Locomotion adaptation deficits in older adults with mild cognitive impairment and Alzheimers disease

患有轻度认知障碍和阿尔茨海默病的老年人的运动适应缺陷

• 批准号: 10754072
• 负责人: Trisha Kesar
• 金额: $ 42.31万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10754072
• 关键词: Activities of Daily Living; Adverse event; Aerobic; Affect; Age; Alzheimer' s Disease; Biological Markers; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Communities; Complex; Disease Progression; Elderly; Equilibrium; Evaluation; Exercise; Fall prevention; Feasibility Studies; Future; Gait; Gait abnormality; Gait speed; Goals; Human; Impaired cognition; Impairment; Individual; Intervention; Knowledge; Length; Literature; Locomotion; Locomotor adaptation; Measures; Motor; Movement; Outcome; Participant; Patients; Pattern; Performance; Persons; Physical Function; Process; Publishing; Quality of life; Research; Resources; Science; Standardization; Stimulus; Telephone; Testing; Time; Training; Walking; burden of illness; cognitive function; cognitive task; cohort; comparison group; environmental change; exercise intervention; falls; flexibility; gait rehabilitation; improved; improved mobility; innovation; mild cognitive impairment; motor impairment; multimodal data; neural; neuropathology; post stroke; sensory feedback; therapeutic target; walking intervention

PROJECT ABSTRACT Community walking function requires complex motor coordination, sensory feedback, dynamic balance, adaptation to changing environmental stimuli, while also attending to tasks such as crossing a street or talking over the phone. Unfortunately, cognitive dysfunction, the hallmark of mild cognitive impairments (MCI) and Alzheimer’s Disease (AD), directly impacts the cognitive-motor neural resources available to carry out such activities of daily living. The rigor of previous research shows that compared to healthy older adults (HOA), people with MCI and AD walk slower, fall more, and have deficits in gait performance. Notably, gait disturbances and changes in gait variability often precede cognitive decline. Thus, our overall goal is to understand the effects of MCI and AD on gait function and locomotor flexibility, and the inter-relationships with cognitive impairments. Locomotor adaptation is a fundamentally important process that enables humans to flexibility respond to environmental demands, enabling normal community walking function. Split-belt walking is a standardized, robust, well studied paradigm for quantifying capacity for locomotor adaptation, with potential implications for walking function and fall prevention. Despite a large body of literature on split-belt adaptation in individuals of multiple ages and neuro-pathologies, surprisingly, split-belt adaptation has not been assessed in MCI and AD. A previous study showed reduction in the rate of split-belt adaptation when able-bodied participants were distracted by a cognitive task, suggesting that adaptation processes interact with cognitive functions. Another study showed multiple sessions of split-belt walking improved mobility outcomes post- stroke, suggesting its potential as an exercise intervention. However, there is a knowledge gap regarding if and how split-belt adaptation relates to cognitive deficits and walking function in individuals with MCI and AD. The current R21 will build upon MPI Kesar and Nocera’s new published study that provides the first preliminary evidence that split-belt adaptation is significantly impaired in people with MCI and AD compared to HOA. Our premise is that in people with MCI and AD, reduced capacity for locomotor adaptation is a fundamental but poorly understood mechanism that can be a sensitive biomarker of cognitive-motor impairments, and an important therapeutic target for exercise-based interventions. Here, we propose the first comparison of split- belt adaptation, in conjunction with comprehensive assessments of gait and cognitive function, in MCI, AD, and HOA. We propose a unique combination of cross-sectional between-group comparisons (Aim 1) and repeated- measures longitudinal time-point comparisons of disease progression (Aim 2). Aim 3 is a preliminary feasibility study to guide future clinical trials on split-belt aerobic walking exercise interventions in MCI and AD. Further, in parallel with locomotor adaptation (not previously studied), we will also evaluate walking function (gait speed, gait endurance, mobility outcomes), gait performance (step length, gait variability, stride time), and cognition in the same participant cohort, generating an innovative, rich, multi-modal dataset.

项目摘要 社区步行功能需要复杂的电动机协调，感觉反馈，动态平衡， 适应不断变化的环境刺激，同时还要参加诸如越过街道或交谈之类的任务 通过电话。不幸的是，认知功能障碍，轻度认知障碍的标志（MCI）和 阿尔茨海默氏病（AD）直接影响可用于执行此类的认知运动神经资源 日常生活的活动。先前研究的严谨表明，与健康的老年人（HOA）相比， MCI和AD步行的人慢，跌倒更多，并定义了步态性能。值得注意的是，步态 干扰和敏捷性的变化通常在认知能力下降之前。那，我们的总体目标是 了解MCI和AD对步态功能和运动灵活性的影响，以及与 认知障碍。运动适应是一个根本重要的过程，使人类能够 灵活性应对环境需求，从而实现正常的社区步行功能。皮带步行是 一种标准化，健壮，研究良好的范式，用于量化运动适应能力，具有潜力 对步行功能和预防的影响。尽管有大量有关脱带适应的文献 令人惊讶的是，多个年龄和神经病理学的个体尚未评估地带适应 MCI和AD。先前的一项研究表明，身体能力降低了皮带的适应率 参与者因认知任务而分心，表明适应过程与认知相互作用 功能。另一项研究表明，多次分裂步行的多次会议改善了在 - 中风，表明其潜力是一种运动干预。但是，关于IF和 皮带的适应性与MCI和AD的个体中的认知定义和步行功能有关。这 当前的R21将基于MPI Kesar和Nocera的新出版研究，该研究提供了第一个初步的 与HOA相比，有MCI和AD的人对皮带的适应性显着损害。我们的 前提是，在MCI和AD的人中，运动适应能力的减小是一个基本，但 不良理解的机制可能是认知运动障碍的敏感生物标志物，并且 基于运动的干预措施的重要治疗靶标。在这里，我们提出了分裂的第一个比较 在MCI，AD和 HOA。我们提出了横截面间比较（AI​​M 1）和重复的独特组合 测量疾病进展的纵向时间比较（AI​​M 2）。 AIM 3是初步的可行性 研究指导MCI和AD中的分裂皮带有氧步行运动干预措施的未来临床试验。更远， 与运动适应（未先前研究）并行，我们还将评估步行功能（步态 速度，获得耐力，移动性结果），获得性能（步长，可变性，步幅），并且 在同一参与者队列中的认知，产生创新，丰富的多模式数据集。