Cognition and Treatment Outcomes of Geriatric Depression

描述（由申请人提供）：这是K23以患者为导向的指导科学家奖提案的重新提交。申请人是一名临床心理学家，他建议发展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学研究结果表明，腹侧边缘系统和背侧皮质调节的异常有助于晚年抑郁症，其中一些异常甚至影响抑郁症对治疗的反应。传统的神经心理学测试虽然对诊断和临床护理有用，但通常评估复杂的认知和情感功能，而没有足够的特异性来促进特定神经网络的研究。相比之下，源自认知神经科学范式的测试已开始用于人类特定神经网络的研究。NIMH工作组“21世纪世纪临床试验中的神经认知结果测量：促进认知神经科学的转化”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测定告知的评估工具，以便：1）促进对临床疾病中神经认知功能的理解; 2）允许精细的理论和临床研究。本申请书中提议的培训和研究旨在使申请人做好应对上述任务的准备。正式的课程，辅导，合作研究和论文写作都是计划的，目的是让申请人在抑郁症和衰老的认知和情感神经科学方面的实质性知识，任务开发和测试验证技术的实验技能，以及临床试验方法的培训。来自康奈尔大学、华盛顿大学和威斯康星州大学的导师和专家在与申请人的培训需求相关的领域具有互补的专业知识。培训经验的过程和内容的设计方式，它可以让申请人有机会从与他的导师互动中最大限度地受益。此外，申请人将追求一个研究项目，可以作为实现其教育目标的培训基地。该项目将调查三个注意力网络（冲突，警觉，警惕）在晚年抑郁症中的功能，并假设：1）所有三个都在晚年抑郁症中受损; 2）即使在抑郁症改善后，所有三个仍然受损;但3）只有冲突网络的损伤与抗抑郁药（西酞普兰）的治疗反应不良有关。

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).