Influence of Strategy Training on Disability for Older Adults with Mild Cognitive Impairment

项目摘要/摘要 认知能力的丧失导致阿尔茨海默病是进行性的和破坏性的，留下老年人 残疾，无法回忆起他们的过去。患有阿尔茨海默氏症的老年人人数预计将 到2050年是三倍，但很少有研究检查淀粉样β蛋白(Aβ)沉积、执行功能和 残疾的进展。更少研究旨在减缓病情进展的非药物干预措施 这些老年人的残疾。我们建议测试一种新颖而有前途的非 药物干预对150例轻度认知障碍老年人残疾进展的影响 之前完成正电子发射断层扫描(PET)成像的损害(MCI) 匹兹堡化合物B(PIB)。我们的干预是战略培训。战略培训优化客户参与度 通过制定自己选择的目标、监控日常活动、安排日程，进行有意义的日常活动 活动，以及解决参与活动中遇到的障碍的问题的解决办法。职业 治疗师在老年人家中提供策略培训，以增强现实世界的应用。我们完成了一个 策略训练的初步随机对照试验(N=30)，我们发现效应大小适中 (Cohen‘s d=0.54)表示6个月时残疾程度的组间差异。在这个第二阶段的试验中，我们将测试 策略训练与强化日常护理对老年人残疾变化的影响 MCI和评估大脑成像和神经认知功能在多大程度上改变了 关于残疾变化的战略培训和加强日常护理。干预措施，如战略培训， 专注于减缓残疾的出现，尽管潜在的病理可能会让老年人继续从事 尽可能长时间地进行有意义的日常活动。这个项目测试了一种新颖而有前途的非 药物干预，并将使我们了解重要的效应调节剂-β沉积和 执行功能--关于具有认知挑战性的日常活动的表现变化。增强我们的 对β沉积、执行功能、残疾和有希望的非药理学的理解 干预可以支持数百万老年人的老龄化，在不久的将来，他们将经历残疾 与MCI有关。

PROJECT SUMMARY/ABSTRACT Loss of cognitive abilities leading to Alzheimer's disease is progressive and destructive, leaving older adults disabled and unable to recall their past. The number of older adults with Alzheimer's disease is expected to triple by the year 2050, yet little research examines amyloid beta (Aβ) deposition, executive function, and progression of disability. Even less examines non-pharmacological interventions designed to slow progression to disability for these older adults. We propose to test the influence of a novel and promising non- pharmacological intervention on progression of disability in a sample of 150 older adults with Mild Cognitive Impairment (MCI) who have previously completed Positron Emission Tomography (PET) Imaging with Pittsburgh Compound B (PiB). Our intervention is Strategy Training. Strategy training optimizes engagement in meaningful daily activities through generating self-selected goals, monitoring daily activities, scheduling activities, and problem-solving solutions to barriers experienced when engaging in activities. Occupational therapists deliver Strategy Training in older adults' homes to enhance real-world application. We completed a preliminary randomized controlled trial of Strategy Training (N=30), and we found a moderate effect size (Cohen's d = 0.54) for between-group differences on disability at 6 months. In this Phase II trial, we will test the effect of Strategy Training compared to Enhanced Usual Care on change in disability among older adults with MCI and assess the extent to which brain imaging and neurocognitive function modify the relationship between Strategy Training and Enhanced Usual Care on change in disability. Interventions, such as Strategy Training, focused on slowing emergence of disability despite underlying pathology may keep older adults as engaged in meaningful daily activities for as long as possible. This project tests a novel and promising non- pharmacological intervention and will inform our understanding of important effect modifiers -Aβ deposition and executive function- on change in performance of cognitively challenging daily activities. Enhancing our understanding of Aβ deposition, executive function, disability, and a promising non-pharmacological intervention could support aging for millions of older adults who, in our near future, will experience disability related to MCI.