Modulating brain networks to reduce gait variability in older adults at risk of falling

调节大脑网络以减少有跌倒风险的老年人的步态变异

• 批准号: 10549840
• 负责人: On-Yee Amy Lo
• 金额: $ 12.49万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-15 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10549840
• 关键词: Acute; Aging; Attention; Brain; Brain imaging; Clinical Research; Clinical Trials; Cognition; Complex; Data; Disease; Dorsal; Elderly; Electrodes; Eligibility Determination; Exhibits; Exposure to; Frequencies; Functional Magnetic Resonance Imaging; Gait; Geriatrics; Goals; Impaired cognition; Individual; Injury; Intervention; Lead; Link; Magnetic Resonance Imaging; Measures; Mind; Motion; Movement; Outcome; Participant; Pattern; Performance; Randomized; Rehabilitation therapy; Research; Rest; Scalp structure; Scientist; Sensory Process; Techniques; Testing; Time; Training; Unsteady Gait; Visit; Walking; Work; career; career development; cognitive neuroscience; cognitive task; cohort; design; effective intervention; evidence base; fall risk; falls; follow-up; gait rehabilitation; improved; innovation; interest; multimodality; neural; neuroimaging; neuromechanism; neuroregulation; noninvasive brain stimulation; novel; patient oriented; post intervention; primary outcome; recruit; secondary analysis; secondary outcome; smartphone application; sustained attention; transcranial direct current stimulation; treatment arm

PROJECT SUMMARY My career goal is to lead efforts to improve gait rehabilitation and mitigate falls risk in older adults by conducting innovative research focused on the neural control and enhancement of gait and mobility. I am particularly interested in developing individualized, multi-modal, and patient-centered interventions that can both stand alone and be combined with current evidenced-based geriatrics rehabilitation programming. Though walking is a repetitive task, one’s temporospatial patterns of movement during walking vary from stride to stride. This gait variability, if sufficiently high, is predictive of both falls and cognitive decline in older adults. Still, the neural mechanisms that give rise to gait variability are not completely understood. We thus lack effective interventions to minimize gait variability in older adults. However, our team has demonstrated that in older adults, those with elevated gait variability exhibit worse ability to sustain performance on a continuous cognitive task over time (i.e., sustained attention). My work has also linked gait variability to the functional connectivity between the two large-scale brain networks believed to underserve sustained attention—namely, the dorsal attention network (DAN) and the default network (DN)—in multiple cohorts of older adults. Based upon these discoveries, we designed a novel multi-channel transcranial direct current stimulation (tDCS) intervention to simultaneously facilitate the excitability of the DAN and inhibit the excitability of the DN. Our preliminary data suggests that a single exposure to this tDCS, as compared to sham, reduces gait variability when tested just following stimulation. My overarching hypothesis is that this form of tDCS can modulate the functional connectivity between the DAN and DN and thus reduce gait variability in older adults. In this project, we will test this hypothesis by examining the acute after-effects of a single session of tDCS on resting-state functional connectivity (Aim 1), as well as determining the effects of a multi-session tDCS intervention on gait variability and related outcomes (Aim 2). We will recruit 30 older adults free of major disease that exhibit higher-than-typical gait variability. Participants will first complete a baseline assessment and two fMRI visits. The same participants will then be randomized to a tDCS intervention arm (ten, once-daily, 20-min sessions) or a ShamàtDCS intervention arm (five, once-daily, 20-min sessions of sham in week one followed by five, once- daily, 20-min sessions of tDCS in week 2). The primary outcome of gait variability will be assessed daily using a validated smartphone app for the entire study period. We expect to demonstrate that tDCS can modulate functional connectivity and reduce gait variability in older adults. The results from this project are expected to inform the design of a larger, more definitive trial of tDCS designed to optimize brain connectivity as it relates to gait variability in older adults. This research, combined with specific training in advanced neuroimaging and neuromodulation, cognitive neuroscience in aging, and the conduct a clinical research in vulnerable older adults, will greatly facilitate my efforts to transition into an independence clinician scientist.

项目摘要 我的职业目标是领导努力，以改善步态康复和减轻老年人的跌倒风险 进行创新研究的重点是神经控制和ACUIT和流动性的增强。我是 特别感兴趣的是开发个性化，多模式和以患者为中心的干预措施 两者都独立，并与当前基于证据的老年医学康复计划结合使用。 尽管步行是一项重复的任务，但步行过程中的暂时性运动模式因大步而有所不同 大步向前。这种步态变异性（如果足够高）可以预测老年人的跌倒和认知能力下降。 尽管如此，引起步态变异性的神经机制尚未完全理解。因此，我们缺乏 有效的干预措施以最大程度地减少老年人的步态变异性。但是，我们的团队已经证明了这一点 老年人，那些具有升高性暴露较高的人，能够保持连续的表现能力 随着时间的流逝，认知任务（即持续关注）。我的工作也将攻击变异性与功能性联系在一起 两个大规模的大脑网络之间的连通性，据信持续关注，即 在多个老年人中，背注意网络（DAN）和默认网络（DN）。基于 在这些发现时，我们设计了一种新型的多通道trancranial直流刺激（TDCS） 干预以简单地支持DAN的兴奋并抑制DN的兴奋。我们的 初步数据表明，与假相比，该TDC的单一接触可降低攻击性变异性 仅在刺激后进行测试。我的总体假设是，这种形式的TDC可以调节 DAN和DN之间的功能连通性，从而降低了老年人的排列能力。在这个项目中， 我们将通过检查单个TDC的急性后效应来检验该假设 功能连接性（AIM 1），并确定多课程TDCS干预对步态的影响 可变性和相关结果（AIM 2）。我们将招募30名没有表现出的主要疾病的老年人 高于典型的步态变异性。参与者将首先完成基线评估和两次fMRI访问。 然后，相同的参与者将被随机分为TDCS干预部门（每天10，20分钟）或 ShamàtDCS干预臂（每天五个，每天一次，在第一周的假手术，然后是五个，一次 - 每天，在第2周的TDC进行了20分钟的会议。收集变异性的主要结果将每天使用 整个研究期间经过验证的智能手机应用程序。我们希望证明TDC可以调节 功能连通性并降低老年人的排列能力。该项目的结果有望 告知旨在优化大脑连通性的TDC的更大，更明确的试验的设计 老年人的步态变异性。这项研究，结合了高级神经影像学和 神经调节，衰老中的认知神经科学以及对脆弱较老的临床研究 成人将极大地支持我过渡到独立临床科学家的努力。