Exercise Versus Cognitive Interventions for Elders at Risk for Dementia

描述(由申请人提供)：本申请涉及广泛的挑战领域(05)比较有效性研究，以及特定挑战主题05-AG-104：比较多种共存疾病的老年患者管理策略的计划资助和试点研究。随着美国人口的老龄化，认知障碍和身体机能减退的风险增加。体育锻炼已被证明对老年人的身体和健康有好处，越来越多的证据表明，系统的锻炼计划可能会增强认知功能。此外，我们团队和其他人开发的认知锻炼计划在增强患有认知障碍的老年人的认知功能方面也很有希望。然而，关于以下方面的数据很少：a)运动能在多大程度上有利于患有轻度认知障碍(MCI)的老年人；b)运动和认知训练在MCI患者中的比较有效性；c)运动和认知干预相结合对MCI的可能优势。拟议的调查将提供一个独特的机会，从认知和生理层面调查与运动和认知相关的训练变化。这项研究将评估运动训练、认知训练以及运动和认知训练的组合对患有MCI的西班牙裔和非西班牙裔老年人的身体健康、炎症和免疫生物标志物以及认知功能的影响。这是第一项比较最先进的非药物干预在MCI中的疗效的研究。这项研究对改善患有MCI的老年人的认知和身体状况以及生活质量具有重大潜力。随着人口老龄化，越来越需要制定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)的特征是经客观认知测试证实的认知功能下降，其程度大于个人年龄的预期，但不足以诊断为痴呆症。美国有500多万老年人患有MCI，越来越多的人认识到，这种情况可能会对管理日常生活中更高层次活动的能力产生不利影响，并降低生活质量。MCI患者进展为痴呆症的风险也比他们的非MCI同龄人高得多。任何可以减少MCI在老年人中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相当大的经济和社会效益。这项拟议的研究将对患有MCI的老年人进行体育锻炼干预、认知锻炼干预以及综合体育和认知干预的比较有效性。这项研究的独特之处在于，它将首次对患有MCI的老年人进行体育运动干预、认知运动干预、综合体育+认知运动干预和非干预控制条件的面对面比较；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、生物学活动(例如，血脂、免疫和炎症反应)和生活质量；3)这些干预措施将应用于西班牙裔和非西班牙裔老年人，以确保广泛适用于美国患有MCI的老年人；4)PEI CEI联合干预将考察认知和体育锻炼干预相结合的可能性，可能比体育锻炼或单独的认知锻炼产生更大的效果。 公共卫生相关性：拟议的调查对安全和非侵入性方法进行了实证比较，这些方法可以改善患有MCI的老年人的认知和身体健康以及他们的生活质量。

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.