Promoting Independence with Compensatory Cognitive Rehabilitation: A Pilot Clinical Trial for Early-Stage Alzheimer's Disease

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ABSTRACT CANDIDATE: Alyssa Lanzi, Ph.D. is an academic speech-language pathologist and Research Assistant Professor at the University of Delaware. In this K23 application, Dr. Lanzi will build on her training and research studying cognitive rehabilitation approaches that preserve independence in adults with mild cognitive impairment (MCI) and early-stage dementia from Alzheimer’s disease (AD). The objective of this award is to acquire new knowledge, skills, and experiences needed to independently conduct clinical trials of these interventions, as well as future dissemination and implementation. Her long-term goal is to establish a productive research program that develops, evaluates, and disseminates cognitive rehabilitation interventions for adults with AD and MCI. CAREER DEVELOPMENT PLAN: Dr. Lanzi proposes to: 1) learn how to design and conduct randomized controlled trials of behavioral interventions for adults with MCI and dementia from AD; 2) receive training in the multidisciplinary assessment of the cognitive, psychological, and independent living skills of this population; 3) acquire knowledge and skills related to dissemination and implementation of behavioral interventions for rehabilitation clinicians. The training plan includes rich experiential learning activities such as multidisciplinary team-based cognitive assessment activities in diverse community settings. ENVIRONMENT: Dr. Lanzi will train with a multidisciplinary team of NIH-funded mentors with expertise in clinical trials research, MCI and dementia from AD, and dissemination/implementation research. Dr. Verdolini Abbott (U Delaware), co-primary mentor, is a senior academic speech-language pathologist and has extensive expertise in clinical trials of behavioral interventions. Dr. Cohen (U Delaware), co-primary mentor, is a rehabilitation-oriented neuropsychologist with a record of multi-disciplinary cognitive assessment research. Dr. Rodakowski (U Pittsburgh), co-mentor, is an academic occupational therapist with expertise in cognitive strategy training and independent living skills for adults with MCI. Dr. Smith (U Florida), co-mentor, is a senior neuropsychologist and renowned expert in MCI, AD, and behavioral intervention approaches. RESEARCH: Most treatment approaches for MCI and dementia from AD have focused on restoring cognitive weaknesses. Unfortunately, these are suboptimal for preserving or improving independent living skills. Aim 1 of the proposed research is to conduct a pilot trial to evaluate the efficacy of the Structured External Memory Aid Treatment, a compensation-based approach for adults with MCI that promotes independent living skills by teaching the use of strategies to compensate for cognitive weaknesses (e.g., note-taking systems). Aim 2 is to evaluate the demographic, clinical, and neuropsychological predictors of treatment adherence. Aim 3 is to refine treatment procedures and materials that will be used to train future interventionists. The completion of these training and research aims are critical for Dr. Lanzi’s career development and continued success in investigating the efficacy and effectiveness of compensatory cognitive interventions that enhance the independence and quality of life of adults with AD.