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Doniger GM, Beeri MS, Bahar-Fuchs A, Gottlieb A, Tkachov A, Kenan H, Livny A, Bahat Y, Sharon H, Ben-Gal O, Cohen M, Zeilig G, Plotnik M. Virtual reality-based cognitive-motor training for middle-aged adults at high Alzheimer's disease risk: A randomized controlled trial. Alzheimers Dement (N Y) 2018; 4:118-129. [PMID: 29955655 PMCID: PMC6021455 DOI: 10.1016/j.trci.2018.02.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction Ubiquity of Alzheimer's disease (AD) coupled with relatively ineffectual pharmacologic treatments has spurred interest in nonpharmacologic lifestyle interventions for prevention or risk reduction. However, evidence of neuroplasticity notwithstanding, there are few scientifically rigorous, ecologically relevant brain training studies focused on building cognitive reserve in middle age to protect against cognitive decline. This pilot study will examine the ability of virtual reality (VR) cognitive training to improve cognition and cerebral blood flow (CBF) in middle-aged individuals at high AD risk due to parental history. Methods The design is an assessor-blind, parallel group, randomized controlled trial of VR cognitive-motor training in middle-aged adults with AD family history. The experimental group will be trained with adaptive “real-world” VR tasks targeting sustained and selective attention, working memory, covert rule deduction, and planning, while walking on a treadmill. One active control group will perform the VR tasks without treadmill walking; another will walk on a treadmill while watching scientific documentaries (nonspecific cognitive stimulation). A passive (waitlist) control group will not receive training. Training sessions will be 45 minutes, twice/week for 12 weeks. Primary outcomes are global cognition and CBF (from arterial spin labeling [ASL]) at baseline, immediately after training (training gain), and 3 months post-training (maintenance gain). We aim to recruit 125 participants, including 20 passive controls and 35 in the other groups. Discussion Current pharmacologic therapies are for symptomatic AD patients, whereas nonpharmacologic training is administrable before symptom onset. Emerging evidence suggests that cognitive training improves cognitive function. However, a more ecologically valid cognitive-motor VR setting that better mimics complex daily activities may augment transfer of trained skills. VR training has benefited clinical cohorts, but benefit in asymptomatic high-risk individuals is unknown. If effective, this trial may help define a prophylactic regimen for AD, adaptable for home-based application in high-risk individuals.
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Affiliation(s)
- Glen M. Doniger
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
- Corresponding author. Tel.: +97235304874; Fax: +97235307572.
| | - Michal Schnaider Beeri
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
- Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Bahar-Fuchs
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Center for Research on Aging, Health, and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
- The Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Amihai Gottlieb
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Anastasia Tkachov
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Hagar Kenan
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Abigail Livny
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Yotam Bahat
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Hadar Sharon
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Oran Ben-Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Maya Cohen
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel
| | - Gabi Zeilig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Doniger GM, Plotnik M, Bahar‐Fuchs A, Gottlieb A, Tkachov A, Bahat Y, Sharon H, Ben‐Gal O, Zeilig G, Beeri MS. [P2–040]: VIRTUAL REALITY‐BASED COGNITIVE‐MOTOR TRAINING FOR MIDDLE‐AGED ADULTS AT HIGH AD RISK: STUDY DESIGN AND BASELINE CHARACTERISTICS FROM A RANDOMIZED CONTROLLED TRIAL. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Meir Plotnik
- Sheba Medical CenterRamat GanIsrael
- Tel Aviv UniversityTel AvivIsrael
| | - Alex Bahar‐Fuchs
- Sheba Medical CenterRamat GanIsrael
- The Australian National UniversityCanberraAustralia
- The University of MelbourneMelbourneAustralia
| | - Amihai Gottlieb
- Sheba Medical CenterRamat GanIsrael
- Tel Aviv UniversityTel AvivIsrael
| | | | | | | | | | - Gabi Zeilig
- Sheba Medical CenterRamat GanIsrael
- Tel Aviv UniversityTel AvivIsrael
| | - Michal Schnaider Beeri
- Mount Sinai School of MedicineNew YorkNYUSA
- The Joseph Sagol Neuroscience Center, Sheba Medical CenterRamat GanIsrael
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