Statement of the Problem: With an estimated 50 million people living with dementia worldwide, the burden of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) is enormous for affected individuals, caregivers, and healthcare costs. The U.S. Department of Veterans Affairs estimates that the number of enrollees with ADRD grew 166% from 2004 to 2014. Traumatic brain injury (TBI) is another significant health issue that affects both civilians and Veterans. However, compared to civilians, active-duty and reserve Service members are at increased risk for TBIs because many operational and military training activities are physically demanding and potentially dangerous. Furthermore, military Service members are increasingly deployed to regions of the world where they are at risk for experiencing blast exposures. Even after they retire from the military, older Veterans may sustain TBIs from injuries caused by falls. Study co-investigator Dr. Barnes has shown that older Veterans with TBI are 60% more likely to develop dementia, and that dementia onset occurs on average 2 years earlier compared to Veterans without TBI. Even mild TBI without loss of consciousness is associated with more than a two-fold increase in the risk of dementia diagnosis among Veterans. Because current pharmacological treatments offer limited benefits with considerable side effects, there has been growing interest in non-pharmacological interventions that focus on lifestyle related factors for preserving and enhancing cognitive function in individuals with mild cognitive impairment (MCI), an intermediate stage of cognitive deterioration between normal cognition and dementia.

Rationale, Significance, and Premise: Mind-body practices that incorporate movement exercises with attention to the body and breath have widely been used to promote general wellness and to improve quality of life in older adults, including those living with dementia and TBI. Partnering Site PI Dr. Helen Lavretsky has shown that mind-body interventions can improve cognitive function in older adults with MCI and ADRD and enhance functional brain connectivity in older adults with MCI. Dr. Lavretsky has pilot data suggesting that Tai Chi, an ancient mind-body practice, promotes well-being, resilience, and emotion regulation; improves cognition; and reduces inflammation in older adults with depression and MCI. Other research groups have published suggestive evidence that Tai Chi improves cognition in people with MCI and early ADRD.

Preventing Loss of Independence through Exercise (PLIÉ) is a multi-domain, integrative group program developed by Coordinating Center co-investigators Drs. Barnes, Mehling, and Chesney specifically for individuals with cognitive impairment. PLIÉ integrates elements from traditional approaches with specific mind-body techniques to train procedural memory for basic functional movements (e.g., sit-to-stand), increase mindful-body awareness, and facilitate social connection. In previous pilot studies, we found that PLIÉ improved cognition and physical performance and quality of life in individuals with ADRD. Preliminary data from our ongoing DOD/PRARP-funded study (AZ160019, PI Chao) has confirmed PLIÉ’s effects on cognitive and physical performance, this time in older adults with MCI. Preliminary data suggests that PLIÉ also decreases feelings of social isolation, increases the ability to regulate distress by attention to body sensations, and brain functional connectivity in individuals with MCI.

Despite suggestive evidence that mind-body interventions may improve cognition in older adults with MCI, the neural mechanisms underlying this effect are not well understood. Moreover, it has been difficult to compare different mind-body interventions because most studies have used different outcome measures, different subject populations, and different intervention intervals. The MOTION study will fill this gap in by examining PLIÉ and Tai Chi’s ability to improve cognition and enhance brain connectivity in people with MCI using parallel methods (i.e., identical inclusion/exclusion criteria, intervention duration, active control group, and outcome measures) in a randomized, controlled trial. The MOTION study innovates by leveraging resources from two well-established research groups with expertise in mind-body research and an information technology company that has developed and pilot-tested a telehealth platform for livestreaming PLIÉ with funds from an NIH Small Business Innovative Research (SBIR) grant.

Impact: Mind-body interventions have the potential to address an enormous public health need because they are safe and can be implemented widely in the community and at home at relatively low cost via livestreaming telehealth technology. A better understanding of the neural mechanisms underlying these promising interventions will providing valuable information that could be used to enhance the effectiveness of these treatments for civilians and Veterans with MCI/ADRD.