Preventing Loss of Independence through Exercise (PLIE) in Persons with Dementia

预防痴呆症患者通过运动丧失独立性 (PLIE)

• 批准号: 9390411
• 负责人: Deborah E. Barnes
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9390411
• 关键词: Address; Adult; Adverse effects; Affect; Age; Alzheimer' s Disease; Amyotrophic Lateral Sclerosis; Award; Awareness; Behavior Therapy; California; Caregiver Burden; Caregivers; Clinical; Cognitive; Communities; Conscious; Contracts; Dementia; Disease; Elderly; Elements; Equilibrium; Equipment and supply inventories; Exercise; Experimental Psychology; Functional Magnetic Resonance Imaging; Funding; Goals; Health; Healthcare; Impairment; Individual; Intervention; Koreans; Learning; Measures; Mediator of activation protein; Medical center; Memory; Methodology; Moods; Movement; Neurodegenerative Disorders; Neurologic Effect; Neurosciences; Outcome; Pain; Parkinson Disease; Participant; Patients; Persons; Pharmaceutical Preparations; Phase III Clinical Trials; Physical Function; Physical Performance; Pilot Projects; Prevalence; Procedures; Psyche structure; Quality of life; Randomized; Randomized Controlled Trials; Rehabilitation therapy; Request for Applications; Research; Research Methodology; San Francisco; Site; Sleep; Standardization; Subgroup; Testing; Training; Unconscious State; Veterans; Vietnam; Work; base; cognitive function; daily functioning; design; efficacy testing; exercise intervention; exercise program; experience; functional restoration; functional status; implicit memory; improved; improved functioning; innovation; intervention program; mindfulness; mode of exercise; novel; post intervention; prevent; primary outcome; procedural memory; programs; public health relevance; secondary outcome; social; treatment as usual

 DESCRIPTION (provided by applicant): The goal of the proposed study is to perform a randomized, controlled trial (RCT) to test the efficacy of a novel integrative exercise program called Preventing Loss of Independence through Exercise (PLIÉ) on function and quality of life in older Veterans living in the community with dementia. Dementia is a devastating condition that affects nearly 1 in 10 older veterans (~1 million individuals). Current dementia medications have minimal impact on function and quality of life and do not stop or slow the disease course; however, there is growing evidence that behavioral interventions such as exercise have a variety of beneficial effects in individuals with dementia. PLIÉ was developed based on recent discoveries in neuroscience and experimental psychology that have found that, although explicit memory (the ability to consciously recall new information) is impaired in individuals with dementia, implicit memory (unconscious learning that typically occurs through repeated exposure) is relatively preserved. Therefore, PLIÉ focuses on training procedural memory (unconscious learning of procedures) to build the strength and capacity to perform the movements that are most needed for daily function (e.g., transitioning safely from sitting to standing). In addition, to maximize the benefits of the training, PLIÉ integrates elements of Eastern and Western exercise modalities to develop mindful body awareness and enhance social connection. We have recently completed a pilot study of the PLIÉ program at an adult day health center in San Francisco, CA, finding that it was associated with clinically meaningful improvements in cognitive function, physical performance and quality of life as well as reduced caregiver burden when compared with usual care at the facility. The proposed study will enable us to build on these exciting pilot study results by performing a full-scale RCT at adult day health centers in Northern California. Most VA Medical Centers currently contract with community-based organizations to provide adult day health care to eligible Veterans with dementia. Therefore, sites for the current study will be adult day health centers that have current contracts with either the San Francisco VA (SFVA) or Palo Alto VA (PAVA). Within each center, study participants will be randomly assigned to receive the PLIÉ intervention program (45 minutes, 2 days/week, 6 months) or Usual Care (UC) control (standard center activities, 45 minutes, 2 days/week, 6 months) (N=144, 72/group). Our co-primary outcomes will be 6-month change in cognitive function (Alzheimer's Disease Assessment Scale - cognitive subscale, ADAS-cog), independence (Functional Independence Measure, FIM) and quality of life (Quality of Life in Alzheimer's Disease, QOL-AD). Changes in caregiver burden (Caregiver Burden Inventory, CBI) will be examined as a secondary outcome. We also propose to determine whether the effects of PLIÉ are maintained over 6 months after the intervention period; thus, all outcomes will be assessed at baseline, 6 months and 12 months. The proposed project will address a critically important Veterans' health problem related to optimizing functional status and quality of life in older Veterans with dementia. It is directly responsive to Request for Applications (RFA) RX-14-011 (RR&D Merit Review Award for Research on Amyotrophic Lateral Sclerosis, Parkinson's Disease and Alzheimer's Disease), which has identified "pioneering new and innovative rehabilitation methodologies to restore function and improve quality of life for Veterans living with [these] neurodegenerative diseases" as a "major focus." Many patients and caregivers currently feel that little is being done to help individuals with dementia maintain function and quality of life. Our proposed study will utilize rigorous research methods to test the efficacy of a highly innovative and promising new program for older adults with dementia. If our program is successful, we will work with VA and community-based organization to implement PLIÉ more broadly.

