A Theoretically Based Memory Training Intervention in Mild Cognitive Impairment

基于理论的记忆训练干预轻度认知障碍

• 批准号: 8107478
• 负责人: MIRIAM Z. MINTZER
• 金额: $ 32.32万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8107478
• 关键词: Activities of Daily Living; Age; Alzheimer' s Disease; Awareness; Biological; Brain Diseases; Caregiver Burden; Caregivers; Clinical; Clinical Trials; Cognitive; Control Groups; Data; Dementia; Disease; Educational Background; Educational Intervention; Elderly; Etiology; Future; Goals; Individual; Intervention; Laboratories; Life; Long-Term Effects; Measures; Mediating; Memory; Memory impairment; Neurodegenerative Disorders; Outcome Measure; Patient Self-Report; Patients; Performance; Pharmacotherapy; Phase; Prefrontal Cortex; Procedures; Process; Quality of life; Randomized; Relative (related person); Risk; Role; Societies; Symptoms; Testing; Time; Training; Training Programs; Treatment outcome; base; behavior measurement; blind; clinically relevant; cognitive change; cognitive function; cognitive training; daily functioning; depressive symptoms; design; diet and exercise; executive function; follow-up; improved; innovation; interest; mild neurocognitive impairment; neuropsychiatry; neuropsychological; normal aging; post intervention; prevent; public health relevance; response; social; stress management; treatment response

DESCRIPTION (provided by applicant): Alzheimer's Disease (AD), a progressive neurodegenerative disorder, is characterized by a gradual decline in cognitive processes and functional abilities. It significantly impacts patients, caregivers, and society as a whole. Individuals with amnestic Mild Cognitive Impairment (a-MCI) are at greater risk for progression to AD than normal healthy older adults. Given that cognitive functioning is still relatively intact in a-MCI, it is a particularly promising target for cognitive training interventions, which capitalize on preserved cognitive abilities. However, there are few well-controlled training studies in MCI. The prefrontal cortex (PFC) is a promising and viable target for cognitive training in MCI. The proposed repetition lag training procedure (RLTP) is a theoretically based, clinically relevant, and innovative incremented difficulty training procedure that is designed to train the PFC-supported general cognitive process of recollection and has shown promise in preliminary studies in high functioning older adults and MCI patients. The proposed pilot clinical trial will test the effects of the RLTP in combination with a theoretically and empirically supported pre-training program in mnemonic strategy use in a single blind randomized controlled design in a-MCI patients, with a 9-month post-intervention follow-up period. Outcome measures were carefully selected to cover a wide range of domains: cognitive neuropsychological, self-report and behavioral measures of everyday functioning and awareness of memory impairment/metamemory, quality of life, caregiver burden, and neuropsychiatric symptoms. Specific Aim 1 is to test the hypothesis that a-MCI patients will improve on the repetition lag task following training. Specific Aim 2 is to test the hypothesis that a-MCI patients who are exposed to the training intervention (experimental group) will show greater improvement in cognitive, functional, and neuropsychiatric measures from baseline to post- training, relative to a-MCI patients who are not exposed to the intervention but who have a similar amount of contact with staff, time in the laboratory, and cognitive stimulation (control group). Specific Aim 3 is to test the hypothesis that better baseline performance on executive function and metamemory tasks and higher education level will be associated with higher post-training improvement scores, and that higher depressive symptoms and age will be associated with lower post-training scores. Specific Aim 4 is to test the degree to which training benefits are maintained at follow-up. Findings will provide clinically relevant information about the short- and long-term effects of an innovative training procedure that has the potential to improve daily functioning. They will also enhance scientific understanding of the malleability of PFC-based processes in response to training interventions in MCI, the role of these processes in individual treatment response, and the ability of such training to slow AD symptom progression. Data will also provide information about the relative sensitivity of different cognitive and functional measures, and about specific training parameters, response predictors and follow-up effects, which will be used to refine the design of a full-scale clinical trial. PUBLIC HEALTH RELEVANCE: Individuals with amnestic Mild Cognitive Impairment (a-MCI) are at greater risk for progression to Alzheimer's Disease (AD) than normal healthy older adults. This pilot clinical trial will test the ability of an innovative and theoretically based memory training intervention to improve cognitive, neuropsychiatric and everyday functioning in a-MCI patients, to maintain that improvement across a 9-month follow-up period, and to slow progression of AD symptoms.

描述（由申请人提供）：阿尔茨海默病（AD）是一种进行性神经退行性疾病，其特征在于认知过程和功能能力的逐渐下降。它对患者、护理人员和整个社会都产生了重大影响。患有遗忘型轻度认知障碍（a-MCI）的个体比正常健康老年人进展为AD的风险更大。鉴于认知功能在a-MCI中仍然相对完整，它是利用保留的认知能力进行认知训练干预的特别有前途的目标。然而，在MCI中很少有良好对照的训练研究。前额叶皮层（PFC）是MCI认知训练的一个有前途和可行的目标。建议的重复滞后训练程序（RLTP）是一种基于理论的，临床相关的，创新的增加难度的训练程序，旨在训练PFC支持的一般认知过程的回忆，并已在高功能老年人和MCI患者的初步研究中显示出希望。拟议的初步临床试验将在a-MCI患者中以单盲随机对照设计测试RLTP与理论和经验支持的记忆策略使用预培训计划相结合的效果，干预后随访期为9个月。仔细选择结果测量，以涵盖广泛的领域：认知神经心理学，自我报告和日常功能的行为测量和记忆障碍/元记忆的意识，生活质量，照顾者负担和神经精神症状。具体目的1是检验a-MCI患者在训练后将改善重复滞后任务的假设。具体目标2是检验以下假设：相对于未暴露于干预但与工作人员接触量、实验室时间和认知刺激相似的a-MCI患者（对照组），暴露于培训干预的a-MCI患者（实验组）将显示从基线到培训后认知、功能和神经精神测量的更大改善。具体目标3是检验以下假设：执行功能和元记忆任务的基线表现更好，教育水平更高，培训后改善评分更高，抑郁症状和年龄更高，培训后评分更低。具体目标4是测试在随访时保持培训益处的程度。研究结果将提供有关创新训练程序的短期和长期影响的临床相关信息，该程序有可能改善日常功能。他们还将加强对PFC为基础的过程的可塑性的科学理解，以应对MCI中的培训干预，这些过程在个体治疗反应中的作用，以及这种培训减缓AD症状进展的能力。数据还将提供有关不同认知和功能测量的相对敏感性，以及有关特定训练参数，反应预测因子和随访效果的信息，这些信息将用于完善全面临床试验的设计。 公共卫生关系：患有遗忘型轻度认知障碍（a-MCI）的个体比正常健康的老年人进展为阿尔茨海默病（AD）的风险更大。这项试点临床试验将测试一种创新的、基于理论的记忆训练干预措施改善a-MCI患者的认知、神经精神和日常功能的能力，在9个月的随访期内保持这种改善，并减缓AD症状的进展。