Walking Interventions, cognitive remediation and mild cognitive impairment

描述（由申请人提供）：本提案概述了一项严格控制的疗效试验，旨在阐明步行干预（WI）、认知修复治疗（CRT）以及WI和CRT联合治疗对轻度认知障碍（MCI）患者步态和认知特定方面的潜在治疗益处。这些研究在临床上很重要，因为它们为未来减少跌倒和预防/延缓老年人痴呆发展的治疗方案的实施提供了框架。本提案中的研究设计通过为包含WI和CRT所赋予的治疗益处的可靠性，可重复性，稳健性和可持续性的相互矛盾的数据的研究领域提供急需的清晰度，从而显著推进了该领域。据我们所知，这是第一个研究WI和CRT（特别是MCI）对个体和综合影响的研究。我们的实验设计将有助于阐明促进WI和/或CRT有益效果的机制，并有助于在未来设计最有效的治疗方案。这些研究在科学上是重要的，因为人们对了解痴呆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越来越感兴趣，这些研究旨在在实验室和自由生活条件下检查每种干预对认知和步态的多个方面的影响。本提案的重点是验证WI， CRT或WI/CRT联合计划的实施将对老年轻度认知障碍患者的认知和步态产生显着和有益的影响。此外，我们将测试相关假设，即与单独提供WI或CRT相比，WI/CRT联合计划将提供协同效益。在具体目标1中，我们将在实验室和自由生活条件下确定每种干预措施对多种步态参数的影响。在具体目标2中，我们将确定每种干预对认知的多个方面的影响。目前的建议带来了许多最新的技术进步，多样化的临床专业知识，一个强大的临床登记，以及强大的临床资源，以了解W， CRT，以及使用随机临床试验方法的WI/CRT联合计划的影响。这些努力是最终开发减少老年人跌倒/痴呆的治疗方案的必要的第一步，并将显著有助于理解衰老对步态和认知能力下降的共同和选择性影响。

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.