物标志物和神经机制。此外，我们将研究日常生活中的认知和社会心理因素如何将认知训练转移到日常功能。我们将采用因子设计对45-90岁的成年人进行随机分组，分别进行10、20、30或40小时的两种形式的认知训练、联合训练或积极控制条件。这项研究将使我们能够为未来的多地点临床试验测试我们的招募、评估和培训方案的可行性。这项探索性研究是同类研究中的第一个，并将用于为未来更大规模的随机对照试验提供重要数据，该试验将在具有代表性的成人样本中检查认知训练的介质。这些信息将指导未来开发和评估负担得起的和更有效的家庭和社区干预措施，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).