Web-based technology and cognitive training: improving executive control in cognitivelyhealthy older adults

Project Summary/Abstract Developing efficient cognitive training for cognitively intact older adults (OA) is a major public health goal, due to its potential for reducing age-related cognitive decline and Alzheimer’s disease/dementia risk. Executive Control (EC) is a relevant training target since it declines with aging and is critical for multi-tasking in daily life. EC training programs for OA have been shown to lead to cognitive improvements, but it remains unclear whether it enhances multi-tasking ability and transfer to different tasks and context, such as everyday life. Most EC training protocols fail to adopt ecological tasks, which limit its clinical relevance and generalization. A promising EC training approach is Emphasis Change (EmCh), which has shown to benefit both younger and OA. Similar approaches have shown training-transfer in OA, suggesting that EmCh may be an appropriate method to induce transfer in OA. To date, EmCh has not been applied in ecological tasks that simulate a daily life situation, nor has it been implemented remotely through a web-based interface. The web-based training is an advancement since it can be delivered at home and is easily scalable. Recently, remote interventions have been relevant to OA due to the COVID-19 pandemic, which limits in-person research participation. The current proposal seeks to bridge the above gaps by implementing EmCh through the Breakfast Game (B-Game), a web-based ecological training platform that simulates a daily life environment and is feasible in OA. The Aims 1 and 2 (K99 phase) of this proposal will be based on a pilot study with cognitively healthy OA in order to 1) investigate acceptability/usability and structure of a 12-session training protocol based on web B-Game, and 2) the effects of EmCh approach, in comparison to a control intervention. The K99 phase will provide pilot data regarding several intervention features and outcomes. These data will be critical to optimize the design for the randomized controlled clinical trial I plan to conduct in the R00 phase (Aim 3), in order to evaluate the efficacy of EmCh/B-Game in OA. The R00 trial will be enriched by Alzheimer`s disease blood-based biomarkers, which will improve diagnostic accuracy and allow me to explore intervention response as a function of pathology. To accomplish these aims, I will develop advanced skills to supplement my training in neuropsychology, as I will: 1) enrich my conceptual understanding of cognitive aging/EC; 2) broaden my knowledge of cognitive training, and its integration with technology and teleneuropsychology; 3) develop expertise in clinical trials; and 4) gain skills in statistical analysis. Additionally, I will 5) enrich my knowledge on Alzheimer`s pathology and 6) gain skills in designing fMRI experiments, relevant aims for my independence as a future trialist focused on aging. I have assembled an excellent and well-rounded mentorship team with expertise in cognitive aging, EC/EmCh, clinical trials, technological interventions, teleneuropsychology, and biomarkers. Overall, this K99/R00 proposal lays the foundation for an independent research career focused on technology-based intervention for OA, in order to reduce age-related cognitive decline and promote Alzheimer’s disease / dementia prevention.