Targeting Autonomic Flexibility to Enhance Cognitive Training Outcomes in Older Adults with Mild Cognitive Impairment

摘要 我们最近完成的R 01表明，加工速度和注意（PS/A）定向的认知训练 （VSOP）对PS/A和工作记忆有显著影响，但对认知控制和情景记忆无显著影响， 长期影响总体上是温和的。在建议的R 01更新中，我们建议确定额外的 进一步增强PS/A训练在轻度遗忘的老年人中的转移和长期效果的属性 认知障碍（MCI）通过解决适应能力，支持适应性学习， 神经可塑性第二阶段双盲随机试验的目的是测试是否增加共振 频率呼吸（RFB）培训VSOP将加强适应能力的多个贡献者， 特别是自主神经系统（ANS）灵活性的中枢和外周通路，这将 加强VSOP训练对MCI患者认知功能和脑功能的影响，延缓MCI患者痴呆的进展。我们 中心假说认为，通过改善自主神经系统（ANS）， 灵活性，将增强神经可塑性，减缓MCI中痴呆的进展，因为适应能力至关重要 VSOP的神经可塑性，但在神经退行性过程中受损。MCI老年人（n = 114） 将被随机分配到8周的联合干预（RFB+VSOP），VSOP与引导成像 放松（IR）控制，和一个等待名单IR控制，在后续定期助推器培训课程。 机制和远端结局包括ANS灵活性和痴呆进展的多个标志物。数据将 收集了14个月的数据这两个主要目的是检查联合的长期影响， ANS灵活性（目标1）以及认知，行为和功能能力（目标2）的干预。的 探索性的目的将是确定联合干预的初步长期效果， 神经变性我们认为这是一个合理的更新计划，从我们完成的R 01，旨在确定 进一步增强认知训练在MCI中的转移效应和长期效应的额外属性。这将是 在第一批研究MCI适应能力的新型联合干预的RCT中， 减缓神经退化的最终目标。拟议的工作与NINR战略计划保持一致， 护理科学，eps。症状管理（在这种情况下，改善MCI的认知和功能症状） 使用非药物干预方法并了解相关机制。

Abstract Our recently completed R01 suggested that processing speed and attention (PS/A) oriented cognitive training (VSOP) produced robust effect on PS/A and working memory, but not in cognitive control or episodic memory, and long-term effects were overall modest. In the proposed R01 renewal, we propose to identify additional attributes to further enhance transferred and long-term effects of PS/A training in older adults with amnestic mild cognitive impairment (MCI) by addressing adaptation capacity that underpins adaptive learning and neuroplasticity. The goal of the stage II double-blinded randomized trial is to test whether adding resonance frequency breathing (RFB) training to VSOP will strengthen multiple contributors to adaptation capacity, particularly the central and peripheral pathways of autonomic nervous system (ANS) flexibility, which will strengthen VSOP training effect on cognitive and brain function and slow the progress of dementia in MCI. Our central hypothesis is that strengthening adaptation capacity, via improving autonomic nervous system (ANS) flexibility, will enhance neuroplasticity and slow progress of dementia in MCI, since adaptation capacity is critical for neuroplasticity of VSOP, but compromised in neurodegenerative process. Older adults with MCI (n = 114) will be randomly assigned to an 8-week combined intervention (RFB+VSOP), VSOP with guided imagery relaxation (IR) control, and a waitlist IR control, with periodical booster training sessions at follow-ups. Mechanistic and distal outcomes include ANS flexibility and multiple markers of dementia progress. Data will be collected across a 14-month period. The two primary aims are to examine long-term effects of the combined intervention on ANS flexibility (Aim 1), as well as the cognitive, behavioral, and functional capacity (Aim 2). The exploratory aim will be to determine the preliminary long-term effect of the combined intervention on neurodegeneration. We consider this a reasonable renewal plan from our completed R01, aiming to identify additional attributes to further enhance transferred and long-term effects of cognitive training in MCI. This will be among the first RCTs to examine a novel, combined intervention targeting adaptation capacity in MCI, with an ultimate goal for slowing neurodegeneration. The proposed work is aligned with NINR strategic plan to advance nursing science, eps. symptoms management (in this case, improving cognitive and functional symptoms in MCI) using a non-pharmacological intervention approach and understanding relevant mechanisms.