Impact of Music Improvisation Training on Brain Function and Cognition among Older Adults

摘要 美国约有580万60岁及以上的成年人患有阿尔茨海默病和相关疾病 痴呆症(AD/ADRD)，每年费用2,900亿美元。患有轻度认知障碍(MCI)的老年人，以及 在典型衰老和痴呆症之间的中间阶段，进展为AD的可能性是那些 拥有正常的认知能力。晚年对认知挑战活动的投入与减少有关 有认知衰退的风险，需要解决认知不活跃的问题。音乐干预是一种 有希望的策略来解决晚年认知活动不足的问题。音乐训练可以改变大脑结构和 非音乐家成年人的功能，从而导致认知、知觉和心理社会优势。这些 认知功能的变化被认为是因为音乐的多峰、复杂的性质有助于 训练诱导的神经可塑性。然而，其机制尚不清楚，大多数研究使用了 传统或死记硬背的键盘训练技巧。基于即兴演奏原则的音乐训练-- 自然产生的音乐旋律和节奏--可能会对认知产生更大的影响 和大脑功能。即兴创作有助于认知灵活性、自我监控、新想法的产生， 执行计划外的马达序列并进入流动状态。从生物学上讲，即兴表演是 与涉及激活前额叶网络和其他大脑网络的不同神经模式相关 都会受到衰老的影响。作为行为改变的一种机制，即兴训练很可能是独一无二的 提高自律能力(监控和控制自己的行为、情绪或思想的能力，以及 根据情景需求进行修改)。然而，还没有研究测试即兴表演训练是否能提高自我 管理和促进老年人在有无认知挑战活动中的维持 MCI。该项目将开发和测试的效果和机制的音乐即兴训练 对患有和不患有MCI的老年人自我调节的干预。我们的总体假设是即兴表演 与对照相比，训练将导致自我调节的改善，即兴训练将 与前额叶大脑网络的具体变化以及最终的认知参与有关。我们的 项目分为两个阶段。在R61阶段，我们将开发音乐即兴训练干预，旨在 改善患有和不患有MCI的老年人的自我调节能力，并进行双臂随机试验 研究：(一)检查干预措施的可行性和可接受性以及研究方法；(二)确定其 对假设的自我调节机制的影响。如果达到了里程碑，我们将继续运行R33 阶段，并进行随机机制试验，以检查干预的效果，与 注意力控制，对患有和不患有MCI的老年人的自我调节和认知投入的影响。这个 这项研究的发现将提高我们对音乐训练潜在机制的理解 干预可以促进行为改变，以保持老年人的健康。

ABSTRACT Approximately 5.8 million adults age 60 and over in the United States live with Alzheimer disease and related dementias (AD/ADRD) at a cost of $290 billion per year. Older adults with mild cognitive impairment (MCI), an intermediate stage between typical aging and dementia, are 3-5 times more likely to progress to AD than those with normal cognition. Late-life engagement in cognitively challenging activities is associated with decreased risk of cognitive decline, and there is a need to address cognitive inactivity. Music interventions are a promising strategy to address late-life cognitive inactivity. Music training can change brain structure and function in non-musician adults, thereby leading to cognitive, perceptual, and psychosocial advantages. These changes in cognitive function are thought to occur because the multimodal, complex nature of music facilitates training-induced neural plasticity. However, the mechanisms are not yet understood, and most studies used traditional or rote keyboard training techniques. Music training based on improvisation principles—the spontaneous generation of musical melodies and rhythms—will likely have more potent effects on cognition and brain function. Improvisation facilitates cognitive flexibility, self-monitoring, novel idea generation, execution of unplanned motor sequences and entrance into a state of flow. Biologically, improvisation is associated with distinct neural patterns involving activation of prefrontal networks and other brain networks that are affected by aging. As a mechanism of behavior change, it is likely that improvisation training will uniquely improve self-regulation (the ability to monitor and control one's own behavior, emotions, or thoughts and modify to situational demands). Yet, no research has tested whether improvisation training can improve self- regulation and facilitate maintenance of cognitively challenging activities among older adults with and without MCI. This project will develop and test the effects and mechanisms of a music improvisation training intervention on self-regulation of older adults with and without MCI. Our overall hypothesis is that improvisation training will lead to improvements in self-regulation, compared to controls, and that improvisation training will be associated with specific changes in prefrontal brain networks and ultimately cognitive engagement. Our project has two phases. In the R61 phase, we will develop a music improvisation training intervention that aims to improve self-regulation among older adults with and without MCI and conduct a 2-arm randomized pilot study to (i) examine feasibility and acceptability of the intervention and study methods and (ii) determine its effects on the hypothesized mechanism of self-regulation. If milestones are met, we will proceed to the R33 phase and conduct a randomized mechanistic trial to examine the effects of the intervention, compared to an attention control, on self-regulation and cognitive engagement among older adults with and without MCI. The findings from this study will improve our understanding of the underlying mechanisms of how music training interventions can facilitate behavior change to maintain health of older adults.