Cognitive intervention to improve simple and complex walking

认知干预改善简单和复杂的步行

• 批准号: 9145392
• 负责人: Roee Holtzer
• 金额: $ 69.53万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9145392
• 关键词: Accounting; Affect; Aging; Area; Attention; Basal Ganglia; Behavior; Bilateral; Chronic; Clinical; Clinical Trials; Cognition; Cognitive; Cognitive remediation; Communities; Complex; Control Groups; Development; Disease; Elderly; Evidence Based Medicine; Exercise; Frail Elderly; Future; Gait; Health; Health education; Image; Impairment; Intervention; Investigation; Knowledge; Length; Link; Locomotion; Measures; Medical; Methods; Near-Infrared Spectroscopy; Neuronal Plasticity; Outcome; Outcome Measure; Parkinson Disease; Participant; Patients; Pattern; Performance; Pharmaceutical Preparations; Pilot Projects; Play; Prevention; Prevention strategy; Prevention trial; Preventive; Psyche structure; Randomized; Randomized Clinical Trials; Rehabilitation therapy; Reporting; Risk; Role; Sampling; Secondary Prevention; Single-Blind Study; Spectrum Analysis; Speed; Testing; Time; Training; Training Programs; United States National Institutes of Health; Walking; aging population; balance testing; base; cognitive function; cognitive process; cognitive testing; cognitive training; computerized; disability; effective intervention; efficacy testing; executive function; fall risk; frailty; frontal lobe; functional status; high risk; improved; improved mobility; innovative technologies; intervention program; neuropsychological; novel strategies; post intervention; prevent; primary outcome; processing speed; programs; public health relevance; response; screening; secondary outcome; sedentary; socioeconomics; treatment as usual

 DESCRIPTION (provided by applicant): Given the major medical and socioeconomic consequences of disability in U.S. seniors and the low compliance with recommended treatments such as physical exercise, investigation of alternate strategies to improve mobility and locomotion is a vital need. Emerging evidence indicates that Executive Functions play an important role in maintaining locomotion in aging and preventing mobility disabilities. However, use of cognitive training programs to improve executive functions as a strategy to increase mobility has not been explored. Exciting results from our preliminary study support the efficacy and feasibility of the cognitive remediation approach to improve locomotion in older adults. We propose to conduct the first single-blind randomized clinical trial to test the efficacy of a computerized cognitive remediation intervention program on improving locomotion in sedentary seniors, a group at an especially high risk for disability. For this study, two groups of 210 sedentary seniors (420 total) will be randomized into either eight-week cognitive remediation (individualized computerized cognitive training) or health education control programs. All participants will receive gait, mobility, and cognitive assessments at baseline, post-intervention, and at six and twelve months after intervention to assess durability of effects. Our primary outcome is post intervention change in gait velocity measured during normal pace walking (simple locomotion) and walking while talking (complex locomotion) conditions as well as performance on the Short Physical Performance Battery (SPPB). Additional outcomes include improvements in mobility related cognitive processes (neuropsychological measures), other quantitative gait assessments (gait variability and gait domains), and neuroplasticity (measured with functional near infra-red spectroscopy). Our hypothesis is that executive functions will respond to the cognitive remediation program and in turn enhance locomotion. The premise of this clinical trial is that disability among seniors is a potentially preventable chronic condition rather than an irreversible consequence of aging and disease. Our proposed novel approach to locomotion has the potential to shift treatment paradigms in the field of disability by introducing cognitive approaches to mobility that can be applied to prevention and rehabilitation in diverse settings. Through this 'proof of concept' secondary prevention trial we will fill an important gap n knowledge for practicing evidence-based medicine and developing effective interventions for a major health outcome affecting a substantial proportion of the U.S. aging population.

 描述（由申请人提供）：鉴于美国老年人残疾的主要医疗和社会经济后果以及对体育锻炼等推荐治疗的依从性低，研究改善流动性和运动能力的替代策略是至关重要的需求。新出现的证据表明，执行功能在维持老年人的运动能力和预防运动障碍方面发挥着重要作用。然而，使用认知训练计划来改善执行功能作为增加流动性的策略还没有被探索。我们的初步研究的令人兴奋的结果支持认知补救方法改善老年人运动的有效性和可行性。我们建议进行第一次单盲随机临床试验，以测试计算机认知补救干预计划对改善久坐老年人运动的有效性，这是一个残疾风险特别高的群体。在这项研究中，两组210名久坐不动的老年人（共420名）将被随机分配到为期八周的认知补救（个性化计算机认知训练）或健康教育对照计划中。所有参与者将在基线、干预后、 并在干预后6个月和12个月评估效果的持久性。我们的主要结果是在正常步速步行（简单运动）和边走边说话（复杂运动）条件下测量的步态速度的干预后变化以及短体力活动成套测验（SPPB）的表现。其他结果包括与运动相关的认知过程（神经心理学测量）、其他定量步态评估（步态变异性和步态域）和神经可塑性（用功能性近红外光谱测量）的改善。我们的假设是，执行功能将响应认知补救计划，并反过来增强运动。这项临床试验的前提是老年人的残疾是一种潜在的可预防的慢性疾病 而不是衰老和疾病的不可逆转的后果。我们提出的新的运动方法有可能通过引入 对流动性的认知方法，可适用于不同环境下的预防和康复。通过这项“概念验证”二级预防试验，我们将填补一个重要的知识空白，以实践循证医学，并为影响相当一部分美国老龄化人口的主要健康结果制定有效的干预措施。