The purpose of this study is to compare the effects of three on-line wellness interventions for improving physical and cognitive function and brain connectivity in adults who are at least 55 years old and are experiencing symptoms of memory and/or cognitive difficulties.
The proposed study will perform a randomized, controlled trial (RCT) to compare the effects of three on-line wellness interventions for adults (age 55 years and older) who are experiencing memory and/or cognitive decline. Study participants will be randomly assigned to one of three on-line wellness interventions: (a) Tai Chi, (b) mindful movement course, or (c) health and wellness education course. All interventions will be one hour long, held on-line twice a week for 12 weeks. The co-primary outcomes are 3-month change in cognitive function (Alzheimer's Disease Assessment Scale - cognitive subscale, ADAS-cog) and functional brain connectivity within the default mode network (DMN). Secondary behavioral outcomes will include measures of specific cognitive processes (e.g., auditory memory, executive function, processing speed), physical function (e.g., mobility), anxiety, depression, fatigue, pain, sleep quality, social activities/social isolation, and quality of life. Secondary neuroimaging outcomes will include measures of functional connectivity in other intrinsic brain networks (e.g., salience, central executive, language), cerebral perfusion, and structural white matter integrity. The behavioral and imaging outcomes will be assessed at baseline and upon completion of the 12-week interventions. To assess durability of the behavioral effects of the interventions, the cognitive and behavioral outcomes will be assessed again 6 months after the completion of the interventions.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
77
Tai Chi is an ancient Chinese form of exercise/martial art that involves a series of movements performed in a slow, focused manner and accompanied by deep breathing.
PLIE is a gentle, mindful movement exercise program that integrates elements of Eastern and Western exercise modalities to develop mindful body awareness and enhance social connection.
This on-line class will consist of hour-long lectures/talks about various topics related to healthy aging and wellness.
VA Health Care System
San Francisco, California, United States
Change in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog) Scores
The Alzheimer's Disease Assessment Scale-Cognitive Subscale is a brief neuropsychological assessment used to assess the severity of cognitive symptoms of dementia. ADAS-cog scores range from 0-70, with higher scores (≥ 18) indicating greater cognitive impairment.
Time frame: Change from baseline to 1-week post-treatment.
Change in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog) Scores
The Alzheimer's Disease Assessment Scale-Cognitive Subscale is a brief neuropsychological assessment used to assess the severity of cognitive symptoms of dementia. ADAS-cog scores range from 0-70, with higher scores (≥ 18) indicating greater cognitive impairment.
Time frame: Change from baseline to 6 months after treatment ends.
Change in Default Mode Network (DMN) functional connectivity
The default mode network (DMN) is a system of connected brain areas that show increased activity when a person is not focused on what is happening around them. Instead, the DMN is especially active when a person is engaged in introspective activities (e.g., daydreaming, or contemplating the past or future). Research suggests that the DMN is disrupted in people with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD). Functional connectivity can be defined as the similarity between brain signals that arise from two anatomically separated brain regions. Similarity between the brain signals can be analyzed using Pearson's correlation.
Time frame: Change from baseline to 1-week post-treatment.
Change in Auditory Memory scores
The stories subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) will be used to assess auditory memory. Raw scores will be transformed to z-scores (with a mean of 0 and standard deviation of 1) for each test score of interest across all participants. Thus the sample mean (across all arms) is zero for each test score. The z-scores were then averaged to produce a composite scores. Higher scores are indicative of better performance.
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Time frame: Change from baseline to 1 week post-treatment.
Change in Auditory Memory scores
The stories subtest of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) will be used to assess auditory memory. Raw scores will be transformed to z-scores (with a mean of 0 and standard deviation of 1) for each test score of interest across all participants. Thus the sample mean (across all arms) is zero for each test score. The z-scores were then averaged to produce a composite scores. Higher scores are indicative of better performance.
Time frame: Change from baseline to 6 months after treatment ends.
