Preventing Cognitive Decline in African Americans with Mild Cognitive Impairment.

预防患有轻度认知障碍的非裔美国人的认知衰退。

• 批准号: 8311700
• 负责人: BARRY W. ROVNER
• 金额: $ 50.74万
• 依托单位: THOMAS JEFFERSON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8311700
• 关键词: Activities of Daily Living; Affect; African American; Aging; Alzheimer' s Disease; Attention; Behavior; Behavior Therapy; Belief; Clinical; Clinical Research; Clinical Trials; Cognition; Cognitive; Communication; Communities; Data; Dementia; Diabetes Mellitus; Discrimination; Economics; Education; Elderly; Epidemiology; Episodic memory; Genetic; Goals; Health Services Accessibility; Home environment; Housing; Hypertension; Impaired cognition; Impairment; Incidence; Intervention; Language; Leisure Activities; Life Style; Literature; Measures; Mediating; Medical; Medical Genetics; Mental Depression; Minority; Moods; Nurses; Occupational; Outcome; Outcome Study; Pattern; Persons; Pharmaceutical Preparations; Placebos; Population; Process; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Research; Resources; Risk Factors; Sampling; Site; Societies; Socioeconomic Factors; Supportive care; Symptoms; Testing; Translating; United States; Verbal Learning; Work; base; cognitive change; cognitive function; community setting; coping; cost; depressive symptoms; efficacy testing; high risk; impression; innovation; instrumental activity of daily living; mild neurocognitive impairment; neuropsychiatry; neuropsychological; normal aging; prevent; primary outcome; programs; secondary outcome; social; treatment effect

Mild Cognitive Impairment (MCI) is a transition state between normal aging and dementia that affects about 25% of older African Americans (AAs) and predicts progression to Alzheimer's disease (AD). AAs may be at higher risk for MCI and AD than Whites, possibly because of differences in genetic, medical, and socioeconomic factors. Thus, there is a pressing need to develop preventative interventions in this high risk population. Based on an extensive epidemiologic literature that suggests that cognitive, physical, and/or social activities may prevent cognitive decline, we propose to conduct a randomized clinical trial to test the efficacy of a culturally relevant intervention, Behavior Activation (BA), to prevent cognitive decline. The intervention incorporates AAs' unique beliefs, practices, and communication patterns; resonates with their coping strategies; and facilitates access to care. We are targeting AAs with the amnestic multiple domain subtype of MCI (aMCI-MD) because they are at especially high risk. A bachelor's level nurse will deliver 6 initial in-home BA treatment sessions over 2-3 months and then 6 subsequent in-home booster sessions using language, materials, and concepts that are culturally relevant to older AAs during this 24 month clinical trial. A bachelor's level nurse will similarly deliver in-home Supportive Therapy (ST) at the same treatment intensity. ST is a placebo treatment that controls for attention. We plan to recruit subjects from multiple community sites (e.g., senior centers, senior high rise apartment houses) that predominately serve older AAs and will randomize 200 older AAs with aMCI-MD to BA or ST. The primary outcome is episodic memory as measured by the Hopkins Verbal Learning Test-Revised (HVLT-R) at baseline and at months 3, 6, 12, 18, and 24. We hypothesize that 20% of BA-treated subjects, compared to 40% of ST-treated subjects, will decline by e 6 points on the HVLT-R over 24-months. A 6-point decline on the HVLT-R translates clinically to the loss of ability to perform an instrumental activity of daily living task. The secondary outcomes are general and domain-specific neuropsychological function, difficulty with instrumental activities of daily living, depression, neuropsychiatric symptoms, and quality-of-life. This research is innovative because it targets a high-risk minority sample; employs a community-based strategy to recruit subjects, deliver the intervention, and assess outcomes; and tests a nonpharmacologic intervention that resonates with the coping strategies of older AAs. Over the past ten years we have developed productive clinical and research programs with AAs in community settings and have the established relationships, preliminary data, and clinical trials expertise to conduct the proposed research.

轻度认知障碍（MCI）是正常衰老和痴呆之间的过渡状态， 25%的老年非裔美国人（AA），并预测进展为阿尔茨海默病（AD）。AA可能在 MCI和AD的风险高于白人，可能是因为遗传、医学和 社会经济因素。因此，迫切需要在这一高风险领域制定预防性干预措施。 人口基于广泛的流行病学文献，表明认知、身体和/或社会 活动可以防止认知能力下降，我们建议进行一项随机临床试验，以测试 一种文化相关的干预，行为激活（BA），以防止认知能力下降。干预 结合了AA独特的信仰，实践和沟通模式;与他们的应对方式产生共鸣 战略;并促进获得护理。我们的目标是具有遗忘多域亚型的AA， MCI（aMCI-MD），因为他们的风险特别高。一个学士学位的护士将提供6个初始的家庭 2-3个月的BA治疗，然后6个后续的使用语言的家庭加强治疗， 材料和概念，在这个为期24个月的临床试验中与老年AA文化相关。本科 一级护士将以相同的治疗强度提供家庭支持治疗（ST）。ST是个 控制注意力的安慰剂治疗。我们计划从多个社区网站招募受试者（例如， 老年中心，高层公寓），主要为老年人服务，并将随机抽取200名 aMCI-MD至BA或ST的老年AA。主要结局是由霍普金斯测量的情景记忆 基线和第3、6、12、18和24个月时的口头学习测试-修订版（HVLT-R）。我们假设 20%的BA治疗受试者和40%的ST治疗受试者的HVLT-R将下降6分 超过24个月。HVLT-R下降6分在临床上转化为丧失执行 工具性日常生活活动任务。次要结果是一般性的和特定领域的 神经心理功能，工具性日常生活活动困难，抑郁，神经精神 症状和生活质量。 这项研究是创新的，因为它针对的是高风险的少数民族样本;采用基于社区的 招募受试者的策略，提供干预措施，评估结果;并测试非药物学 与老年AA的应对策略产生共鸣的干预。在过去的十年里， 与AA一起在社区环境中开发了富有成效的临床和研究项目，并建立了 关系、初步数据和临床试验专业知识来进行拟议的研究。