A randomized trial of dance on mood, balance and brain in Alzheimer's Disease

项目摘要 阿尔茨海默病（Alzheimer's disease，AD）是痴呆症中最常见的一种，也是最常见的神经退行性疾病 在老年人中，是美国第六大死亡原因。神经精神症状（冷漠，抑郁， 焦虑）以及步态和平衡的改变是AD的突出的继发症状，其增加了医疗费用 并降低痴呆症患者及其护理者的生活质量（QoL）。AD和其他疾病的护理 2013年，美国痴呆症的治疗费用估计为2030亿美元。姑息治疗服务是旨在 缓解降低慢性病患者及其护理人员生活质量的疾病症状。的 世界卫生组织已确定有必要将循证姑息治疗服务纳入 对包括AD在内的严重慢性病的持续护理。然而，最近的两个国家卫生研究院讲习班结束了 缺乏证据限制了更广泛地使用非药物活性来缓解继发性症状， 慢性疾病，并确定了基于艺术的身心实践，特别是研究不足。舞蹈是一门艺术- 基于活动，可以改善生活质量，减少抑郁症状，并改善健康老年人的平衡 成年人，帕金森病患者和AD患者。因此，舞蹈同时解决两组突出的 AD的次要症状：1）步态和平衡，2）神经精神症状。然而，机制 舞蹈是如何发挥这些作用的尚不清楚。填补这一知识空白可以增加舞蹈的使用 改善庞大且不断增长的患者人群的生活质量。此外，更好地了解 舞蹈期间发生的生理变化与改善的生活质量和症状管理有关 可以促进识别可能改善AD继发症状的其他干预措施， 可能从舞蹈中受益的病人群体。我们提供的飞行员数据支持我们的假设， 通过改变与运动相关的大脑网络中的大脑活动，改善老年AD患者的生活质量 和社会参与。我们假设舞蹈通过同时改善平衡和平衡感而有益于生活质量， 通过运动改善步态，通过社会参与改善冷漠和抑郁。我们已经制定了一个 严格的科学设计，以测试舞蹈运动和社会参与的独立贡献， 生活质量此外，我们建议收集措施，使我们能够了解舞蹈如何影响不同的 身体系统。我们将收集大脑成像数据，以评估大脑功能和结构的变化;详细 平衡和步态的测量;以及压力的血液生物标志物。更好地了解舞蹈如何影响 改善AD患者的生活质量可能会提高姑息治疗服务的质量 通过帮助了解如何更好地使用非药物干预措施， 影响QoL的继发症状。

Project Summary Alzheimer’s disease (AD) is the most common form of dementia, the most common neurodegenerative disease in older adults, and the 6th leading cause of death in the US. Neuropsychiatric symptoms (apathy, depression, anxiety) and altered gait and balance are prominent secondary symptoms of AD that increase medical costs and decrease quality of life (QoL) for the person with dementia and their caregiver. Care for AD and other dementias in the US was estimated at $203 billion in 2013. Palliative care services are health services that aim to relieve disease symptoms that decrease QoL for people with chronic disease and their caregivers. The World Health Organization has identified a need to integrate evidence-based palliative care services into the continuum of care for serious chronic diseases including AD. However, two recent NIH workshops concluded that lack of evidence limits the broader use of non-pharmacologic activities to relieve secondary symptoms of chronic disease, and identified arts-based mind-body practices as particularly understudied. Dance is an arts- based activity that can improve QoL, decrease symptoms of depression, and improve balance in healthy older adults, those with Parkinson disease, and AD. Thus, dance simultaneously addresses two sets of prominent secondary symptoms in AD: 1) gait and balance and 2) neuropsychiatric symptoms. However, the mechanisms by which dance exerts these effects are unknown. Filling this knowledge gap could increase the use of dance to improve QoL in a large and growing patient population. In addition, a better understanding of the physiological changes that occur during dance that are linked to improved QoL and symptom management could facilitate identification of other interventions that may ameliorate secondary symptoms of AD, and other patient populations that might benefit from dance. We present pilot data to support our hypothesis that dance improves QoL in older adults with AD through changes in brain activity in brain networks related to movement and social engagement. We hypothesize that dance benefits QoL by simultaneously improving balance and gait through movement, and improving apathy and depression through social engagement. We have laid out a rigorous scientific design to test the independent contributions of dance movement and social engagement to QoL. In addition, we propose to collect measures that will allow us to learn about how dance affects different body systems. We will collect brain imaging data to evaluate changes in brain function and structure; detailed measures of balance and gait; and blood biomarkers of stress. Better understanding of how dance affects the body and brain to improve quality of life in people with AD may improve the quality of palliative care services offered to people with AD by helping to understand how to better use non-pharmacologic interventions to target secondary symptoms that affect QoL.