Cognitive/Brain Effects of Adding Weight Loss to Exercise in Obese Older Adults

描述(申请人提供)：美国和全世界的人口正在迅速老龄化~联合国估计，到2050年，老年人口将有史以来第一次超过年轻人。与此同时，肥胖症正在迅速达到流行的程度。世界卫生组织表示，自1980年以来，全球肥胖率翻了一番，2008年，有15亿成年人肥胖。老龄化、超重人口的组合对认知健康有严重影响，因为老龄化和肥胖症都与认知能力下降有关，因老龄化和肥胖症而增加的风险因素，如胰岛素抵抗和高血压。认知功能低下是一个重大的公共卫生问题，特别是在老年人中，因为它会降低个人进行日常生活活动或遵循规定的保健活动的能力，导致更多的制度化和丧失独立性。有很好的证据表明有氧运动有益于老年人的认知功能。运动还可以改善血糖调节和胰岛素敏感性，并可能降低炎症，这些都是运动导致认知改善的潜在机制。通过减少卡路里摄入量来刻意减肥，比单独运动更能改善认知能力下降的代谢风险因素，这表明减肥和减脂可能会增强运动的认知益处。然而，减肥对老年人来说是否安全和健康是一个有争议的问题，一些研究实际上表明，较高的体重与老年人的认知能力较好相关。因此，在有氧运动干预的基础上增加卡路里限制是否对肥胖老年人的认知、大脑结构和功能有额外的好处，这一点尚不清楚。这项拟议的研究通过调查肥胖老年人在运动中增加减肥的潜在影响，解决了国家和世界范围内的健康问题。 治疗老年人肥胖相关认知减退的途径。这项研究也为候选人提供了一个很好的培训途径，他的总体职业目标是成为一名独立的临床和翻译研究人员。她在衰老认知神经成像方面的强大背景将通过临床试验研究和行为减肥干预方面的培训、新的分析技术以及肥胖症、痴呆症和其他老年综合征的知识而得到加强。这项培训将使她能够设计新的试验，进一步调查代谢性疾病的可改变风险因素与大脑和认知之间的关系。

DESCRIPTION (provided by applicant): The population in the US and worldwide is aging rapidly~ the United Nations estimates that by 2050, for the first time in history, the population f older people will exceed the population of younger people. At the same time, obesity is rapidly reaching epidemic proportions. The World Health Organization states that worldwide, obesity has doubled since 1980, and in 2008, 1.5 billion adults were obese. The combination of an aging, overweight population has serious implications for cognitive health, as aging and obesity are both associated with cognitive decline, as are risk factors that are increased by both aging and obesity, such as insulin resistance and hypertension. Poor cognitive function is a significant public health concern, particularly in older adults, because it can reduce an individual's ability o perform activities of daily living or follow prescribed health care activities, leads to increased institutionalization and loss of independence. There is good evidence that aerobic exercise benefits cognitive function in older adults. Exercise also improves glucose regulation and insulin sensitivity, and may lower inflammation, all potential mechanisms for exercise-induced improvement in cognition. Intentional weight loss through reduced caloric intake improves metabolic risk factors for cognitive decline more than exercise alone, suggesting that weight and fat loss may enhance the cognitive benefits of exercise. However, whether weight loss is safe and healthy for older adults is a matter of controversy, and some studies actually show that higher body weight is associated with better cognition in older adults. Thus, it is unknown whether adding caloric restriction to an aerobic exercise intervention provides an additive benefit on cognition, and brain structure and function, beyond exercise alone in obese older adults. The proposed study addresses concerns of national and worldwide health significance by investigating the effects of adding weight loss to exercise in obese older adults as a potential avenue for remediation of obesity-related cognitive decline in older adults. This study also provides an excellent avenue for training for the candidate, whose overall career goal is to become an independent clinical and translational researcher. Her strong background in cognitive neuroimaging of aging will be augmented by training in clinical trial research and behavioral weight loss interventions~ new analysis techniques~ and knowledge of obesity, dementia, and other geriatric syndromes. This training will allow her to design new trials that further investigate the relationships between modifiable risk factors for metabolic disease and the brain and cognition.