A Brain-based Approach to Enhancing Executive Control Functions in Healthy Aging

描述（由申请人提供）：目标方向不佳，或在分散注意力的环境中失去集中注意力和“专注于任务”的能力，是老年人的常见抱怨。这种主观的报告是一致的认知老化研究文献中的一个新兴的共识，这表明，执行控制过程所必需的保持目标方向是特别容易下降，随着年龄的增长。不幸的是，在文献中报道的执行控制缺陷的有效治疗方法很少，尽管它们对日常生活功能有显着影响，并在以后的生活中保持功能独立性。在这里，我们认为，这种治疗的疗效是阻碍了我们的理解的神经机制subserving在大脑中的执行控制处理。该提案的第一个目的是开发执行控制过程的强大生物标志物，以补充治疗疗效的神经认知和功能结局指标。这些生物标志物将用于识别对治疗最敏感的神经过程，并预测神经认知和功能的获得，从而为设计更有针对性和更有效的基于大脑的治疗提供信息。该提案的第二个目的是明确使用基于综合策略和有针对性的过程训练协议来测试这种基于大脑的方法，以增强健康老龄化中的执行控制处理。通过这种综合治疗方法，我们打算通过在治疗师指导的、基于策略的目标管理计划中强化和情境化目标，来利用从有针对性的培训中获得的收益。这个程序是标准化的利益过程（执行控制），但指导策略应用到个人突出，自我生成的目标和个人相关的现实生活中的情况。将在神经、神经认知和功能结局水平评估结局。这种支架式的方法，从大脑到行为到持久的功能变化，确保认知补救工作直接有益于老年人，更广泛地说，通过延迟对家庭护理，疗养院或医院服务的需求，同时保持老年人的功能独立性和尊严。 公共卫生相关性：与正常衰老相关的认知能力下降会对个人的生产力、身体健康和总体幸福感产生广泛影响。特别是随着未来几十年人口老龄化的预期增加，与年龄相关的认知能力下降是一个主要的公共卫生问题。该项目的目的是研究与年龄相关的认知能力下降的神经机制，并开发干预措施和生物标志物来评估这些干预措施的有效性。

DESCRIPTION (provided by applicant): Poor goal direction, or loss of ability to concentrate and 'stay on task' in a distracting environment, is a common complaint in advanced age. Such subjective reports are consistent with an emerging consensus in the cognitive aging research literature suggesting that the executive control processes necessary for maintaining goal direction are particularly susceptible to decline with advancing age. Unfortunately, there have been few efficacious treatments for executive control deficits reported in the literature despite their significant impact on daily life functions and the maintenance of functional independence into later life. Here we argue that the efficacy of such treatments is hindered by our poor understanding of the neural mechanisms subserving executive control processing in the brain. The first aim of the proposal is to develop robust biomarkers of executive control processes to complement neurocognitive and functional outcome measures of treatment efficacy. These biomarkers will serve to identify neural processes that are most responsive to treatment and predictive of neurocognitive and functional gain, thus informing the design of more targeted and efficacious brain-based treatments. A second aim of the proposal is to test this brain-based approach explicitly using an integrated strategy-based and targeted process training protocol to enhance executive control processing in healthy aging. Through this combined treatment approach we intend to leverage gains realized from targeted training by reinforcing and contextualizing them in a therapist-guided, strategy-based goal management program. This program is standardized for the process of interest (executive control), but guides strategy application to individually-salient, self-generated goals and personally-relevant real-life situations. Outcomes will be assessed at the neural, neurocognitive and functional outcome levels. Such a scaffolded approach, building from the level of brain to behavior to lasting functional change, ensures that cognitive remediation efforts benefit older adults directly, and society more generally, by delaying the need for home care, nursing home or hospital services while preserving the functional independence and dignity of an aging population. PUBLIC HEALTH RELEVANCE: Cognitive decline associated with normal aging can have a broad impact on an individual's productivity, physical health and general sense of well-being. Especially with the expected increase in the aging population in the next few decades, age-related cognitive decline is a major public health issue. The aim of this project is to investigate the neural mechanisms underlying age-related cognitive decline and to develop interventions and biomarkers to evaluate the efficacy of these interventions.