Accelerated Age-related Cognitive Decline: Impact of Exercise on Executive Function and Neuroplasticity (EXEC-study)

与年龄相关的认知能力加速衰退：运动对执行功能和神经可塑性的影响（EXEC 研究）

• 批准号: 10612082
• 负责人: Ulf G Bronas
• 金额: $ 52万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10612082
• 关键词: 3-Dimensional; Acceleration; Address; Adherence; Affect; Age; Age-associated memory impairment; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Anisotropy; Atrophic; Attention; Attenuated; Behavior Therapy; Blood Vessels; Brain; Brain region; Caring; Cerebrovascular Circulation; Chronic Kidney Failure; Clinical; Code; Cognition; Cognitive; Communities; Control Groups; Data; Dementia; Diffusion; Digit structure; Disease; Dose; Elderly; Ethnic Origin; Exercise; Functional Magnetic Resonance Imaging; Goals; Health; Hippocampus; Home; Impaired cognition; Institutionalization; Learning; Longevity; Magnetic Resonance Imaging; Measures; Mediation; Medical; Memory; Moderate Exercise; Nerve Degeneration; Neuronal Plasticity; Nonpharmacologic Therapy; Oxidative Stress; Participant; Patients; Perfusion; Persons; Pharmaceutical Preparations; Pharmacologic Substance; Pilot Projects; Population; Populations at Risk; Prevalence; Prevention; Process; Randomized; Renal function; Rest; Risk; Severities; Severity of illness; Structure; Testing; Treatment Protocols; Walking; Work; adherence rate; arterial spin labeling; attentional control; behavioral response; blood perfusion; brain behavior; cerebral atrophy; cerebral hypoperfusion; cognitive function; cohort; comorbidity; comparison control; effective therapy; executive function; exercise adherence; exercise program; exercise training; functional decline; illness length; improved; information processing; mild cognitive impairment; morphometry; placebo group; poor health outcome; premature; preservation; prevent; primary outcome; retention rate; sex; side effect; systemic inflammatory response; walking program; white matter

Abstract: Older adults with chronic kidney disease (CKD) present on the spectrum of Alzheimer's Disease and Related Dementias (ADRD) approximately 10 years earlier than age and sex matched controls. The prevalence of accelerated age-related cognitive decline and dementia is remarkably high in older adults with CKD, affecting as many as 20-50%. Cognitive impairment in this population leads to poor health outcomes, decreased medication and medical care adherence, functional decline and an accelerated loss of independence, and premature institutionalization. The accelerated age-related cognitive decline in patients with CKD is due, in part, to the CKD disease process itself, which leads to a reduction in white matter integrity that is superimposed on accelerated neurodegeneration of brain regions including atrophy of the hippocampus. Moreover, reduced kidney function is independently associated with lower cerebral blood flow leading to cerebral hypoperfusion, which further exacerbates cognitive decline. Current treatment regimens for CKD do not include strategies to prevent accelerated cognitive decline and related dementia. The available pharmaceutical therapies to enhance cognition have only modest short-term effects on slowing cognitive impairment, have intolerable side effects, and require dose-reduction in CKD patients. Thus, there is a pressing need to develop non-pharmacological therapies to prevent or forestall cognitive decline in older adults with CKD at risk for ADRD. The objective of this study is to test the hypothesis that a 6-month home-based walking exercise program in 116 older adults with mild cognitive impairment and CKD will improve executive function, cognitive subdomains, brain white matter integrity, structure, and functional connectivity compared to attention control. We will achieve this objective by addressing the following specific aims. 1: Does exercise work? Quantify change in executive cognitive function (primary outcome), and cognitive subdomains. 2. For whom does exercise work? Examine if factors (e.g. age, sex, cognitive impairment, and, comorbid conditions) moderate exercise-induced improvement in cognitive function domains at 6-months. 3. How does exercise work? Using MRI we will quantify change from baseline to 6-months in white matter integrity, functional connectivity, cerebral blood flow and perfusion, and hippocampal volume. We will also evaluate the mediation effects of total exercise volume on cognitive function domains and MRI measures at 6-months. Our long-term goal is to develop community-based, behavioral interventions to prevent age-related cognitive decline and ADRD in at risk populations across the lifespan. This study will address a critical gap in our understanding of the use of exercise in the prevention and treatment of accelerated age-related cognitive decline in older adults with CKD and mild cognitive impairment. By combining cognitive function assessment with MRI, we will be able to evaluate the brain-behavior response to exercise and discern the relationships at a level previously not conducted in this population. The potential clinical impact is high and readily translatable.

文摘: