Feasibility of the Memory and Attention Adaptation Training-Geriatrics Intervention in Older Cancer Survivors with Mild Cognitive Impairment

项目总结 阿尔茨海默病(AD)和阿尔茨海默病相关痴呆症(ADRD)在美国影响着600多万老年人，尽管癌症风险与AD/ADRD之间的关系尚未完全阐明，但部分老年癌症幸存者在癌症治疗后几个月至几年后会发展为AD/ADRD。老年癌症幸存者是一个快速增长的人口；在美国，65岁的癌症幸存者有1000万。老年癌症幸存者会经历先前治疗的长期副作用，如癌症相关认知功能障碍(CRCD)。CRCD是一种普遍的副作用，会造成记忆、注意力和执行功能的困难。多达35%的癌症幸存者在完成癌症治疗后几个月到几年会出现CRCD症状。老年癌症患者，特别是认知储备较低的患者，最容易患CRCD。一种假设是CRCD可能有助于患有轻度认知障碍(MCI)和AD/ADRD的老年癌症幸存者的认知效果。 先前评估非药物干预(如认知训练)对患有MCI和AD的老年人的研究表明，认知和神经精神症状有所改善。患有MCI的老年癌症幸存者有发展为AD的风险，然而，如果CRCD导致认知障碍，这可能是一个可逆的组成部分。记忆和注意适应训练-老年病学(MAAT-G)是一种基于认知行为疗法的CRCD干预措施。向罹患AD/ADRD风险最大的MCI的老年癌症幸存者提供MAAT-G可能通过解决CRCD的可逆成分而改善感知和客观认知功能。MAAT-G由临床心理学家通过视频会议在十个研讨会的系列会议上发表。作为父母K76奖的一部分，MAAT-G由PI使用背景、基于队列的成熟、特定挑战(CCMSC)模型进行调整；来自老年癌症幸存者的反馈指导了干预措施的进一步调整。K76的主要目标是评估MAAT-G对积极接受治疗的老年癌症患者的初步疗效。虽然在目前设计的母体研究中，这些患者中的许多可能不符合MCI的标准。因此，这一行政补充的首要目标是通过确定这一人群中的同意率、干预依从率和研究完成率来评估在35名已完成癌症治疗的MCI老年癌症幸存者中使用MAAT-G的可行性。我们还将研究干预后感知和客观认知功能以及功能独立性的变化。此外，我们将通过对患者和入选患者的照顾者的半结构化访谈，收集有关MAAT-G在患有MCI的老年癌症幸存者中的可行性和认知益处的观点。如果MAAT-G在患有MCI的老年癌症幸存者中使用是可行的，未来的工作将在该人群的随机临床试验中评估MAAT-G对感知和客观认知以及功能独立性的益处。

PROJECT SUMMARY Alzheimer’s Disease (AD) and Alzheimer’s Disease Related Dementias (ADRD) affect more than 6 million older adults in the United States and although the relationship between risks of cancer and AD/ADRD are not fully elucidated, a proportion of older cancer survivors will subsequently develop AD/ADRD months to years after cancer treatment. Older cancer survivors are a rapidly growing population; in the United States there are >10 million cancer survivors aged 65. Older cancer survivors experience long-term side effects from prior therapy, such as Cancer-Related Cognitive Dysfunction (CRCD). CRCD is a prevalent side effect and creates difficulties in memory, attention and executive function. Up to 35% of cancer survivors experience CRCD symptoms months to years after completion of their cancer therapy. Older patients with cancer, particularly those with lower cognitive reserve, are most vulnerable to CRCD. One hypothesis is that CRCD may contribute to cognitive effects in older cancer survivors with Mild Cognitive Impairment (MCI) and AD/ADRD. Prior studies evaluating non-pharmacologic interventions (e.g. Cognitive Training) for older adults with MCI and AD have demonstrated improvement in cognitive and neuropsychiatric symptoms. Older cancer survivors with MCI are at risk of progressing to AD, however if CRCD is contributing to cognitive difficulties, this may be a reversible component. Memory and Attention Adaptation Training-Geriatrics (MAAT-G) is a cognitive behavioral therapy-based intervention for CRCD. Providing MAAT-G to older cancer survivors with MCI who are at greatest risk for developing AD/ADRD may afford improvements in perceived and objective cognitive function by addressing the reversible components of CRCD. MAAT-G is delivered by a clinical psychologist via videoconferencing during a series of ten workshop sessions. As a component of the parent K76 award, MAAT-G was adapted by the PI using the Contextual, Cohort-based, Maturity, Specific Challenge (CCMSC) model; feedback from older cancer survivors guided further adaptation of the intervention. The primary goal of the K76 is to assess the preliminary efficacy of MAAT-G on older adults with cancer actively on treatment. Though in the parent study as currently designed, many of these patients may not meet criteria for MCI. Therefore, the overarching goal of this administrative supplement is to evaluate the feasibility of delivering MAAT-G in 35 older cancer survivors with MCI who have completed cancer therapy by determining consent rate, intervention adherence rate, and study completion rate in this population. We will also examine the change in perceived and objective cognitive function and functional independence following the intervention. Additionally, we will gather perspectives on the feasibility and perceived cognitive benefits of MAAT-G in older cancer survivors with MCI through semi-structured interviews with patients and caregivers of the enrolled patients. If MAAT-G is feasible to deliver in older cancer survivors with MCI, future work would evaluate the benefit of MAAT-G on perceived and objective cognition and functional independence in a randomized clinical trial in this population.