Remediating Age Related Cognitive Decline: Mindfulness-Based Stress Reduction and Exercise

 描述（由申请人提供）：绝大多数老年人将遭受认知功能的下降，如记忆和认知控制（或执行功能），干扰他们参与和从事有意义活动的能力。重要的是，最近的观察表明，大脑在生命后期仍保持可塑性，这表明及时和个性化的干预可能会纠正与年龄相关的认知能力下降。两种有希望的干预措施是基于正念的减压和运动，每一种似乎都以多模式的方式发挥作用，使CNS功能发生可塑性变化，以改善老年人的记忆和认知控制。我们的研究团队对这些干预措施进行了几项研究，支持它们的益处和改善认知功能的途径。我们提出了一个2x2析因设计的随机对照试验，以明确测试MBSR和运动对年龄相关的认知能力下降的补救。我们将580名65岁以上的健康社区成年人随机分为四种情况：单独的MBSR，单独的运动，MBSR+运动或健康教育（对照条件）。参与者将接受为期6个月的急性期方案干预，随后是12个月的维持期。我们将检查（1）使用经过充分验证且敏感的神经心理学电池来改善认知，重点关注记忆和认知控制;（2）机制变化，例如皮质醇减少和胰岛素敏感性提高（3）可塑性的神经成像标志物：结构和功能连接性变化表明认知改善背后的可塑性中枢神经系统变化（4）预测干预反应的个体变异性。我们的主要目标是开展高质量的临床试验，使数据和生物样本成为科学界的资源。然后，我们不仅可以通过将个人与最有利于他们的现成干预措施相匹配来改善老年人的生活，我们还可以通过干预措施来了解神经可塑性变化的机制，以挽救随着衰老而出现的认知衰退，从而建立一个更活跃，更有活力的老年社区。

 DESCRIPTION (provided by applicant): The vast majority of older adults will suffer declines in cognitive functions such as memory and cognitive control (or executive function), interfering with their ability to participate and engage in meaningful activities. Importantly, the recent observation that the brain retains plasticity late into life suggests that timely and personalized interventions might remediate age-related cognitive decline. Two promising interventions are Mindfulness-Based Stress Reduction and Exercise, each of which appears to act in multi-modal ways to make plastic changes in CNS function to improve memory and cognitive control in older adults. Our research team has conducted several studies of these interventions, supporting their benefits and pathways to improved cognitive functioning. We propose a 2x2 factorial design RCT to definitively test MBSR and exercise for remediation of age-related cognitive decline. We will randomize 580 healthy community-living adults aged 65+ to one of four conditions: MBSR alone, exercise alone, MBSR+exercise, or health education (a control condition). Participants will receive protocolized interventions for a six-month acute period, followed by a 12-month maintenance period. We will examine (1) cognitive improvements using a well-validated and sensitive neuropsychological battery focusing on memory and cognitive control; (2) mechanistic changes such as reduced cortisol and improved insulin sensitivity (3) neuroimaging markers of plasticity: structural and functional connectivity changes indicating plastic CNS changes underlying the cognitive improvements (4) individual variability that predicts response to the interventions. Our main goal is to carry out a high-quality clinical trial, such that data and biosamples will become a resource for the scientific community. Then, we can not only improve the lives of older adults in the near-term by matching individuals to readily available interventions that most benefit them, we can also understand the mechanisms of neuroplastic changes with interventions to rescue cognitive decline with aging, leading to a more active and vital senior community.