Are two interventions are better than one? Combining cognitive training and non-invasive neurostimulation in older adults.

引言、基本原理和新颖性相关的认知能力下降是一个日益严峻的挑战和公共卫生问题。它可以对个人及其家庭的生活质量（QoL）产生重大影响。增强大脑修改/重建神经连接的自然能力的干预措施已被证明可以增强轻度认知障碍（MCI）和健康老年人的认知功能。认知训练和神经刺激干预的结果都很有希望，证明了认知功能的增强。然而，需要直接的证据来确定成功是否是“特定领域的”，或者是否可以使用日常生活活动测量（ADL）将益处转移到其他认知需求和日常事件中。由于MCI患者及其家属将生活质量列为他们希望培养的主要因素，因此有必要调查干预措施如何影响生活质量，作为认知和神经效应之外的结果指标。认知训练干预结合神经刺激在老年人群中的可接受性和可行性.收集关于干预对假定的脑电图（EEG）生物标志物影响的初始数据。收集初始数据，评估认知和神经刺激联合干预的效果是否大于单独干预。该项目解决了方法学上的差距，并通过结合互补技术（无创神经刺激，EEG和QoL问卷），全面介绍了老年人的认知训练及其机制。我们预计，这两种干预措施将增加认知功能和日常生活质量，与那些参与者在联合干预表现出最大的improvement.MethodThe记忆改变测试将被用来评估认知功能/MCI分类。与先前的研究一致，将招募约60名参与者（70岁以上）。参与者将在干预前后完成以下任务：工作/情景/言语记忆任务、视觉注意力、处理速度、执行功能、生活质量问卷、医院焦虑和抑郁评分以及日常生活活动评估。实验组干预治疗组对照组第1组（n=20）单独认知干预：15次计算机辅助认知训练第2组（n=20）单独神经刺激：15次tACS第3组（n=20）联合认知干预和神经刺激：15次tACS治疗，同时进行认知训练任务将使用“计算机辅助认知训练”（剑桥认知系统）干预，并在iPad/计算机软件上完成。经颅交流电刺激（tACS）将用于无创电刺激。tACS使用通过头皮电极施加到特定大脑区域的低水平交流电。由于神经振荡在大脑的运作结构中起着至关重要的作用，tACS可能在增强认知功能方面更有效。将在认知训练前后采集EEG。20名MCI受试者将接受认知训练结合神经刺激方案。他们的结果将与年龄匹配的对照组进行比较。这将是一个试点研究的可行性使用我们的协议在临床population.ImpactThis项目进一步了解成功的老龄化在社会和生物科学，并有助于对干预措施，改善老年人及其家庭的生活，减少对医疗保健系统的压力。该项目将特别强调通过针对个人最了解的认知下降缺陷来改善生活质量。

Introduction, Rationale & NoveltyAge-related cognitive decline presents an ever increasing challenge and public health issue. It can have a significant impact both an individuals' and their families' quality of life (QoL). Interventions which enhance the brain's natural ability to modify/restructure neural connections have been shown to enhance cognitive functioning, in both individuals with Mild Cognitive Impairment (MCI) and healthy older adults. Both cognitive training and neurostimulation interventions results are promising, demonstrating enhancement of cognitive function. However, direct evidence is needed to determine whether the success is 'domain-specific' or whether benefits are carried over to other cognitive demands and daily events, using Activities in Daily Living Measures (ADL). As people with MCI and their families have rated QoL as the principal factor they wish to foster, there is a need to investigate how interventions impact on QoL as an outcome measure in addition to cognitive and neural effects.Research aims:1. Acceptability and feasibility using cognitive training intervention combined with neurostimulation within the ageing population.2. Gather initial data on the effect of intervention on putative Electroencephalography (EEG) biomarkers.3. Gather initial data assessing whether the effect of combined cognitive and neurostimulation interventions is greater than either intervention alone.This project addresses methodological gaps and provides a comprehensive account of cognitive training and its mechanism in older adults by combining complementary techniques: non-invasive neurostimulation, EEG and QoL questionnaires. We expect that both interventions will increase cognitive function and quality of daily life, with those participants in the combined intervention demonstrating the greatest improvement.MethodThe Memory Alteration Test will be used to assess cognitive function/MCI classification. In line with previous research, ~60 participants (aged 70+) will be recruited.Participants will complete the following tasks before and after intervention: working/episodic/verbal memory tasks, visual-attention, processing speed, executive function, a QoL Questionnaire, Hospital Anxiety and Depression Score and an Activities of Daily Living Assessment. Participants will be randomly allocated to one of three conditions.Experimental Group Intervention Treatment Group Control GroupGroup 1 (n=20) Cognitive Intervention alone: 15 sessions of Computer-Assisted Cognitive TrainingGroup 2 (n=20) Neurostimulation alone: 15 sessions of tACSGroup 3 (n=20) Combined Cognitive Intervention and Neurostimulation: 15 sessions of tACS, concurrent with a cognitive training taskA 'Computer-Assisted Cognitive Training' (Cambridge Cognition Systems) intervention will be used and completed on iPad/computer software. Transcranial Alternating Current Stimulation (tACS) will be used for non-invasive electrical stimulation. tACS uses low level alternating currents applied via scalp electrodes to specific brain regions. As neural oscillations play a crucial role in the operational architecture of the brain, tACS may prove even more effective in enhancing cognitive functions. EEG will be acquired before and after cognitive training. 20 participants with MCI will receive cognitive training combined with neurostimulation protocol. Their results will be compared to the same intervention in age-matched controls. This will be a pilot study for feasibility of using our protocol in clinical populations.ImpactThis project furthers the understanding of successful ageing within social and biological sciences and contributes towards interventions that improve the lives of older adults and their families, reducing pressures on the healthcare system. The project will specifically emphasise improvements to QoL by targeting the deficits in cognitive decline which individuals are most aware of.