Cognitive training and dual-task ability in older adults

老年人的认知训练和双重任务能力

• 批准号: 8548957
• 负责人: COURTNEY HALL
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8548957
• 关键词: Address; Age; Age-Years; Age-associated memory impairment; Aging; Attention; Clinic; Cognition; Cognitive; Data; Drug usage; Economics; Effectiveness; Elderly; Equilibrium; Etiology; Exhibits; Future; Gait; Goals; Health Care Costs; Impairment; Incidence; Injury; Intervention; Intervention Studies; Measures; Mission; Morbidity - disease rate; Motor; Musculoskeletal; Outpatients; Participant; Patient Care; Physical therapy; Population; Publishing; Quality of life; Randomized; Recruitment Activity; Rehabilitation therapy; Research; Resources; Savings; Sensory; Speed; Task Performances; Testing; Therapeutic; Time; Training; Veterans; Visit; Walking; base; cognitive ability; cognitive function; cognitive task; cognitive training; cost; effective intervention; equilibration disorder; executive function; fall risk; falls; high risk; human very old age (85+); improved; motor impairment; novel; novel strategies; primary outcome; processing speed; sensory input; sensory system

DESCRIPTION (provided by applicant): The number of veterans over 85 years of age has tripled during this decade (US Dept of Veterans Affairs, 2007). It has been demonstrated that the rate of falls doubles after age 75 (Hausdorff, 2001). Given the increased incidence of falls with age and associated morbidity, this study has significance to aging veterans. Historically, degradation of balance control in older adults has been attributed to impairments of the motor and/or sensory systems. As a result, therapy has focused on motor and sensory impairments. However, evidence suggests that an impaired ability to allocate attentional resources to balance during dual-task situations is a powerful predictor of falls (Verghese, 2002). Despite this fact, few studies have examined whether interventions can improve older adults' dual-task ability. The goal of this study is to develop effective interventions to improve ability to allocate attention to balance and gait under dual-task conditions. Studies have shown that dual-task performance by older adults can be improved; however, the majority of research has been in non-balance related tasks (Rogers and Fisk, 2001). Interventions with small numbers provide the only evidence for the effectiveness of training to improve ability to divide attention in gait tasks. Silsupadol et al. (2009a, 2009b) foud that only participants trained under dual-task conditions showed improvements in gait under dual-task conditions. In contrast, Hall and Heusel-Gillig (2010) found that balance rehabilitation with no specific dual-task training resulted in improved gait under dual-task conditions. Further research is warranted to determine optimal balance rehabilitation parameters. Thus, the first aim of the study is to examine the extent to which the addition of dual-task practice improves gait under dual-task conditions. A novel approach to improving gait is through the enhancement of cognitive function. Pharmacologic interventions have demonstrated a positive effect on gait by the use of drugs that improve cognition (Auriel, 2006). Recent findings suggest that specific cognitive abilities (speed of processing, attention, and executive control) are associated with ability to walk under dual-task conditions (Hall, in press; Holtzer, 2006). There is substantial evidence that cognitive training can improve these specific cognitive abilities in older adults (Ball, 2002). It is unknown whether such improvements in cognition would enhance gait under dual-task conditions. Thus, another goal of the study is to examine the extent to which cognitive training benefits dual-task ability. Specific Aim 1 Examine the extent to which the inclusion of dual-task practice to standard balance rehabilitation results in greater benefits to dual-task ability. Hypothesis 1a: There will be greater improvement in walking under dual-task conditions following balance rehabilitation that includes dual-task activities. Hypothesis 1b: Improved motor abilities will explain a significant proportion of the variance of improved ability to walk under dual-task conditions. Specific Aim 2 Examine the extent to which the addition of cognitive training following balance rehabilitation results in greater benefits to dual-task ability. Hypotheis 2a: There will be additional improvements in the ability to walk under dual-task conditions following cognitive training. Hypothesis 2b: There will be greater benefits to walking under dual-task conditions following speed of processing training versus general cognitive training. Hypothesis 2c: Improved cognitive abilities will explain a significant proportion of the variance o further improvements in walking under dual-task conditions. Older adults (n = 44) who have been referred to physical therapy (PT) for gait or balance impairments who have dual-task impairment (based on published criteria for the timed up and go test with a subtraction task) will be randomized to receive either standard balance rehabilitation or balance rehabilitation with dual-task practice. Following PT, subjects will receive cognitive training (CT), either speed of processing or generalized cognitive training. Primary outcomes are ability to walk while performing four different cognitive tasks of varying difficulty. Assessment will occur at baseline, post-PT, post-CT.

