Problem Adaptation Therapy for Mild Cognitive Impairment with Depression

轻度认知障碍抑郁症的问题适应疗法

• 批准号: 9335774
• 负责人: DIMITRIS N KIOSSES
• 金额: $ 74.16万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9335774
• 关键词: Adult; Affective; Alzheimer' s Disease; Alzheimer' s disease risk; Area; Bypass; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Custom; Data; Dementia; Development; Diagnosis; Elderly; Emotions; Episodic memory; Funding; Goals; Home environment; Impaired cognition; Institution; Intervention; Investigation; Major Depressive Disorder; Manuals; Measures; Mediating; Medical; Medical center; Mental Depression; Mental Health; Modification; Montgomery and Asberg depression rating scale; Moods; Neuropsychology; Outcome; Participant; Patients; Persons; Population; Problem Solving; Procedures; Psychiatry; Public Health; Randomized; Recruitment Activity; Research; Research Assistant; Research Infrastructure; Research Personnel; Risk; Site; Stress; Subgroup; Supportive care; Symptoms; Tablets; Techniques; Testing; Therapeutic Intervention; Trail Making Test; United States National Institutes of Health; World Health Organization Disability Assessment Schedule; amnestic mild cognitive impairment; base; clinically significant; cognitive change; cognitive function; cost; cost effective; demented; depressive symptoms; disability; emotion regulation; environmental adaptation; executive function; functional decline; human very old age (85+); improved; medical schools; meetings; mild cognitive impairment; minor depressive disorder; novel; pilot trial; power analysis; primary outcome; psychosocial; therapy design; treatment effect

ABSTRACT This collaborative R01 combines the expertise of the Department of Psychiatry, Johns Hopkins Bayview Medical Center and the Department of Psychiatry at Weill Cornell Medical College in the areas of depression and MCI research. We propose to test whether Problem Adaptation Therapy for MCI patients (PATH-MCI), a novel psychosocial intervention designed to reduce depression in MCI patients, has better cognitive, functional, and affective outcomes compared to Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in older adults with Mild Cognitive Impairment (MCI) and major or minor depression. Problem Adaptation Therapy (PATH) is a novel psychosocial intervention designed to reduce depression and disability in older adults with major depression, wide range of cognitive impairment (from mild cognitive deficits to moderate dementia), and disability. PATH aims to reduce depression by improving emotion regulation. To achieve its goals of emotion regulation, PATH utilizes a simplified problem solving approach, employs environmental adaptations to bypass cognitive and functional limitations, and involves a significant other when appropriate. Preliminary data show that PATH significantly improves cognitive, functional and affective outcomes in older adults with major depression and mild cognitive deficits compared to another depression treatment, Supportive Therapy for Cognitively Impaired Older Adults (ST-CI). We streamlined the PATH manual focusing only on MCI patients (PATH-MCI) and modify it to increase its treatment effects and reduce costs by: a) providing in-office instead of home-delivered sessions; b) utilizing individualized techniques, such as the MindMe tablet app, customized CDs, or step-by-step written plan, to help patients regulate their emotions between sessions; and c) incorporating monthly booster sessions. Based on our power analysis, we will randomize 80 older adults (60-85 years old) with MCI and major or minor depression to 15 in-office sessions (12 in first 12 weeks and 3 booster monthly sessions afterwards) of PATH- MCI vs. ST-CI in both sites. Both sites are major academic medical institutions that have shown evidence of feasibility of recruitment, randomization, retention, and assessment procedures. Weill Cornell researchers have conducted other NIH and Alzheimer's Association funded investigations that include administration of PATH in older adults with wide range of cognitive deficits (from mild cognitive deficits to moderate dementia). Assessments will be performed at baseline, 6 (no cognitive outcomes), 12, 24, 36 (no cognitive outcomes) and 52 weeks by research assistants unaware of the study hypotheses and the participant's randomization status. In each site, certified mental health clinician will administer PATH-MCI and ST-CI.

摘要 这个协作的R01结合了约翰霍普金斯大学贝维尤精神病学系的专业知识 韦尔康奈尔医学院抑郁症领域的医学中心和精神病学系 和MCI研究。我们建议测试MCI患者的问题适应疗法(PATH-MCI)，a 旨在减少MCI患者抑郁的新型心理社会干预措施，具有更好的认知、功能和功能， 与老年认知受损老年人支持性治疗(ST-CI)的情感结局比较 患有轻度认知障碍(MCI)和严重或轻度抑郁症的成年人。 问题适应疗法(PATH)是一种新型的心理社会干预措施，旨在减少抑郁症和 患有严重抑郁、广泛认知障碍(来自轻度认知缺陷)的老年人的残疾 到中度痴呆症)和残疾。Path旨在通过改善情绪调节来减少抑郁。至 为了达到情绪调节的目标，Path使用了简化的问题解决方法，采用了 环境适应以绕过认知和功能限制，并在以下情况下涉及重要的其他方面 恰如其分。初步数据显示，Path显著改善了认知、功能和情感 患有重度抑郁症和轻度认知障碍的老年人与另一种抑郁症患者的预后比较 认知受损老年人的治疗，支持疗法(ST-CI)。我们简化了小路 手动聚焦仅针对MCI患者(Path-MCI)，并对其进行修改以增加其治疗效果并减少 成本：a)提供办公室会议而不是家庭会议；b)利用个性化技术，如 作为MindMe平板电脑应用程序、定制CD或循序渐进的书面计划，帮助患者规范他们的 会议之间的情绪；以及c)纳入每月的助推器会议。 基于我们的力量分析，我们将80名老年人(60-85岁)随机分为MCI和主要或次要两组 抑郁到15次办公室会议(前12周12次，之后每月3次)-- 两个站点的MCI与ST-CI。这两个地点都是主要的学术医疗机构，都有证据表明 招募、随机、保留和评估程序的可行性。威尔康奈尔大学的研究人员 进行了其他由NIH和阿尔茨海默氏症协会资助的调查，包括管理 有广泛认知缺陷(从轻度认知缺陷到中度痴呆症)的老年人的路径。 评估将在基线、6(无认知结果)、12、24、36(无认知结果)和 52周，研究助理不知道研究假设和参与者的随机状态。 在每个地点，注册的精神卫生临床医生将管理路径-MCI和ST-CI。