Use of the KF Modified Story Memory Technique to Improve New Learning and Memory in Individuals with Mild Cognitive Impairment

项目摘要 轻度认知障碍（MCI）的患病率在60岁以上的成年人中为7-25%， 风险随着年龄的增长而增加。新的学习和记忆（LM）障碍在MCI患者中很常见， 对日常生活的几个方面产生负面影响，包括日常活动和社会活动的独立性 功能尽管老年人和临床医生都对LM治疗有需求， 到目前为止，康复（CR）方案得到I类研究证据的支持，从而限制了 这些潜在有效的治疗可以应用于患有MCI的个体。 凯斯勒基金会改良的故事记忆技术（KF-mSMTTM）是一种手动的，10节CR 旨在治疗受损LM的方案。在我们中心进行了十多年的研究和开发 已经证明KF-mSMT对于改善患有神经病症的个体的LM是有效的（例如， MS，TBI），跨越三个功能领域（客观行为，神经功能和日常生活）， 随着时间的推移保持改善。这一令人信服的数据提供了I类证据，支持 KF-mSMT用于改善这些人群中的LM。此外，我们还积累了关于 KF-mSMT在MCI患者中的疗效，突出了KF-mSMT可能的成功应用 对于MCI患者。 我们将进行一项多中心、双盲、安慰剂对照的随机临床试验（RCT）， 将KF-mSMT应用于120名符合MCI标准的参与者。结果将立即评估， 治疗后6个月以及治疗后18个月检查长期 冲击结果将通过3种机制进行测量：（1）神经心理学评估（NPE）， 治疗后客观认知表现的变化（2）整体功能（AGF）评估， 检查治疗后日常生活中认知的变化和（3）功能性磁共振成像（fMRI） 检查治疗前至治疗后LM表现的脑激活模式的变化。的 在这项随机对照试验中，将日常生活活动作为先验终点的检查是所提出的一个高度创新的方面， 工作，强调作为一个显着的差距，在康复文献的许多专家在CR。重要的是 本研究中采用的严格的研究设计高度响应了NIA提出的目标 在他们的战略方向（第14页），以“确定个人如何能够保持功能与年龄或恢复， 功能丧失后，由于不动，疾病或创伤”，同时也旨在确定“机制， 这些常见的医疗和行为干预措施可能会减缓身体和认知能力的下降。”

Project Summary Prevalence rates for Mild Cognitive Impairment (MCI) range from 7-25% for adults over the age of 60, with risk increasing with age. Impairments in new learning and memory (LM) are common in persons with MCI and negatively impact several aspects of everyday life, including independence in daily activities and social functioning. Despite the demand for LM treatments by older adults and clinicians alike, few cognitive rehabilitation (CR) protocols to date are supported by Class I research evidence, thereby limiting the degree to which potentially efficacious treatments can be applied to individuals with MCI. The Kessler Foundation modified Story Memory Technique (KF-mSMTTM) is a manualized, 10-session CR protocol designed to treat impaired LM. Over a decade of research and development conducted at our center has demonstrated the KF-mSMT to be effective for improving LM in individuals with neurological conditions (e.g., MS, TBI), across three realms of functioning (objective behavior, neural functioning, and everyday life) with improvements maintained over time. This convincing data provides Class I evidence supporting the efficacy of the KF-mSMT for improving LM in these populations. In addition, we have accumulated strong pilot data on the efficacy of the KF-mSMT in individuals with MCI, highlighting the likely successful application of the KF-mSMT to individuals with MCI. We will conduct a multi-site, double-blind, placebo-controlled randomized clinical trial (RCT), administering the KF-mSMT to 120 participants who meet criteria for MCI. Outcome will be assessed immediately following treatment, 6 months following treatment as well as 18 months following treatment to examine the long-term impact. Outcome will be measured via 3 mechanisms: (1) Neuropsychological Evaluation (NPE) to examine post-treatment changes on objective cognitive performance (2) Assessment of Global Functioning (AGF) to examine post-treatment changes in cognition in daily life and (3) functional magnetic resonance imaging (fMRI) to examine pre to post-treatment changes in patterns of cerebral activation underlying LM performance. The examination of daily life activities as an a priori endpoint in this RCT is a highly innovative aspect of the proposed work, highlighted as a significant gap in the rehabilitation literature by many experts in CR. Importantly, the rigorous research design employed in the current study is highly responsive to the objectives set forth by the NIA in their strategic directions (p.14), to “determine how individuals can maintain function with age or regain that function after loss due to immobility, illness, or trauma”, while also designed to identify the “mechanism through which common interventions, both medical and behavioral, may slow the physical and cognitive decline.”