Cognitive Remediation of Cognitive Control in Late-Life Depression

晚年抑郁症认知控制的认知治疗

• 批准号: 10675453
• 负责人: Kevin James Manning
• 金额: $ 20.69万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10675453
• 关键词: Address; Affect; Aftercare; Antidepressive Agents; Atrophic; Attention; Automobile Driving; Award; Behavior; Behavior Control; Brain; Brain imaging; Clinical; Clinical Research; Clinical Trials Design; Cognition; Cognition Disorders; Cognitive; Cognitive remediation; Critiques; Data; Data Analyses; Dementia; Depressed mood; Diagnosis; Educational workshop; Elderly; Emotional; Evaluation; Exhibits; Foundations; Functional Magnetic Resonance Imaging; Functional disorder; Goals; Impaired cognition; Impairment; Intervention; Knowledge; Lead; Learning; Licensing; Link; Magnetic Resonance Imaging; Major Depressive Disorder; Measures; Medial; Mediating; Mental Depression; Mental Health; Mentored Patient-Oriented Research Career Development Award; Neural Interconnection; Neurosciences; Outcome; Parietal Lobe; Patients; Probability; Process; Psychotherapy; Randomized, Controlled Trials; Regulation; Research; Research Personnel; Rest; Risk; System; Testing; Therapeutic; Training; Training Programs; White Matter Hyperintensity; active control; active control group; behavior change; career; cerebral atrophy; clinical practice; clinical risk; cognitive ability; cognitive change; cognitive control; cognitive function; cognitive process; cognitive reappraisal; cognitive testing; computerized; depressive symptoms; determinants of treatment resistance; disability; emotion regulation; executive function; follow-up; frontal lobe; geriatric depression; group intervention; improved; mild cognitive impairment; neural circuit; neural network; pre-clinical; programs; randomized trial; response; treatment response; treatment-resistant depression

Dr. Manning is a licensed clinical neuropsychologist who specializes in the cognitive evaluation of older adults. The focus of his clinical practice and clinical-research is cognitive disorders and depression in the elderly. This K23 Award is a critical step toward his career as an independent investigator focused on understanding and modifying pathophysiologic processes of late-life depression (LLD). LLD is a risk state for later dementia. It is thought that frontolimbic brain changes result in both depression and cognitive weaknesses that interact to increase the likelihood of dementia in LLD. Mild impairments in executive functions (EF) appear especially relevant to LLD. Weaknesses in EF are common in LLD and predictive of treatment resistance and a later dementia diagnosis. The process appears to be dynamic, in the sense that decrements in EF promote depressive symptoms, and increases in depression lead to greater impairment in EF. One way to intervene would thus be to address depressive symptoms, e.g., with antidepressants and / or psychotherapy. However, antidepressants have rather limited efficacy and a delayed clinical response in LLD. Furthermore, antidepressants and psychotherapy do not consistently improve EF post-treatment. The other means to intervene, then, would be to target EF. We propose to use computerized cognitive remediation to change EF, depression, and executive control connectivity and explore whether this change is associated with changes in limbic connectivity and long-term cognitive decline in LLD. With the resubmission of this Award application, Dr. Manning proposes a training and research plan that provides a foundation from which to study mechanisms related to treatment response and cognitive decline in LLD. He has four training goals: 1) Expand his knowledge of mechanisms affecting treatment response and cognitive decline in LLD. 2) Develop expertise in the acquisition and analysis of structural and functional MRI. 3) Obtain training in the utilization and evaluation of cognitive remediation interventions, and 4) Learn clinical trial design and analysis of mechanisms of therapeutic change in LLD. In response to the Reviewers' thoughtful critiques, the training plan now emphasizes coursework in clinical neuroscience, MRI analysis, and randomized trials, as well as workshops in preclinical dementia identification. Dr. Manning pays close attention to the use of structural and functional MRI, sensitive cognitive assessment, and longitudinal follow-up as a means to identify LLD patients at risk for cognitive decline. Beyond providing excellent training, this research approach has the strong potential to shed light on the pathophysiology of LLD.

曼宁博士是一位有执照的临床神经心理学家，专门从事老年人的认知评估。 他的临床实践和临床研究的重点是老年人的认知障碍和抑郁症。这 K23奖是迈向他职业生涯的关键一步，专注于理解和 修改后期抑郁症（LLD）的病理生理过程。 LLD是后来痴呆症的风险状态。这是 认为额头大脑变化会导致抑郁症和认知弱点相互作用 增加LLD痴呆症的可能性。尤其是执行职能的轻度损害（EF）尤其是 与LLD有关。 EF中的弱点在LLD中很常见，并且可以预测治疗耐药性和以后的 痴呆诊断。从EF促进的意义上，该过程似乎是动态的 抑郁症状和抑郁症的增加会导致EF损害更大。一种干预的方法 因此，将通过抗抑郁药和 /或心理治疗来解决抑郁症状。然而， 抗抑郁药在LLD中具有相当有限的功效和延迟的临床反应。此外， 抗抑郁药和心理疗法并不能始终改善EF后处理后。另一种方式 那么，干预将是针对EF。我们建议使用计算机化的认知补救来改变EF， 抑郁症以及执行控制连通性，并探索这种变化是否与变化有关 LLD的边缘连通性和长期认知下降。 随着该奖项申请的重新提交，曼宁博士提出了一个培训和研究计划， 为研究与治疗反应和认知能力下降有关的机制提供了一个基础 lld。他有四个培训目标：1）扩大他对影响治疗反应的机制的了解和 LLD认知能力下降。 2）在结构和功能MRI的获取和分析方面发展专业知识。 3）接受认知补救干预措施的利用和评估培训，4）学习临床 LLD治疗变化机制的试验设计和分析。回应审稿人的 周到的批评，培训计划现在强调临床神经科学，MRI分析和 随机试验以及临床前痴呆鉴定的研讨会。曼宁博士密切关注 使用结构和功能性MRI，敏感认知评估以及纵向随访 识别有认知能力下降风险的LLD患者的手段。除了提供出色的培训，这项研究 方法具有强大的潜力，可以阐明LLD的病理生理。