描述（由申请人提供）： 在这十年中，85岁以上的退伍军人人数增加了两倍（美国退伍军人事务部，2007年）。已经证明，跌倒率在75岁以后的跌幅（Hausdorff，2001年）。鉴于随着年龄和相关的发病率而增加的跌倒发病率增加，这项研究对老化的退伍军人具有重要意义。从历史上看，老年人平衡控制的降解归因于运动和/或感觉系统的损害。结果，治疗集中在运动和感觉障碍上。但是，有证据表明，在双重任务情况下，分配注意力资源以平衡的能力受损是跌倒的有力预测指标（Verghese，2002）。尽管这一事实，很少有研究研究干预措施是否可以提高老年人的双任务能力。这项研究的目的是制定有效的干预措施，以提高双重任务条件下的关注和步态的能力。研究表明，老年人的双重任务表现可以提高。但是，大多数研究都是在与非平衡相关的任务中（Rogers and Fisk，2001）。少数的干预措施为训练有效性提供了提高步态任务中注意力的有效性的唯一证据。 Silsupadol等。 （2009a，2009b）foud，只有在双重任务条件下接受培训的参与者在双重任务条件下的步态有所改善。相比之下，Hall和Heusel-Gillig（2010）发现，在双重任务条件下，没有任何特定双任务训练的平衡康复可以改善步态。有必要进行进一步的研究以确定最佳的平衡康复参数。因此，该研究的第一个目的是检查双任务实践的添加程度可以在双重任务条件下改善步态。改善步态的新方法是通过增强认知功能。药理干预措施通过使用改善认知的药物对步态产生了积极影响（Auriel，2006）。最近的发现表明，特定的认知能力（处理速度，注意力和执行控制速度）与在双重任务条件下行走的能力有关（Hall，Press； Holtzer，2006）。有大量证据表明，认知训练可以提高老年人的这些特定认知能力（Ball，2002）。在双任务条件下，这种认知方面的改善是否会增强步态，这是尚不清楚的。因此，该研究的另一个目标是检查认知训练对双任务的能力的程度。具体目标1检查将双任务实践纳入标准平衡康复的程度，从而为双任务能力带来更大的好处。假设1a：在包括双任务活动在内的平衡康复之后，在双重任务条件下行走将有更大的改善。假设1B：提高的运动能力将解释在双重任​​务条件下行走能力的改善方差的很大一部分。具体目标2检查了在平衡康复之后增加认知训练的程度，从而为双任务能力带来了更大的好处。假设2a：认知训练后双重任务条件下行走的能力将有所改善。假设2b：在加工训练速度与一般认知训练之后，在双重任务条件下行走将有更大的好处。假设2C：提高的认知能力将解释差异的很大比例o在双重任务条件下行走的进一步改善。已转介到具有双重任务障碍的步态或平衡障碍的老年人（n = 44）（根据已发布的定时标准并通过减法任务进行测试），将随机分配以接收标准的平衡康复或通过双重任务实践进行平衡康复。 PT之后，受试者将接受认知训练（CT），无论是处理速度还是广义认知训练。主要结果是在执行四个不同的认知任务时走路的能力。评估将在基线时进行 PT，CT.CT。