Resilient Together for Dementia: A live video resiliency dyadic intervention for persons with dementia and their care-partners early after diagnosis

项目摘要 在这份K23提案中，我概述了一个全面的5年培训计划，该计划将支持我向 独立调查员专注于开发和严格测试二元体的干预措施（即，对）的人 老年痴呆症患者及其非正式护理伙伴，重点是早期干预。在本申请中， 我提出了一个重要的和创新的建议，这是直接与我提出的培训和职业发展 目标.背景：阿尔茨海默病和相关痴呆（ADRD）对残疾人及其家属产生了大量的压力。 配偶护理伙伴（SP），他们在诊断后都经历了大量的情绪困扰。情绪困扰是 在二人组中相互依赖，如果不治疗，就会变成慢性病，对双方的健康产生负面影响， 生活质量，以及他们应对ADRD相关短期和长期挑战的能力。解决 早期情绪困扰，当残疾人仍然可以有意义地参与时，是预防慢性疾病的一个未开发的机会。 情感上的痛苦，并保持双方的生活质量。具体目标和研究设计：我的目标是开发 第一个版本的现场视频弹性一起为痴呆症（RT-D）干预和方法，通过1）采访和 PWD-SP二元组的定量调查（N=20），以及来自2）ADRD医疗焦点小组的额外反馈 利益攸关方（N=4）（目标1）。接下来，我将探索，通过一个开放的试点（N=5对）与离职面谈和前后自我- 报告评估、实时视频RT-D和程序的初步可行性、可接受性和可信度，以及 根据需要进一步完善RT-D（目标2）。最后，我将通过RT-D与对照组的试点可行性RCT（N= 最多50对），RT-D的可行性，可接受性和可信度遵循预定的基准（目标3）。 研究结果将通过R 01机制和未来的研究扩展这一点，为混合疗效-有效性试验提供信息 努力让更多的家庭成员和其他护理伙伴参与进来。培训和指导：我的目标是支持 3个培训目标，以发展以下方面的专门知识：1）定性和混合方法评估，为干预措施适应提供信息; 2） 老年医学和ADRD临床护理的专业培训; 3）促进二元干预的临床试验方法 发展和完善。我将从我的主要导师Ana-Maria博士领导的模范团队获得指导 Vranceanu是一位临床健康心理学家，擅长混合方法研究和现场视频二元干预 我的共同导师克莉丝汀里奇博士是一位老年病学家和姑息治疗医生，有几十年的工作经验 改善ADRD的治疗。我的培训目标得到了1）专家导师团队，2）丰富的机构 环境在马萨诸塞州总医院和哈佛医学院，和3）有针对性的课程，科学 会议、研讨会和计划的出版物。与国家情报局的使命有关。该K23符合NIA的优先事项， 制定干预措施，以维持健康和福祉，减轻ADRD的负担。影响：我是一名临床医生 心理学家，在神经系统人群的夫妇和家庭干预方面具有专业知识。所获得的经验将 作为ADRD二元干预的独立职业的基础，重点是早期干预。

PROJECT SUMMARY In this K23 proposal, I outline a comprehensive 5-year training program that will support my transition towards an independent investigator focused on the development and rigorous testing of interventions for dyads (i.e., pairs) of persons living with dementia (PWDs) and their informal care-partners, with an emphasis on early intervention. In this application, I propose a significant and innovative proposal that is directly tied with my proposed training and career development goals. Background: Alzheimer's disease and related dementias (ADRD) produce a host of stressors for PWDs and their spousal care-partners (SPs), who both experience substantial emotional distress after diagnosis. Emotional distress is interdependent within dyads and – without treatment—becomes chronic and negatively impacts both partners' health, quality of life, and their ability to navigate the short and long-term challenges associated with ADRDs. Addressing emotional distress early, when PWDs can still meaningfully participate, is an unexplored opportunity to prevent chronic emotional distress and preserve quality of life for both partners. Specific aims and research design: I aim to develop the first version of the live video Resilient Together for Dementia (RT-D) intervention and methodology via 1) interviews and quantitative surveys (N=20) of PWD-SP dyads, with additional feedback from 2) focus groups with ADRD medical stakeholders (N=4) (Aim 1). Next, I will explore, via an open pilot (N=5 dyads) with exit interviews and pre-post self- report assessments, the initial feasibility, acceptability, and credibility of the live video RT-D and procedures, and to further refine RT-D as needed (Aim 2). Finally, I will establish, via a pilot feasibility RCT of the RT-D versus control (N= up to 50 dyads), the feasibility, acceptability and credibility of RT-D following predetermined benchmarks (Aim 3). Findings will inform a hybrid efficacy-effectiveness trial through the R01 mechanisms and future studies extending this work to include additional family members and other care-partners. Training and mentoring: My aims are supported by 3 training goals to develop expertise in: 1) qualitative and mixed methods assessment to inform intervention adaptation; 2) specialty training in geriatrics and ADRD clinical care; 3) clinical trial methodology to facilitate dyadic intervention development and refinement. I will obtain mentorship from an exemplary team led by my primary mentor Dr. Ana-Maria Vranceanu, a clinical health psychologist with expertise in mixed-methods research and live video dyadic intervention development, and my co-mentor Dr. Christine Ritchie, a geriatrician and palliative care physician with decades of work improving the treatment of ADRD. My training goals are supported by 1) a team of expert mentors, 2) a rich institutional environment at Massachusetts General Hospital and Harvard Medical School, and 3) targeted coursework, scientific meetings, seminars and planned publications. Relevance to the NIA mission. This K23 is in line with NIAs priorities to develop interventions to the maintain health and wellbeing and reduce the burden of ADRDs. Impact: I am a clinical psychologist with expertise in couple and family interventions for neurological populations. The experience gained will serve as the foundation for an independent career in dyadic interventions for ADRDs, with a focus on early intervention.