Change in Attention/Executive Function Cognitive Domain Scores
Neuropsychological tests will included the following domains: Attention/Executive Function (Trail Making Test A and B, Stroop Interference \[Golden version\]) Raw scores will be transformed to z-scores (with a mean of 0 and standard deviation of 1) for each test score of interest across all participants. Thus the sample mean (across all arms) is zero for each test score. The z-scores will be averaged to produce composite scores. Higher scores are indicative of better performance.
Time frame: Change from baseline to 1-week post-treatment.
Change in Attention/Executive Function Cognitive Domain Scores
Neuropsychological tests will included the following domains: Attention/Executive Function (Trail Making Test A and B, Stroop Interference \[Golden version\]) Raw scores will be transformed to z-scores (with a mean of 0 and standard deviation of 1) for each test score of interest across all participants. Thus the sample mean (across all arms) is zero for each test score. The z-scores will be averaged to produce composite scores. Higher scores are indicative of better performance.
Time frame: Change from baseline to 6 months after treatment ends.
Change in Verbal Fluency scores
Controlled Oral Word Association test (FAS). Raw scores will be transformed to z-scores (with a mean of 0 and standard deviation of 1) for each test score of interest across all participants. Thus the sample mean (across all arms) is zero for each test score. Higher scores are indicative of better performance.
Time frame: Change from baseline to 1-week post-treatment.
Change in Verbal Fluency scores
Controlled Oral Word Association test (FAS). Raw scores will be transformed to z-scores (with a mean of 0 and standard deviation of 1) for each test score of interest across all participants. Thus the sample mean (across all arms) is zero for each test score. Higher scores are indicative of better performance.
Time frame: Change from baseline to 6 months after treatment ends.
Change in Processing Speed Scores
Processing speed will be assessed with the coding subtest of RBANS as well as the Digit Symbol Substitution Test (DSST). Raw scores will be transformed to z-scores (with a mean of 0 and standard deviation of 1) for each test score of interest across all participants. Thus the sample mean (across all arms) is zero for each test score. The z-scores will be averaged to produce composite scores. Higher scores are indicative of better performance.
Time frame: Change from baseline to 1-week post-treatment.
Change in Processing Speed Scores
Processing speed will be assessed with the coding subtest of RBANS as well as the Digit Symbol Substitution Test (DSST). Raw scores will be transformed to z-scores (with a mean of 0 and standard deviation of 1) for each test score of interest across all participants. Thus the sample mean (across all arms) is zero for each test score. The z-scores will be averaged to produce composite scores. Higher scores are indicative of better performance.
Time frame: Change from baseline to 6 months after treatment ends.
Change in Mobility
Mobility will be assessed with the Timed Up and Go (TUG) test, which assesses the time it takes participants to stand up from a chair, walk 3 meters, turn around, walk back to the chair and sit down. In addition, we will assess steady-state gait during 90 seconds of continuous over-ground walking at normal preferred speed, with and without the addition of a dual task challenge (counting backward by one or by two).
Time frame: Change from baseline to 1-week post-treatment.
Change in Mobility
Mobility will be assessed with the Timed Up and Go (TUG) test, which assesses the time it takes participants to stand up from a chair, walk 3 meters, turn around, walk back to the chair and sit down. In addition, we will assess steady-state gait during 90 seconds of continuous over-ground walking at normal preferred speed, with and without the addition of a dual task challenge (counting backward by one or by two).
Time frame: Change from baseline to 6 months after treatment ends.
Change in Salience Network functional connectivity
The Salience Network consists of a network of brain regions whose cortical hubs are the anterior cingulate and ventral anterior insular (i.e., frontoinsular) cortices. This network also includes nodes in the amygdala, hypothalamus, ventral striatum, thalamus, and specific brainstem nuclei.
Time frame: Change from baseline to 1-week post-treatment.
Change in Language Network functional connectivity
The Language Network consists of a group of left-lateralized frontal and temporal brain regions that responds to written/spoken/signed words and sentences, but not to mental arithmetic, music perception, executive function tasks, or action/gesture perception.
Time frame: Change from baseline to 1-week post-treatment.