Personalized brain activity modulation to improve balance and cognition in elderly fallers

个性化大脑活动调节以改善老年跌倒者的平衡和认知

• 批准号: 9789799
• 负责人: Bradley D. Manor
• 金额: $ 62万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789799
• 关键词: Anatomy; Bilateral; Brain; Brain region; Cerebrospinal Fluid; Characteristics; Cognition; Cognitive; Consequentialism; Custom; Decision Making; Double-Blind Method; Double-blind trial; Elderly; Electrodes; Equilibrium; Executive Dysfunction; Fall prevention; Future; Gait; Gait speed; Head; Individual; Individual Differences; Intervention; Lead; Left; Leg; Measures; Modeling; Motor; Motor Cortex; Musculoskeletal Diseases; Nervous System control; Neuraxis; Outcome; Participant; Pathway interactions; Peripheral; Physical Function; Physical Performance; Physical activity; Population; Posture; Prefrontal Cortex; Prevention trial; Problem Solving; Process; Psyche structure; Randomized; Reading; Regulation; Reporting; Scalp structure; Series; Short-Term Memory; Skin; Speed; Structure; Task Performances; Technology; Testing; Trail Making Test; Vulnerable Populations; Walking; Woman; age related; aged; aging brain; arm; base; brain tissue; cognitive function; cognitive task; cost; cranium; design; executive function; fall risk; falls; fear of falling; follow up assessment; follow-up; improved; improved mobility; men; mental function; motor control; neuromuscular; neuromuscular function; primary outcome; processing speed; recruit; relating to nervous system; secondary outcome; sustained attention; therapy design; treatment arm; trend; young adult

Standing and walking are almost always completed in unison with other mental tasks such as talking, reading or problem solving. The ability to safely perform this important type of “dual tasking” is dependent upon one's capacity to effectively activate the appropriate brain networks involved in both motor and cognitive function. In older adults who have suffered recent, otherwise unexplained falls, such dual tasking significantly interferes with the control of standing or walking. We thus contend that strategies designed to facilitate brain activation within cognitive-motor brain networks hold great potential to reduce dual task costs, enhance numerous other aspects of physical and cognitive function, and ultimately, reduced falls in older adults. Transcranial direct current stimulation (tDCS) is a safe, noninvasive technology that can selectively enhance brain excitability (i.e., the likelihood of activation) by passing low-level currents between electrodes placed upon the scalp. We have demonstrated in a series of ground-breaking studies that tDCS targeting the left dorsolateral prefrontal cortex (dlPFC)—a primary brain region involved in cognitive “executive” function—incudes lasting improvements in dual task performance and mobility in older adults. Still, the optimal brain region(s) to target with tDCS, and the duration of benefits induced by multi-session tDCS interventions, are unknown. Moreover, to date, tDCS delivery has attempted to optimize current flow based on modeling of a “typical” brain and has thus not been personalized to individual differences in the anatomy of the aging brain. We will conduct a randomized, sham-controlled, double-blinded trial with a 6-month follow-up period to compare the effects of 4 different personalized, multisession tDCS interventions on the dual task costs to standing and walking (Aim 1), as well as other physical (Aim 2) and cognitive (Aim 3) factors on the causal pathway to falls that are important to everyday function, in older adults with previous falls. We will recruit 120 men and women (30 per intervention arm) aged 65-85 years with two or more falls within the past year, who are fearful of falling again, yet have no major neural or musculoskeletal disorders. tDCS interventions will entail 20 sessions over a four-week period targeting 1) the left dlPFC only; 2) the bilateral primary motor cortex (M1, leg regions) only; 3) both of these regions simultaneously; or 4) neither of these regions (i.e., sham). We will utilize current flow modeling of baseline structural MRIs to customize tDCS electrode placement and stimulation parameters to optimize current flow to the desired target(s) within each participant's brain. We hypothesize that multi-focal tDCS designed to simultaneously increase functional activation of motor and cognitive networks will have the greatest benefits on dual tasking and other important physical and cognitive outcomes on the causal pathway to falls in this vulnerable population of older adults. The outcomes of this trial will also set the stage for future falls prevention trials using tDCS.

站立和行走几乎总是与其他心理活动如说话、阅读 或者解决问题安全地执行这种重要类型的“双重任务”的能力取决于一个人的 有效激活与运动和认知功能相关的适当大脑网络的能力。在 对于那些最近经历过无法解释的福尔斯摔倒的老年人来说，这种双重任务的处理明显干扰了 控制站立或行走。因此，我们认为，旨在促进大脑激活的策略 在认知运动脑网络中， 身体和认知功能方面，并最终减少老年人的福尔斯。经颅直流 电流刺激（tDCS）是一种安全的、非侵入性的技术，其可以选择性地增强大脑兴奋性（即， 激活的可能性）。我们有 在一系列突破性的研究中证明，tDCS靶向左背外侧前额叶皮层， （dlPFC）-参与认知“执行”功能的主要大脑区域-包括持久的改善， 老年人的双重任务表现和活动能力。尽管如此，tDCS靶向的最佳大脑区域， 多疗程tDCS干预所诱导的获益持续时间尚不清楚。此外，到目前为止，tDCS 递送已经尝试基于对“典型”大脑的建模来优化电流， 个性化的个体差异在老龄化的大脑解剖。 我们将进行一项随机、假对照、双盲试验，随访6个月， 比较4种不同的个性化、多阶段tDCS干预对双重任务成本的影响 站立和行走（目标1），以及其他身体（目标2）和认知（目标3）因素， 在有福尔斯病史的老年人中，导致福尔斯跌倒的因果通路对日常功能很重要。我们 将招募120名年龄65-85岁的男性和女性（每个干预组30名），其中有两次或两次以上的福尔斯跌倒， 在过去的一年里，他们害怕再次摔倒，但没有严重的神经或肌肉骨骼疾病。tDCS 干预措施将需要在四周内进行20次会议，目标是：1）仅左侧dlPFC; 2）双侧dlPFC。 仅初级运动皮层（M1，腿部区域）; 3）这两个区域同时存在;或4）这两个区域都不存在 区域（即，sham）。我们将利用基线结构MRI的电流建模来定制tDCS 电极放置和刺激参数，以优化流向每个电极内的期望目标的电流 参与者的大脑。我们假设，多灶性tDCS设计用于同时增加功能性 运动和认知网络的激活将对双重任务和其他重要任务产生最大的好处。 身体和认知结果的因果路径福尔斯在这个脆弱的人口老年人。 这项试验的结果也将为未来使用tDCS预防福尔斯跌倒的试验奠定基础。