PATH-Pain: A Primary Care-Based Psychosocial Intervention To Improve Cognitive and Depression Outcomes in Older Adults with MCI and Early Stage AD

PATH-Pain：一种基于初级保健的心理社会干预措施，可改善患有 MCI 和早期 AD 的老年人的认知和抑郁结果

• 批准号: 10297969
• 负责人: DIMITRIS N KIOSSES
• 金额: $ 71.82万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10297969
• 关键词: Acute; Address; Affective; Aftercare; Alzheimer' s Disease; Alzheimer' s disease related dementia; Attention; Behavioral; Calendar; Caregivers; Clinical; Cognition; Cognitive; Cognitive deficits; Data; Dementia; Elderly; Emotional; Emotions; Family member; Feeling hopeless; Friends; Habits; Health; Impaired cognition; Individual; Internal Medicine; Intervention; Interview; Location; Measures; Mediating; Medicine; Mental Depression; Mental Health; Montgomery and Asberg depression rating scale; Neurology; Neuropsychology; Outcome; Pain; Pain intensity; Pain management; Pamphlets; Participant; Patients; Persons; Pharmaceutical Preparations; Population Intervention; Primary Health Care; Problem Solving; Procedures; Psychiatry; Public Health; Questionnaires; Randomized; Reaction; Research Assistant; Research Personnel; Resources; Risk; Severities; Site; Stress; Structure; Tablets; Techniques; Telephone; Testing; Time; acceptability and feasibility; attentional control; base; chronic depression; chronic pain; chronic pain patient; clinically significant; cognitive function; cognitive testing; comorbid depression; comorbidity; dementia risk; depressive symptoms; disability; distraction; emotion dysregulation; emotion regulation; environmental adaptation; experience; follow-up; functional outcomes; improved; member; mild cognitive impairment; novel; pain outcome; pain reduction; perceived stress; pleasure; positive emotional state; power analysis; primary outcome; psychosocial; recruit; satisfaction; secondary outcome; sex; stress reduction; sustained attention; therapy design; tool; treatment as usual; treatment effect; usual care arm

This MPI R01 combines the expertise of the Departments of Psychiatry, Neurology, and Internal Medicine at Weill Cornell Medicine to address MCI (mild cognitive impairment) and early stage AD/ADRD in patients with comorbid chronic pain and depression. We propose to test whether Problem Adaptation Therapy for Pain (PATH-Pain), a novel primary-care based psychosocial intervention designed to reduce stress in MCI and early stage AD/ADRD patients with comorbid depression and pain, has better cognitive, affective, and functional outcomes than Attention Control Usual Care. PATH-Pain is an easy-to-administer psychosocial intervention designed to improve emotion regulation and reduce stress in older adults with MCI or early stage AD/ADRD, chronic pain, and depression. To reduce stress, PATH-Pain aims to: a) reduce negative emotions associated with pain and pain-related disability; b) reduce negative emotions that interfere with pain treatment (e.g., hopelessness, helplessness); c) increase positive emotions and increase engagement in pleasurable activities; d) help patients identify addressable problems in their lives and try to find the best possible solution to these problems; e) reduce interpersonal tension between patients and family members, caregivers, and friends; and f) shift attention during experiences of pain to reduce pain intensity. To achieve these aims, PATH-Pain employs emotion regulation, problem solving, and behavioral activation techniques. In our preliminary study, PATH-Pain participants showed high acceptability and treatment satisfaction with the intervention. Based on our power analysis, we will randomize 100 older adults (60 years and older) with MCI or early stage dementia (probable or possible Alzheimer’s Disease), comorbid depression, and chronic pain to 8 weekly in-office sessions and 6 monthly phone (3 individual and 3 group) sessions of PATH-Pain vs. Attention Control Usual Care in 4 primary care sites. The Attention Control Usual Care arm consists of Usual Care, a pamphlet on pain and depression, and a structured interview of the same duration as each PATH-Pain session. The structured interview aims to control for attention and time, and will consist of general questions regarding health habits and other non-medical topics unrelated to cognitive impairment, pain, and depression. The investigators have shown evidence of feasibility of recruitment, retention, and assessment procedures for the proposed study. Assessments will be performed at baseline, and weeks 5 (no cognitive outcomes), 9, 24 (no cognitive outcomes), 36, and 52 by research assistants unaware of the study hypotheses and the participants’ randomization status. PATH-Pain will be administered by certified mental health workers and the Attention-Control sessions will be administered by a non-clinician team member experienced in structured interviews.

这款MPI R01结合了威尔康奈尔医学院精神病学、神经病学和内科的专业知识，以解决MCI（轻度认知障碍）和早期AD/ADRD患者的共病慢性疼痛和抑郁。我们建议测试疼痛问题适应疗法（PATH-Pain）是否比注意控制常规治疗具有更好的认知、情感和功能结局，这是一种新型的基于初级保健的社会心理干预，旨在减轻MCI和早期AD/ADRD患者的压力，并伴有抑郁和疼痛。