Cognition and Treatment Outcomes of Geriatric Depression

描述(由申请者提供)：这是K23患者导向的指导性科学家奖的重新提交的提案。申请者是一名临床心理学家，他建议培养独立调查员职业生涯所需的技能，重点是在老年抑郁症及其治疗的研究中使用认知和情感神经科学方法。最近的临床和神经影像研究表明，腹侧边缘和背侧皮质调节的异常与老年抑郁症有关，其中一些异常甚至会影响抑郁症的治疗反应。传统的神经心理学测试虽然对诊断和临床护理有用，但往往评估复杂的认知和情感功能，而没有足够的特异性来促进对特定神经网络的研究。相比之下，源于认知神经科学范式的测试已经开始用于对人类特定神经网络的研究。NIMH工作组《21世纪临床试验中的神经认知结果测量：推进认知神经科学的翻译》已经认识到这种方法在临床环境中的科学和临床潜力，该工作组敦促该领域开发和实施由认知分析提供信息的评估工具，以便：1)促进对临床疾病中神经认知功能的理解；以及2)允许进行精细化的理论和临床研究。本申请书中提议的培训和研究旨在使申请者做好应对上述任务的准备。正式的课程、教程、合作研究和论文写作都是为了给申请者提供关于抑郁症和衰老的认知和情感神经科学的实质性知识，任务开发和测试验证技术的实验技能，以及临床试验方法学的培训。来自康奈尔大学、华盛顿大学和威斯康星大学的导师和专家被选中，他们在与申请人的培训需求相关的领域具有互补的专业知识。培训过程和内容的设计使申请者有机会从与导师的互动中获得最大的好处。此外，申请者将从事一项研究项目，该项目可以作为实现其教育目标的培训基础。该项目将调查三个注意网络(冲突、警报、警觉)在晚年抑郁症中的功能，并假设：1)这三个网络在晚年抑郁症中都受到损害；2)即使抑郁症改善，这三个网络都仍然受损；但3)只有冲突网络中的受损与抗抑郁剂(西酞普兰)治疗反应差有关。

DESCRIPTION (provided by applicant): This is a resubmission of a proposal for a K23 Patient-Oriented Mentored Scientist Award. The applicant is a clinical psychologist, who proposes to develop the skills necessary for independent investigator's career focusing on the use of cognitive and affective neuroscience methods in studies of geriatric depression and its treatment. Recent clinical and neuroimaging findings suggest that abnormalities in ventral limbic and dorsal cortical regulation contribute to late-life depression and some of these abnormalities even influence the response of depression to treatment. Traditional neuropsychological tests, while useful for diagnosis and clinical care, often assess complex cognitive and affective functions without sufficient specificity to contribute to studies of specific neural networks. In contrast, tests originating from cognitive neuroscience paradigms have begun to be used in studies of specific neural networks in humans. The scientific and clinical potential of this approach in clinical settings has been recognized by the NIMH Workgroup, "Neurocognitive Outcome Measures in 21st Century Clinical Trials: Advancing the Translation of Cognitive Neuroscience" that urged the field to develop and implement assessment tools that are informed by cognitive assays in order to: 1) advance the understanding of neurocognitive function in clinical disorders; and 2) allow for refined theoretical and clinical research. The training and research proposed in this application aims to prepare the applicant to respond to the above mandate. Formal coursework, tutorials, collaborative studies, and paper writing all were planned with the goal of giving the applicant substantive knowledge in cognitive and affective neuroscience of depression and of aging, experimental skills in task development and test validation techniques, as well as training in clinical trials methodology. Mentors and experts from Cornell, Washington University, and the University of Wisconsin were selected with complementary expertise in areas relevant to the applicant's training needs. The process and content of the training experience was designed in a way that it can give the applicant the opportunity to best benefit from interaction with his mentors. Moreover, the applicant will pursue a research project that can function as the training ground for accomplishing his educational objectives. The project will investigate the function of three attentional networks (conflict, alerting, vigilance) in late-life depression and hypothesizes that: 1) All three are impaired in late-life depression; 2) All three remain impaired even after improvement of depression; but 3) Only impairment in the conflict network is associated with poor treatment response to an antidepressant (citalopram).