Training Foundational Skills to Enhance Cognition in Older Adults

到2030年，老年人的数量将超过儿童，占美国65岁或以上人口的25%。 人们主要担心增加对那些病情下降的人的护理对公共卫生系统的影响 医疗和心理健康。同样重要且日益令人担忧的是，大多数老年人的生活质量 通常在衰老，但认知功能下降的成年人。认知功能减退可从 随着寿命的增长，中年会影响到日常生活的许多方面。更多的一个 目前常见的提高认知能力的方法是使用电子游戏。有证据表明 动作类视频游戏通常可以提高选择性注意力，而一些非动作类自适应游戏已经 结果表明，它能提高选择性注意力、处理速度和工作记忆。有一些重要的优势 基于游戏的认知训练，包括在家中的易用性，这也提供了扩展的分布式 如果比赛是娱乐性的，练习和一般的高参与度和积极性。当前的许多干预措施 成功地影响了目标特定领域的行为，但几乎没有表现出远距离转移到功能上 在训练有素的领域之外。我们提出了一个使用电子游戏来增强认知能力的项目。 与目前正在使用的那些相比，这是非常关键的。我们的训练游戏使用凝视来训练注意力，这迫使我们保持一个恒定的水平 交战的机会。此外，这些游戏针对的是在典型衰老过程中受到影响的特定注意力技能。 (分心和反应抑制)。分心干扰影响执行和记忆的证据 功能以及驾驶安全等实用功能表明，如果这些游戏有效地提高 对分心的反应，这种训练可能会对日常功能产生很大的转移作用。这些比赛一直是 成功地用于训练受损的注意力，包括抵抗分心的青少年和年轻人 我们预计，通过一些优化，它们在使用时将同样有效 上了年纪的人。我们建议利用两年的规划期进行一项临床试验，目的是：确定和 解决游戏为适应老年人感官能力减弱而需要的任何修改； 优化训练剂量和效果保持测试时机；测试和完善结果电池 评估。随后对60-80岁的健康成年人进行的大样本随机对照试验将采用： 积极控制组；有轻度认知障碍的老年人的探索性亚样本；4个水平 结果评估(注意力的主要测量；脑电、功能磁共振、DTI变化的生物标记物；评估 认知功能；实际功能评估和自我效能感)；以及对 评估认知障碍和痴呆症的风险。我们的跨学科领导团队代表着专业知识 在衰老研究，神经心理学，老年心理健康，影像和影像分析，临床试验方法， 生物统计学以及健康相关评估和干预游戏的开发和使用。

By 2030, older adults will outnumber children with 25% of the population of the United States age 65 or older. There are major concerns about the impact on public health systems from increased care for those with declining medical and mental health. An equally important and growing concern is for quality of life in the majority of older adults who are aging typically but experiencing decline in cognitive function. Cognitive decline can begin in middle age and increase throughout the lifespan affecting many aspects of daily function. One of the more common current approaches to enhancing cognitive performance is use of video-games. There is evidence that action video games can improve selective attention generally and some non-action adaptive games have been shown to improve selective attention, processing speed and working memory. There are important advantages of game-based cognitive training including the ease of use at home which also provides for extended distributed practice and generally high engagement and motivation if the games are entertaining. Many current interventions successfully affect behavior in the specific domain targeted, but have demonstrated little far transfer to function outside the trained domain. We propose a project that uses video-games for cognitive enhancement that differ critically from those currently in use. Our training games use gaze to train attention which forces a constant level of engagement. Additionally, these games target specific attentional skills that are affected in typical aging (distraction and response inhibition). Evidence that interference from distraction affects executive and memory function as well as practical function such as driving safety suggests that if these games effectively improve response to distraction, this training may show far transfer effects to daily function. These games have been used successfully to train impaired attention including resistance to distraction in teens and young adults with developmental disorders and we expect that with some optimization they will be equally effective in use with older adults. We propose to use the 2-year planning period to conduct a clinical trial that aims: to identify and address any modifications of the games required for adaptation to diminished sensory abilities in older adults; to optimize training dosage and test timing of retention of effects; and to test and refine the battery of outcome assessments. A subsequent large sample randomized control trial of healthy adults aged 60-80 would employ: an active control group; an exploratory sub-sample of older adults with mild cognitive impairment; 4 levels of outcome assessment (primary measures of attention; EEG, FMRI, DTI biomarkers of change; assessment of cognitive function; assessment of practical function and perception of self-efficacy); and a long-term follow-up to assess risk of cognitive impairment and dementia. Our cross-disciplinary leadership team represents expertise in aging research, neuropsychology, geriatric mental health, imaging and imaging analysis, clinical trial methods, biostatistics and development and use of games for health-related assessment and intervention.