Walking Interventions, cognitive remediation and mild cognitive impairment

描述（由申请方提供）：本提案概述了一项严格对照的有效性试验，旨在阐明行走干预（WI）、认知补救治疗（CRT）以及WI和CRT联合方案对轻度认知障碍（MCI）个体步态和认知特定方面的潜在治疗获益。这些研究在临床上是重要的，因为它们为将来实施治疗方案提供了框架，该治疗方案减少了福尔斯并预防/延迟了老年痴呆症的发展。本提案中的研究设计通过为研究领域提供急需的清晰度来显著推进该领域，该研究领域包含WI和CRT所赋予的治疗获益的可靠性、再现性、稳健性和可持续性方面的相互冲突的数据。据我们所知，这是第一项研究，以检查个人，并结合，影响WI和CRT（特别是在MCI的背景下）。我们的实验设计将有助于阐明负责促进WI和/或CRT的有益作用的机制，并有助于设计未来最有效的治疗方案。这些研究很重要，因为人们越来越有兴趣了解痴呆症发展过程中步态变化和认知能力下降之间的潜在相互作用，这些研究旨在检查实验室和自由生活条件下每种干预措施对认知以及步态多个方面的影响。 本提案的重点是检验以下假设：WI、CRT或WI/CRT联合程序的实施将对MCI老年人的认知和步态产生显著和有益的影响。此外，我们将检验相关假设，即与单独实施WI或CRT相比，联合WI/CRT程序将提供协同受益。在具体目标1中，我们将确定实验室和自由生活条件下每种干预对多个步态参数的影响。在具体目标2中，我们将确定每种干预措施对认知多个方面的影响。目前的提案带来了许多最新的技术进步，多样化的临床专业知识，强大的临床登记，以及强大的临床资源，以了解W，CRT，并结合WI/CRT程序使用随机临床试验方法的影响。这些努力是最终开发减少老年人福尔斯/痴呆症的治疗计划的必要的第一步，并将大大有助于了解衰老对步态和认知能力下降的共同和选择性影响。 公共卫生相关性：这是一项严格对照的疗效试验，旨在了解步行干预、认知补救治疗以及步行和认知补救联合治疗对轻度认知障碍患者痴呆和跌倒风险的影响。这些发现将为认知功能和步态之间的联系提供深入了解，并对痴呆症，老年病，虚弱，生活方式干预和神经科学研究等临床研究领域产生重大影响。

DESCRIPTION (provided by applicant): This proposal outlines a tightly controlled efficacy trial designed to elucidate the potential therapeutic benefit of a walking intervention (WI), cognitive remediation therapy (CRT), as well as combined WI and CRT program towards specific aspects of gait and cognition in individuals with mild cognitive impairment (MCI). These studies are important clinically because they provide the framework for the implementation of a therapeutic program in the future which reduces falls and prevents/delays the development of dementia in the elderly. The design of the studies in this proposal significantly advance the field by providin much needed clarity to a research area that contains conflicting data on the reliability, reproducibility, robustness, and sustainability of the therapeutic benefit conferred by WI and CRT. To our knowledge this is the first study to examine the individual, and combined, effects of WI and CRT (particularly in the context of MCI). Our experimental design will contribute to the process of elucidating the mechanism(s) responsible for promoting the beneficial effects of WI and/or CRT, and contribute to designing the most effective therapeutic program in the future. Scientifically these studies are important because there is increasing interest in understanding the potential interactions between gait changes and cognitive decline during the development of dementia, and these studies are designed to examine the effects of each intervention towards cognition as well as multiple aspects of gait, under both laboratory and free-living conditions. The focus of this proposal is to test the hypothesis that implementation of a WI, CRT, or a combined WI/CRT program, will have significant and beneficial effects towards cognition and gait in elderly individuals with MCI. Additionally, we will test the related hypothesis that the combined WI/CRT program will provide synergistic benefit compared to the delivery of either WI or CRT alone. In Specific Aim 1 we will determine the effects of each intervention towards multiple gait parameters under both laboratory and free living conditions. In Specific Aim 2 we will determine the effects of each intervention towards multiple aspects of cognition. The current proposal brings to bear many of the latest technological advances, diverse clinical expertise, a powerful clinical registry, and strong clinical resources in order to understand the effects of a W, CRT, and a combined WI/CRT program using a randomized clinical trial approach. These efforts are a necessary first step for the eventual development of a therapeutic program that reduces falls/dementia in the elderly, and will significantly contribute to the understanding of th shared and selective effects of aging towards gait and cognitive decline. PUBLIC HEALTH RELEVANCE: This is a tightly controlled efficacy trial designed to understand the effects of a walking intervention, cognitive remediation therapy, and combined walking and cognitive remediation program towards aspects of dementia and fall risk in individuals with mild cognitive impairment. These findings will provide insight to links between cognitive function and gait, and have a significant impact in clinical research areas of dementia, geriatrics, frailty, lifestyle interventions, and neuroscience research.