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

项目摘要 阿尔茨海默氏病（AD）和阿尔茨海默氏病相关痴呆（ADRD）影响美国超过600万老年人，尽管癌症风险与AD/ADRD之间的关系尚未完全阐明，但一部分老年癌症幸存者随后将在癌症治疗后数月至数年内发展AD/ADRD。老年癌症幸存者是一个快速增长的人群;在美国有超过1000万65岁的癌症幸存者。老年癌症幸存者会经历既往治疗的长期副作用，如癌症相关认知功能障碍（CRCD）。CRCD是一种普遍的副作用，并在记忆，注意力和执行功能方面造成困难。高达35%的癌症幸存者在完成癌症治疗后数月至数年内出现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应。 先前评估MCI和AD老年人非药物干预（如认知训练）的研究已证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进展为AD的风险，但是如果CRCD导致认知困难，这可能是可逆的成分。记忆和注意力适应训练-老年医学（MAAT-G）是一种基于认知行为疗法的CRCD干预。向患有MCI的老年癌症幸存者提供MAAT-G，这些患者发展AD/ADRD的风险最大，可以通过解决CRCD的可逆成分来改善感知和客观认知功能。MAAT-G是由临床心理学家通过视频会议在一系列的10个研讨会会议。作为母公司K76奖的一部分，PI使用上下文、基于队列、成熟度、特定挑战（CCMSC）模型对MAAT-G进行了调整;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。尽管在目前设计的母研究中，许多患者可能不符合MCI的标准。因此，本行政补充的总体目标是通过确定该人群的知情同意率、干预依从率和研究完成率，评估在35名已完成癌症治疗的MCI老年癌症幸存者中提供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，我们将通过与患者和入选患者的护理人员的半结构化访谈，收集有关MAAT-G在MCI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.