Rhythm and Timing Exercises for Cerebral Vascular Disease in American Indians

描述（由申请人提供）：相对于非印第安人，美洲印第安人（AIs）的脑血管疾病（CBVD）发病率不成比例地高，其中风率是普通美国人口的两倍。神经成像技术显示cbvd相关的大脑异常与神经心理表现的破坏有关。脑卒中后认知障碍的治疗一直具有挑战性。认知治疗包括强烈的、集中的、有规律的心理活动、智力刺激和行为练习，以帮助个体恢复或维持认知功能。并降低脑损伤后与年龄相关的认知能力下降和痴呆的风险。交互式节拍器（IM）治疗是一种很有前途的行为治疗cbvd相关的认知和运动功能。这项技术通过简单的、重复的运动任务（例如，拍手、拍脚），根据设定的节奏，对个人的反应进行操作性条件反射。通过视觉

DESCRIPTION (provided by applicant): American Indians (AIs) experience a disproportionately high incidence of cerebrovascular disease (CBVD) relative to non-Indians with twice the stroke rate of the general US population. Neuroimaging techniques have shown CBVD-related brain abnormalities to be associated with disruption of neurpsychological performance. Therapy for post-stroke cognitive impairment has been challenging. Cognitive therapy involves intense, focused, regular mental activity, intellectual stimulation, and behaviora exercises that assist individuals to regain or maintain cognitive function. and reduce the risk of age-related cognitive decline and dementia after brain insult. Interactive Metronome (IM) therapy is a promising form of behavioral therapy for CBVD-related cognitive and motor function. This technology uses operant conditioning of an individual's responses through simple, repetitive motor tasks (e.g., clapping hands, tapping feet) in time with a set beat. Through visual and auditory feedback, IM addresses processing speed, attention, and immediate and delayed memory, all of which can be affected by CBVD. IM therapy can improve quality of life, physical mobility, gait, and CBVD- related cognitive deficits. The ongoing Strong Heart Stroke Study (SHSS) (1R01HL093086-01A1; Dedra Buchwald, PI) is investigating CBVD-related brain abnormalities through MRI scans on 1000 AIs from the original SHS cohort. The proposed study will capitalize on this current SHSS to conduct a randomized, controlled trial to ascertain the effects of a culturally tailored IM intervention on cognition, depression, and quality of life. We ill target SHSS participants with subclinical CVBD defined by impaired cognitive processing speed. We will select a sample of 180 American Indians age 68 to 80 years participating in the SHSS. The specific Aims for this study of older American Indians are as follows: 1) Determine if the culturally-adapted IM intervention can improve cognitive functioning among older AIs with CBVD; and 2) Estimate the impact of IM on health-related quality of life. This study will yield important insights into the relationships among cognitive and motor rehabilitation, neuropsychological assessment, and brain abnormalities that can inform treatment efforts as one way to reducing AI CBVD disparities.