 描述（由申请人提供）： 拟议研究的目标是进行一项随机对照试验（RCT），以测试一种名为“通过运动预防失去独立性”（PLIÉ）的新型综合运动计划对生活在社区的老年退伍军人的功能和生活质量的功效痴呆症是一种毁灭性的疾病，影响着近十分之一的老年退伍军人（约 100 万人），目前的痴呆症药物对功能和生活质量的影响很小，并且不能阻止或减缓疾病进程。证据表明PLIÉ 是基于神经科学和实验心理学的最新发现而开发的，例如运动等行为干预措施对痴呆症患者有多种有益作用，这些发现发现，尽管患有痴呆症的人的外显记忆（有意识地回忆新信息的能力）受到损害。痴呆症中，内隐记忆（通常通过重复接触而发生的无意识学习）相对保留，因此，PLIÉ 专注于训练程序记忆（程序的无意识学习），以增强执行日常功能最需要的动作的力量和能力（例如，安全地从此外，为了最大限度地发挥培训的效益，PLIÉ 整合了东西方运动方式的元素，以培养正念身体意识并增强社交联系。我们最近在旧金山的一家成人日间健康中心完成了 PLIÉ 计划的试点研究。 ，加利福尼亚州，发现与该机构的常规护理相比，它与认知功能、身体表现和生活质量的临床有意义的改善以及减轻的护理人员负担相关。拟议的研究将使我们能够在这些令人兴奋的试点研究的基础上继续进行。通过执行结果目前，大多数退伍军人事务部医疗中心都与社区组织签订了合同，为符合条件的患有痴呆症的退伍军人提供成人日间医疗服务。目前与旧金山 VA (SFVA) 或帕洛阿尔托 VA (PAVA) 签订了合同。在每个中心内，研究参与者将被随机分配接受 PLIÉ 干预计划（45 分钟，每周 2 天，6 个月）或常规干预计划。护理 (UC) 控制（标准中心活动，45 分钟，每周 2 天，6 个月）（N=144，72 人/组）我们的共同主要结果将是认知功能的 6 个月变化（阿尔茨海默病评估量表 - 认知分量表、ADAS）。 -cog）、独立性（功能独立性测量，FIM）和生活质量（阿尔茨海默病的生活质量，QOL-AD）。库存、CBI）将作为次要结果进行检查，以确定 PLIÉ 的效果是否在干预期后保持超过 6 个月；因此，所有结果将在基线、6 个月和 12 个月的项目中进行评估。解决与优化患有痴呆症的老年退伍军人的功能状态和生活质量相关的至关重要的退伍军人健康问题。 申请请求 (RFA) RX-14-011（RR&D 肌萎缩侧索硬化症、帕金森病和阿尔茨海默病研究优异评审奖），该奖项确定了“开创性的新型创新康复方法，以恢复退伍军人的功能并提高生活质量”患有[这些]神经退行性疾病”作为“主要焦点”。许多患者和护理人员目前认为，在帮助痴呆症患者维持功能和生活质量方面几乎没有采取任何措施。拟议的研究将利用严格的研究方法来测试针对患有痴呆症的老年人的高度创新和有前途的新计划的有效性。如果我们的计划成功，我们将与 VA 和社区组织合作，更广泛地实施 PLIÉ。