Cognitive Reserve and Training in Older Veterans with Traumatic Brain Injury

Veterans Affairs Med Ctr San Francisco, San Francisco CA

Investigators

Linked publications & trials

Abstract

? DESCRIPTION: Traumatic brain injury (TBI), common among military personnel, appears to not only result in cognitive dysfunction following the injury but to also have dire long-term consequences in aging. Individuals who experienced TBI earlier in life are at increased risk for developing dementia in older adulthood. This underscores the need to intervene to prevent dementia among individuals who previously experienced TBI, potentially by identifying ways to enhance cognitive reserve. The concept of cognitive reserve refers to qualities of an individual's cognitive capacity that can protect against cognitive decline, such as having higher educational and occupational attainment, better academic skills, and a more cognitively-stimulating lifestyle. In other older adult populations, greater cognitive reserve has been shown to reduce risk for dementia, even among older adults with Alzheimer's neuropathology. It remains to be investigated whether cognitive reserve can help buffer the neural system in aging against late-life cognitive impairment and dementia in individuals with a history of TBI. The research proposed for this Career Development Award-2 (CDA-2) aims to: 1) characterize cognitive function in older Veterans with a history of TBI by focusing on executive control, 2) identify aspects of cognitive reserve that promote cognitive resilience in older Veterans with a history of TBI, and 3) conduct a pilot intervention trial investigating whether a computerized executive control training intervention can improve cognitive function and enhance cognitive reserve in this population. This work will be accomplished in two studies. The first study is a cross-sectional comparison of 35 older Veterans (60-75 years old) with a history of repetitive mild TBI or at least one moderate TBI with 35 demographically-matched Veterans without TBI. These groups will be compared with respect to their performance on a cognitive battery designed to assess abilities involved in and related to executive control. We will also measure different aspects of cognitive reserve (i.e., education, occupational attainment, literacy, and engagement in cognitively-stimulating activities) to investigate the association between these factors and cognitive performance. The second study is a pilot intervention trial investigating a neuroscience-based computerized cognitive training intervention designed to target executive control. Sixty older Veterans (60-75 years old) with 1) a history of repetitive mild TBI or at least one moderate TBI and 2) subjective cognitive complaints or evidence of executive control deficits on objective testing will be randomly-assigned to the intervention or an active control condition (computerized word games) for four weeks. Using cognitive assessments and everyday functioning measures, we will investigate whether the intervention leads to improved cognitive performance, whether effects generalize to non-trained abilities and everyday functioning, and whether effects are maintained over a 3-month follow-up period. This program of research is designed to increase understanding of the role of cognitive reserve in protecting against TBI-associated cognitive impairment in late life and whether cognitive reserve can be enhanced with cognitive training. The applicant for this CDA-2 is a VA postdoctoral fellow who has studied predictors of cognitive aging. With this award, she aims to gain additional research experience and training to facilitate her career goal of becoming an independent VA investigator. The applicant seeks training in the conduction of TBI-focused research and intervention trials (e.g., randomized controlled trials) to investigate neuroscience-based cognitive training. The applicant's career goals are to become an expert in cognitive reserve and its effects in aging and how to promote cognitive reserve to prevent dementia in older Veterans, using TBI as the ideal clinical model to study these phenomena.