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）的风险更高。轻度认知障碍包括功能下降，可能包括参与有意义活动和个人自信/掌控感的下降，并与抑郁症状、家庭沟通满意度差和身体功能下降有关。针对轻度认知障碍患者和照顾者的现有干预措施往往侧重于单一问题，如记忆或身体活动，没有可用的多方面支持性护理干预措施来满足轻度认知障碍患者及其照顾者的需求，以防止过早脱离参与和出现抑郁症状的风险。每日增强有意义活动（DEMA）干预采用家庭二元、基于优势和积极健康的方法，以现有的二元技能和价值观为基础，实现有意义的活动参与，以解决有效干预的优先需求，防止轻度认知障碍患者过早脱离参与和抑郁症状。DEMA建立在我们之前的描述性工作和老年学理论、人类职业模型和问题解决疗法的组成部分之上。我们的初步调查结果表明，干预和措施是可以接受的，并向参与者征求了改善交付的建议。本试点研究的目的是：1)评估修订后的DEMA干预措施的可行性和满意度；2)通过纳入比较组来估计干预的效应量。mci -照顾者二组（n = 36）将被随机分配到DEMA组或信息支持组；每个小组将接受6次双周会议（2次面对面会议和4次电话会议），由一名训练有素的干预者进行。MCI患者和护理人员的数据将在干预前、干预后立即（两周）和项目后3个月评估时收集。描述性统计分析将用于对DEMA或信息支持小组的满意度和感知，一般线性混合模型将用于估计干预对近端和远端结果的影响大小。研究结果将为后续R01的设计提供参考：1)在纵向随机临床试验中测试DEMA对MCI患者-护理者的疗效；2)探索实施的成本/收益。如果发现它是有效的，DEMA有可能减缓从轻度认知损伤到AD的残疾进展速度，并改善患者和护理人员的生活质量。

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.