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及其相关疾病。 痴呆症（AD/ADRD），每年花费2900亿美元。轻度认知障碍（MCI）的老年人， 处于典型衰老和痴呆之间的中间阶段的人进展为AD的可能性是那些处于典型衰老和痴呆之间的中间阶段的人的3-5倍。 正常的认知。晚年参与认知挑战性活动与减少 认知能力下降的风险，需要解决认知活动不足的问题。音乐是一种 解决晚年认知活动缺乏的有前途的策略。音乐训练可以改变大脑结构， 在非音乐家的成年人中发挥作用，从而导致认知，感知和心理社会优势。这些 认知功能的变化被认为是因为音乐的多模态，复杂的性质促进了 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 传统的或死记硬背的键盘训练技术。以即兴创作原则为基础的音乐训练 音乐旋律和节奏的自发产生-可能会对认知产生更有力的影响 和大脑功能。即兴创作促进了认知灵活性、自我监控、新想法的产生， 执行计划外的电机序列并进入流动状态。从生物学上讲，即兴创作 与涉及前额叶网络和其他大脑网络激活的不同神经模式相关， 会受到衰老的影响作为一种行为改变的机制，即兴训练很可能会独特地 改善自我调节（监控和控制自己的行为，情绪或思想的能力， 适应形势的要求）。然而，还没有研究测试即兴训练是否能提高自我- 调节和促进维持老年人的认知挑战性活动， MCI。这个项目将开发和测试音乐即兴训练的效果和机制 干预对老年MCI患者自我调节的影响。我们的总体假设是 与对照组相比，训练将导致自我调节的改善，即兴训练将 与前额叶脑网络的特定变化以及最终的认知参与有关。我们 项目分两个阶段。在R61阶段，我们将开发一种音乐即兴训练干预， 改善有和没有MCI的老年人的自我调节，并进行一项双臂随机试验 研究（i）检查干预措施和研究方法的可行性和可接受性，以及（ii）确定其 影响自我调节的假设机制。如果达到里程碑，我们将继续进行R33 阶段，并进行随机机制试验，以检查干预措施的效果， 注意力控制，自我调节和认知参与老年人与MCI和没有。的 这项研究的发现将提高我们对音乐训练的潜在机制的理解。 干预措施可以促进行为改变，以维持老年人的健康。

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.