Dementia poses a significant challenge to aging Veterans. Yet, dementia often has a long preclinical phase which may be the optimal window for impactful preventative care. Motoric Cognitive Risk syndrome (MCR) is a preclinical dementia syndrome characterized by slow gait speed and subjective cognitive complaints. There are limited preventative treatment options for Veterans with MCR. However, physical activity-based treatments that improve both mobility and cognition are likely to be beneficial for older Veterans with MCR. Functional Power Training (FPT) and Music-Based Digital Therapy (MBDT) are evidence-based treatments that improve walking and may be effective treatments for Veterans with MCR. FPT and MBDT potentially enhance mobility through different mechanisms. However, there is individual variability in responses. Individuals who are not responding to a given treatment may benefit from different treatments or combinations of treatments, highlighting the need for a personalized adaptive approach. This 5-year Career Development Award (CDA-2) builds on my prior work as an exercise physiologist delivering exercise treatments to older adults and the formative work from my 2-year VA Rehabilitation Research and Development CDA-1. The CDA-2 will conduct a pilot Sequential Multiple Assignment Randomized Trial (SMART) to identify effective adaptive interventions using FPT and MBDT (n=54). The proposed study will 1) develop and refine adaptive intervention manuals for use with older Veterans with MCR; 2) assess the feasibility and safety of adaptive interventions through a pilot SMART; and 3) evaluate the acceptability of adaptive interventions and SMART design. Successful completion of this CDA-2 will provide the groundwork for subsequent fully powered SMART and Adaptive Intervention trials contributing to evidence-based personalized treatments. This will advance my research career focusing on developing and testing innovative adaptive dementia prevention treatments for older Veterans who are at high risk for transitioning to dementia. Specialized training objectives to accomplish these research aims and the long-term career goal are 1) acquire a foundation for implementation science, 2) gain expertise in advanced programmatic clinical trials (Adaptive Interventions & SMART), 3) advance skills in mixed methods, qualitative analysis, and interviews, 4) expand my knowledge and experiences in rehabilitation science and integrate with implementation science, 5) enhance grant writing, scholarly dissemination, and leadership. I will use the combination of didactic coursework provided by a rich academic research environment, hands-on research training, and mentorship from a team of experts who can offer extensive knowledge and support this CDA-2 and my research career.

Dementia is a growing concern among aging Veterans. This study will evaluate personalized preventative dementia treatments for Veterans at risk for dementia. We will target Veterans with Motoric Cognitive Risk syndrome (MCR), which is characterized by slow gait speed and cognitive concerns (e.g., problems with memory and/or concentration). We will test two therapeutic exercise treatments: one focuses on power training, while the other employs music-based therapy. This study will use a novel study design, Sequential Multiple Assignment Randomized Trial (SMART). Successful completion of this study will lay the foundation for subsequent research trials, contributing to valuable evidence for personalized rehabilitation medicine for older Veterans. Moreover, achieving these milestones aligns with the researcher’s career goal of developing and testing innovative personalized dementia prevention strategies using novel study designs for older Veterans at the highest risk of transitioning to dementia.