Training Foundational Skills to Enhance Cognition in Older Adults

摘要：到2030年，美国65岁及以上的老年人将超过儿童，占总人口的25%。随着老年人口的规模和比例不断扩大，阿尔茨海默病（AD）和相关痴呆症的发病率也将增加。在过去十年中，美国因阿尔茨海默病死亡的人数增加了120%以上，阿尔茨海默病目前是导致死亡的主要原因。增加对医疗和精神健康状况下降者的护理对公共卫生系统的影响是一个主要问题。另一个重要的问题是老年人的生活质量，他们通常会变老，但记忆力和认知功能会下降。轻度认知障碍（MCI）可以从中年开始，并在整个生命周期中增加，影响日常功能的许多方面。到目前为止，还没有有效的治愈或治疗方法来减缓MCI或AD的进展。然而，最近的一些证据表明，增强认知功能可能会减少MCI， AD和相关痴呆的影响并延迟发病，因此预防的可能性越来越大。目前提高认知能力的一种更有前途的方法是使用电子游戏。动作视频游戏可以提高选择性注意力、处理速度和工作记忆。基于游戏的认知训练的优点包括易于在家使用，提供了扩展的分布式练习和高参与度。我们提出了一个利用电子游戏来增强认知能力的项目，这个项目与目前使用的项目有很大的不同。我们的训练游戏使用凝视来训练注意力，这迫使玩家保持高水平的粘性。此外，这些游戏的目标是特定的注意力技能，这些技能在典型的衰老过程中会受到影响（分心和反应抑制），影响执行和记忆功能，以及驾驶安全等实用功能。这些游戏已经成功地用于训练注意力受损，包括对有发育障碍的青少年和年轻人的注意力分散的抵抗力。我们期望训练对老年人同样有效。我们建议使用2年的计划期来进行临床试验，其目的是：确定和解决适应老年人感官能力下降所需的游戏的任何修改；优化训练剂量和试验时间对保持效果的影响；测试和完善一系列的结果评估。随后对60-80岁的健康成年人进行大样本随机对照试验：4个参与者组（积极的受训者，2个积极的对照组，1个轻度认知障碍组）；结果评估分为4个等级(1)；注意的主要措施；2. EEG、FMRI、结构和DTI生物标志物的变化（重点关注AD易感的大脑区域，如海马、内侧颞叶）；3. 认知/记忆功能评估；和4。实际功能评估和自我效能感感知)。一项长期随访将评估与对照样本相比，训练组MCI、AD和相关痴呆的发生率。我们的跨学科领导团队代表了AD/MCI研究，神经心理学，老年心理健康，临床试验方法，生物统计学以及开发和使用与健康相关的评估和干预游戏的专业知识。

ABSTRACT: By 2030, older adults will outnumber children with 25% of the population of the United States age 65 or older. The rate of Alzheimer’s disease (AD) and related dementias will also increase as the size and proportion of the older adult population continues to expand. In the past decade, deaths from AD have increased more than 120% in the US and AD is currently a leading cause of death. The impact on public health systems from increased care for those with declining medical and mental health is a major concern. An additional important concern is for the quality of life in older adults who are aging typically but experiencing decline in memory and cognitive function. Mild cognitive impairment (MCI) can begin in middle age and increase throughout the lifespan affecting many aspects of daily function. To date there is no effective cure or treatment to slow progression of MCI or AD. Prevention, however, is a growing possibility with some recent evidence that enhancement of cognitive function may reduce effects and delay the onset of MCI, AD and related dementias. One of the more promising current approaches to enhancing cognitive performance is use of video-games. Action video games can improve selective attention, processing speed and working memory. Advantages of game-based cognitive training include the ease of use at home which provides for extended distributed practice and high engagement. We propose a project that uses video-games for cognitive enhancement that differ critically from those currently in use. Our training games use gaze to train attention which forces a constant high level of engagement. Additionally, these games target specific attentional skills that are affected in typical aging (distraction and response inhibition) and that affect executive and memory function as well as practical function such as driving safety. These games have been used successfully to train impaired attention including resistance to distraction in teens and young adults with developmental disorders. We expect training to be equally effective in older adults. We propose to use the 2-year planning period to conduct a clinical trial that aims: to identify and address any modifications of the games required for adaptation to diminished sensory abilities in older adults; to optimize training dosage and test timing of retention of effects; and to test and refine the battery of outcome assessments. A subsequent large sample randomized control trial of healthy adults aged 60-80 would employ: 4 participant groups (active trainees, 2 active control groups, a group with MCI); 4 levels of outcome assessment (1. primary measures of attention; 2. EEG, FMRI, structural and DTI biomarkers of change (with a focus on brain regions vulnerable in AD such as hippocampus, medial temporal lobe); 3. assessment of cognitive/memory function; and 4. assessment of practical function and perception of self-efficacy). A long-term follow-up would assess the rate of MCI, AD and related dementias in trained compared to control samples. Our cross-disciplinary leadership team represents expertise in AD/MCI research, neuropsychology, geriatric mental health, clinical trial methods, biostatistics and development and use of games for health-related assessment and intervention.