Meaningful Activity Intervention for Persons with Mild Cognitive Impairment

描述（由申请人提供）：轻度认知障碍（MCI）影响多达20%的老年人，他们患阿尔茨海默病（AD）的风险更大。MCI涉及功能下降，可能包括参与有意义的活动和自己的信心/掌握感的下降，并且它与抑郁症状，家庭沟通满意度差和身体功能下降有关。MCI患者和护理人员的现有干预措施通常集中在单一问题上，例如记忆或身体活动，并且没有可用的多方面支持性护理干预措施来满足MCI患者及其护理人员的需求，以防止过早脱离和抑郁症状的风险。每日增强有意义活动（DEMA）干预使用家庭二元，基于力量和积极的健康方法，建立在现有的二元技能和价值观的基础上，以实现有意义的活动参与，以解决有效干预的优先需求，以防止MCI患者过早脱离和抑郁症状。DEMA建立在我们以前的描述性工作和老年学理论，模型人类职业，和解决问题疗法的组成部分。我们的初步调查结果显示，干预和措施是可以接受的，并征求了与会者的建议，以改善交付。本试点研究的目的是：1）评价修订后的DEMA干预措施的可行性和满意度; 2）通过纳入对照组估计干预措施的效应量。MCI-护理人员配对（n = 36对）将被随机分配至DEMA或信息支持组;每组将接受6次每两周一次的会议（2次面对面和4次电话会议），由经过培训的干预者进行。将在干预前、干预后立即（两周）和项目后3个月评估时收集MCI患者和护理人员结局的数据。描述性统计分析将用于评估对DEMA或信息支持组的满意度和感知，一般线性混合模型将用于估计干预对近端和远端结局的效应量。研究结果将为后续R 01的设计提供信息，以：1）在纵向随机临床试验中测试DEMA对MCI患者-护理人员二人组的疗效; 2）探索实施的成本/效益。如果发现它是有效的，DEMA有可能减缓从MCI到AD的残疾进展速度，并改善患者和护理人员的生活质量。 公共卫生相关性：轻度认知障碍（MCI）影响五分之一的老年人，他们患阿尔茨海默病（AD）的风险更大，经历各种困难并降低生活质量。本研究旨在评估修订后的每日有意义活动增强干预（DEMA）的可行性和满意度，并通过纳入对照组来估计干预的效果大小。DEMA采用家庭二元，基于优势的积极健康方法，以现有的二元技能和价值观为基础，完成有意义的活动参与，以解决有效干预的优先需求，以防止MCI患者过早脱离和抑郁症状。

DESCRIPTION (provided by applicant): Mild cognitive impairment (MCI) affects as many as 20% of older adults who are at a greater risk of developing Alzheimer's disease (AD). MCI involves functional decline that may include decrements in engagement in meaningful activities and one's own sense of confidence/mastery, and it is associated with depressive symptoms, poor satisfaction with family communication, and declining physical function. Existing interventions for MCI patients and caregivers often focus on a single problem, such as memory or physical activity and there are no available multi-faceted supportive care interventions to meet the needs of the MCI patients and their caregivers in order to prevent premature disengagement and risk for depressive symptoms. The Daily Enhancement of Meaningful Activity (DEMA) intervention uses a family dyadic, strengths-based, and positive health approach that builds on existing dyadic skills and values to accomplish meaningful activity engagement to address the priority needs for efficacious interventions to prevent premature disengagement and depressive symptoms in MCI patients. The DEMA builds on our previous descriptive work and gerontology theory, the model human occupation, and components of the Problem-Solving Therapy. Our preliminary findings showed that the intervention and measures were acceptable, and suggestions were solicited from the participants for improving delivery. The purpose of this pilot study is to 1) evaluate the feasibility and satisfaction of the revised DEMA intervention; and 2) estimate effect sizes for the intervention through the incorporation of a comparison group. The MCI-caregiver dyads (n = 36 dyads) will be randomized to the DEMA or informational support groups; each group will receive 6 bi-weekly sessions (2 face-to-face and 4-phone delivered) with a trained intervener. The data from MCI patients and caregivers outcomes will be collected at pre-intervention, immediately (two weeks) post-intervention, and 3 months post-program evaluation. Descriptive statistics analysis will be used for satisfaction with and perception of the DEMA or informational support groups and general linear mixed models will be used to estimate the effect sizes of the intervention on the proximal and distal outcomes. Findings will inform the design of a subsequent R01 to: 1) test the efficacy of DEMA for MCI patient-caregiver dyads in a longitudinal randomized clinical trial; and 2) explore the costs/benefits of implementation. If it is found to be efficacious, DEMA has the potential to slow the rate of disability progression from MCI to AD and improve quality of life outcomes for patients and caregivers. PUBLIC HEALTH RELEVANCE: Mild cognitive impairment (MCI) affects one of fifth older adults, who are at a greater risk of developing Alzheimer's disease (AD) and experience various difficulties and decrease their quality of life. This study is to evaluate the feasibility and satisfaction of the revised Daily Enhancement of Meaningful Activity intervention (DEMA); and estimate effect sizes for the intervention through the incorporation of a comparison group. The DEMA uses a family dyadic, strengths-based, positive health approach that builds on existing dyadic skills and values to accomplish meaningful activity engagement to address the priority needs for efficacious interventions to prevent premature disengagement and depressive symptoms in MCI patients.