Cognitive Remediation to Improve Mobility in Sedentary Seniors

Emerging evidence indicates that Executive Functions play an important role in maintaining
locomotion in aging and preventing mobility disabilities. However, use of cognitive training
programs to improve executive functions as a strategy to increase mobility has not been
explored. Exciting results from the preliminary study support the efficacy and feasibility of
the cognitive remediation approach to improve locomotion in older adults.

The premise of this clinical trial is that disability among seniors is a potentially
preventable chronic condition rather than an irreversible consequence of aging and disease.
The investigators proposed novel approach to locomotion has the potential to shift treatment
paradigms in the field of disability by introducing cognitive approaches to mobility that can
be applied to prevention and rehabilitation in diverse settings. Through this 'proof of
concept' secondary prevention trial the investigators will fill an important gap in knowledge
for practicing evidence-based medicine and developing effective interventions for a major
health outcome affecting a substantial proportion of the U.S. aging population.

Inclusion Criteria:

1. Adults aged 70 and older, residing in the community.

2. Plan to be in area for next year.

3. Able to speak English at a level sufficient to undergo our cognitive assessment
battery.

4. Ambulatory. Subjects are classified as 'non-ambulatory' if they are unable to leave
the confines of their home and attend a clinic visit.

5. Gait velocity ≤1 m/s.

6. Short Physical Performance Battery score ≤9.

Exclusion Criteria:

1. Presence of dementia identified by any one of the following: Telephone based Memory
Impairment Screen score (T-MIS) of <5, Alzheimer's Disease 8 (AD8) ≥ 2. Or dementia
diagnosed by baseline cognitive assessment.

2. Serious chronic or acute illness such as cancer (late stage, metastatic, or on active
treatment), chronic pulmonary disease on ventilator or continuous oxygen therapy or
active liver disease.

3. Mobility limitations solely due to musculoskeletal limitation or pain (e.g., severe
osteoarthritis) that prevent subjects from completing mobility tests. Presence of
arthritis will not be used to exclude subjects if they can complete the mobility
tasks.

4. Any medical condition or chronic medication use (e.g., neuroleptics) that will
compromise safety or affect cognitive functioning or terminal illness with life
expectancy less than 12 months.

5. Presence of progressive, degenerative neurologic disease (e.g., Parkinson's disease or
ALS).

6. Hospitalized in the past 6 months for severe illness or surgery that specifically
affects mobility (e.g. hip or knee replacement) and that prevent subjects from
completing mobility tests or plans for surgery affecting mobility in the next 6
months.

7. Severe auditory or visual loss.

8. Active psychoses or psychiatric symptoms (such as agitation) noted during the clinic
visit that will prevent completion of study protocols.

9. Living in nursing home.

10. Participation in other intervention trial or observational studies. -