Rhythm and Timing Exercises for Cerebral Vascular Disease in American Indians

描述（由申请人提供）：相对于非印度人，美洲印第安人（AI）的脑血管疾病（CBVD）发生率不成比例地高，卒中率是美国普通人群的两倍。神经影像学技术显示CBVD相关的大脑异常与神经心理学表现的破坏有关。中风后认知障碍的治疗一直具有挑战性。认知疗法包括强烈的，集中的，有规律的心理活动，智力刺激和行为练习，帮助个人恢复或保持认知功能。并降低脑损伤后与年龄相关的认知能力下降和痴呆的风险。交互式节拍器（IM）治疗是一种有前途的CBVD相关认知和运动功能的行为治疗形式。该技术通过简单的、重复的运动任务（例如，拍手，拍脚）与一组节拍的时间。通过视觉 和听觉反馈，IM解决了处理速度，注意力，即时和延迟记忆，所有这些都可能受到CBVD的影响。IM治疗可以改善生活质量、身体活动能力、步态和CBVD相关的认知缺陷。正在进行的强心卒中研究（SHSS）（1 R 01 HL 093086 - 01 A1; Dedra Buchwald，PI）正在通过MRI扫描研究来自原始SHS队列的1000例AI的CBVD相关脑异常。拟议的研究将利用目前的SHSS进行随机对照试验，以确定文化定制的IM干预对认知，抑郁和生活质量的影响。我们将目标锁定为患有亚临床CVBD（定义为认知处理速度受损）的SHSS参与者。我们将选择180名年龄在68至80岁的美国印第安人参加SHSS。本研究的具体目的如下：1）确定文化适应性IM干预是否可以改善患有CBVD的老年AI的认知功能; 2）估计IM对健康相关生活质量的影响。这项研究将对认知和运动康复、神经心理学评估和大脑异常之间的关系产生重要的见解，这些关系可以为治疗工作提供信息，作为减少AI CBVD差异的一种方法。

DESCRIPTION (provided by applicant): American Indians (AIs) experience a disproportionately high incidence of cerebrovascular disease (CBVD) relative to non-Indians with twice the stroke rate of the general US population. Neuroimaging techniques have shown CBVD-related brain abnormalities to be associated with disruption of neurpsychological performance. Therapy for post-stroke cognitive impairment has been challenging. Cognitive therapy involves intense, focused, regular mental activity, intellectual stimulation, and behaviora exercises that assist individuals to regain or maintain cognitive function. and reduce the risk of age-related cognitive decline and dementia after brain insult. Interactive Metronome (IM) therapy is a promising form of behavioral therapy for CBVD-related cognitive and motor function. This technology uses operant conditioning of an individual's responses through simple, repetitive motor tasks (e.g., clapping hands, tapping feet) in time with a set beat. Through visual and auditory feedback, IM addresses processing speed, attention, and immediate and delayed memory, all of which can be affected by CBVD. IM therapy can improve quality of life, physical mobility, gait, and CBVD- related cognitive deficits. The ongoing Strong Heart Stroke Study (SHSS) (1R01HL093086-01A1; Dedra Buchwald, PI) is investigating CBVD-related brain abnormalities through MRI scans on 1000 AIs from the original SHS cohort. The proposed study will capitalize on this current SHSS to conduct a randomized, controlled trial to ascertain the effects of a culturally tailored IM intervention on cognition, depression, and quality of life. We ill target SHSS participants with subclinical CVBD defined by impaired cognitive processing speed. We will select a sample of 180 American Indians age 68 to 80 years participating in the SHSS. The specific Aims for this study of older American Indians are as follows: 1) Determine if the culturally-adapted IM intervention can improve cognitive functioning among older AIs with CBVD; and 2) Estimate the impact of IM on health-related quality of life. This study will yield important insights into the relationships among cognitive and motor rehabilitation, neuropsychological assessment, and brain abnormalities that can inform treatment efforts as one way to reducing AI CBVD disparities.