Cognitive Rehabilitation and Exposure Therapy for Geriatric Hoarding

项目总结/摘要 囤积症（HD）是一种慢性、进行性和使人衰弱的精神疾病， 对个人和社区造成毁灭性后果，特别是对老年人。HD定义为持续性 “舍”或“舍”，是指舍，是指舍。 和/或难以决定保留什么和丢弃什么。结果，杂波累积， 填充活动生活区，妨碍空间的正常使用，并导致痛苦和残疾。社区 流行病学报告估计，临床上显著的囤积症状在个体中的患病率为7%， 60岁以上的人，70岁以上的人甚至更高。HD是唯一的神经精神疾病， 除痴呆外，严重程度和人群患病率随年龄的进展。 抑制和认知转换已被确定为HD老年人的关键缺陷。这些 执行功能区与RDoC认知控制域一致，特别是 选择、更新、表示和维护子构造。研究结果表明，这些缺陷可能 有助于HD的症状表达、功能损害程度和对HD的适度反应 治疗此外，预期的和经验的恐惧和焦虑，与RDoC的结构一致， 急性和潜在的威胁，导致丢弃物品和杂物积累的持续问题。当 这些结构是有针对性的，我们的小组已经产生了临床和统计学显著的结果。 与NIMH战略目标3.1一致，为未得到满足的治疗提供有效的治疗方法， 在行为科学领域，该项目旨在对老年人进行第一次验证性疗效试验 HD的。我们提出了一项随机对照试验，比较CREST和病例管理对照条件下的150名50岁成人 老了，HD我们正在研究年龄作为一个调节器，因此将包括中年和晚年 参与者将对治疗结果进行评估，包括囤积严重程度和功能结果， 在基线（0个月）、治疗中期（3个月）、治疗结束（6个月）、3个月（9个月）时进行 随访6个月（12个月）。参与者将在2017年12月15日至2018年12月30日期间接受26次每周60分钟的个人课程。 疗程最长32周（6-7.5个月）。他们将接受50%的家庭和50%的办公室访问。我们将 检查介导CREST改善的因素（改善的抑制/认知转换和减少的 丢弃物品的恐惧/焦虑）通过生理、行为、自我报告和范式评估。 个体因素（例如，年龄和其他人口统计学因素，基线认知控制，基线囤积 严重性）和治疗因素（例如，会议出席情况）将作为主持人进行评估。具体目标 包括确定CREST验证功效、CREST效应的机制以及 冠。如果成功，这个项目将导致在真实的世界环境中进行有效性试验。

Project Summary/Abstract Hoarding disorder (HD) is a chronic, progressive, and debilitating psychiatric condition that leads to devastating personal and community consequences, particularly for older adults. HD is defined by persistent difficulty discarding or parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making decisions about what to keep and what to discard. As a result, clutter accumulates and fills active living areas, preventing the normal use of space and resulting in distress and disability. Community epidemiological reports estimate the prevalence of clinically significant hoarding symptoms at 7% in individuals over age 60 and even higher rates in those over age 70. HD is the only neuropsychiatric condition that progresses in severity and population prevalence with age apart from dementia. Inhibition and cognitive switching have been identified as key deficits in older adults with HD. These executive functioning areas are consistent with the RDoC cognitive control domain and particularly the goal selection, updating, representation, and maintenance subconstruct. Findings suggest that these deficits may contribute to the symptomatic expression of HD, degree of functional impairment, and modest responses to HD treatment. Furthermore, anticipatory and experiential fear and anxiety, consistent with the RDoC constructs of acute and potential threat, lead to sustained problems with discarding items and clutter accumulation. When these constructs are targeted, our group has produced clinically and statistically significant outcomes. Consistent with NIMH strategic goal 3.1, to arrive at effective treatment approaches for unmet therapeutic domains in behavioral science, this project seeks to conduct the first confirmatory efficacy trial for older adults with HD. We propose a RCT comparing CREST to a case management control condition for 150 adults age 50 and older with HD. We are examining age as a moderator and will therefore include both midlife and late life participants. An evaluation of treatment outcome, including hoarding severity and functional outcomes, will be conducted at baseline (0 months), mid-treatment (3 months), end of treatment (6 months), 3-month (9 months) and 6-month follow-up (12 months). Participants will receive 26 weekly 60-minute individual sessions over the course of 32 weeks maximum (6-7.5 months). They will receive 50% in home and 50% office visits. We will examine factors that mediate improvement in CREST (improved inhibition/cognitive switching and reduction in fear/anxiety of discarding items) through physiological, behavioral, self-report, and paradigm assessments. Individual factors (e.g., age and other demographic factors, baseline cognitive control, baseline hoarding severity) and treatment factors (e.g., session attendance) will be evaluated as moderators. The specific aims include determining confirmatory efficacy of CREST, mechanisms of CREST effects, and moderators of CREST. If successful, this project would lead to an effectiveness trial in a real world setting.