Exercise Versus Cognitive Interventions for Elders at Risk for Dementia

描述（由申请人提供）：该申请涉及广泛的挑战领域（05）比较有效性研究，以及具体的挑战主题05- ag -104：计划拨款和试点研究，用于比较老年患者多种共存条件的管理策略。随着美国人口的老龄化，认知障碍和身体状况下降的风险增加。体育锻炼已被证明对老年人的身体和健康都有好处，而且越来越多的证据表明，系统的锻炼计划可以增强认知功能。此外，我们小组和其他人开发的认知锻炼项目在增强有认知障碍的老年人的认知功能方面表现出了很大的希望。然而，在以下方面缺乏数据：a)运动对轻度认知障碍（MCI）老年人的益处程度b)运动和认知训练在MCI患者中的相对有效性c)运动和认知联合干预对MCI的可能优势拟议的调查将提供独特的机会，在认知和生理水平上调查运动和认知相关的训练变化。该研究将评估运动训练、认知训练以及运动和认知训练相结合对西班牙裔和非西班牙裔轻度认知损伤老年人身体健康、炎症和免疫生物标志物以及认知功能的影响。这是同类研究中第一个比较最先进的非药物干预对轻度认知损伤疗效的研究。这项研究对于改善老年轻度认知障碍患者的认知和身体状况以及生活质量具有重要的潜力。随着人口老龄化，越来越需要开发能够优化和维持认知和身体健康的干预措施。轻度认知障碍（MCI）的特征是客观认知测试证实的认知能力下降，其程度大于个体年龄的预期，但不足以诊断为痴呆症。在美国，有超过500万的老年人患有轻度认知障碍，人们越来越认识到这种情况可能会对管理日常生活高级活动的能力产生不利影响，并降低生活质量。患有轻度认知障碍的人发展为痴呆症的风险也比非轻度认知障碍的同龄人高得多。任何能够减少老年人轻度认知障碍的认知后果的方法都将对受影响的个人、他们的家庭和整个国家产生可观的经济和社会效益。提出的研究将检验体育锻炼干预、认知锻炼干预和体育+认知联合干预对老年轻度认知障碍患者的比较效果。这项研究的独特之处在于，它将是第一个在患有轻度认知障碍的老年人中对体育锻炼干预、认知锻炼干预、体育+认知锻炼联合干预和无干预控制条件进行正面比较的研究；2)将检查一系列广泛的结果变量，包括认知功能、身体耐力和健康、生物活性（如脂质谱、免疫和炎症反应）和生活质量；3)干预措施将适用于西班牙裔和非西班牙裔老年人，以确保对美国老年轻度认知障碍患者的广泛适用性；4) PEI+CEI联合干预将检验认知和体育锻炼相结合的干预是否可能比单独的体育锻炼或认知锻炼产生更大的效果。

DESCRIPTION (provided by applicant): This application addresses Broad Challenge Area (05) Comparative Effectiveness Research, and Specific Challenge Topic 05-AG-104: Planning Grants and Pilot Studies for Comparisons of Management Strategies for Older Patients with Multiple Coexisting Conditions. As the population of the United States ages, there is an increased risk of cognitive impairment and physical deconditioning. Physical exercise has been shown to have physical and health benefits in the elderly and there is increasing evidence that systematic exercise programs may enhance cognitive function. In addition, cognitive exercise programs developed by our group and others have shown to be promising in enhancing cognitive function in older adults with cognitive impairment. There is a paucity of data, however, on the following: a) The extent to which exercise can benefit older adults with mild cognitive impairment (MCI) b) The comparative effectiveness of exercise and cognitive training among persons with MCI c) The possible advantages of combined exercise and cognitive interventions for MCI The proposed investigation will offer the unique opportunity to investigate exercise- and cognitive-related training changes at cognitive and physiological levels. The study will assess the impact of exercise training, cognitive training, and a combination of exercise and cognitive training on physical fitness, inflammatory and immunological biomarkers, and cognitive function among Hispanic and non-Hispanic older adults with MCI. This represents the first study of its type to compare the efficacy of state of the art non-pharmacological interventions in MCI. The study has significant potential to improve cognitive and physical status as well as quality of life in older adults with MCI. With the aging of the population, there is an increasing need to develop interventions that can optimize and maintain cognitive and physical health. Mild Cognitive Impairment (MCI) is characterized by cognitive decline confirmed by objective cognitive testing that is greater than would be expected for an individual's age but insufficient to merit a diagnosis of dementia. Over 5 million older adults in the United States have MCI and it is increasingly recognized that this condition may adversely affect the ability to manage higher order activities of daily living and reduce quality of life. Individuals with MCI are also at a considerably higher risk for progression to dementia than their non-MCI peers. Any approach that could reduce the cognitive consequences of MCI in older adults would have considerable economic and social benefits to afflicted individuals, their families, and the country at large. The proposed study will examine the comparative effectiveness of a physical exercise intervention, a cognitive exercise intervention, and a combined physical plus cognitive intervention in older adults with MCI. This study is unique in that ) it would be the first to conduct a head-to-head comparison of a Physical Exercise Intervention, a Cognitive Exercise Intervention, a Combined Physical plus Cognitive Exercise Intervention, and a no-intervention control condition among older adults with MCI; 2) a broad array of outcome variables will be examined including measures of cognitive functioning, physical endurance and fitness, biological activity (e.g., lipid profiles, immune and inflammatory response), and quality of life; 3) the interventions will be administered to Hispanic and non-Hispanic older adults to ensure broad applicability to older adults with MCI in the US; 4) the Combined PEI+CEI intervention will examine the possibility that the integration of the cognitive and the physical exercise intervention may result in greater effects than physical exercise or cognitive exercise alone. PUBLIC HEALTH RELEVANCE: The proposed investigation offers an empirical comparison of safe and non-invasive approaches that could improve the cognitive and physical health of older adults with MCI as well as their quality of life.