Cognitive Rehabilitation for Veterans with Parkinson's Disease

超过100，000名患有帕金森病（PD）的美国退伍军人目前接受PD相关护理， 从VA的服务。除了明确的运动并发症外，PD还具有进行性 认知能力下降，主要是执行功能（EF）缺陷。PD相关的认知功能下降在临床上 重要的是，它会导致长期功能障碍和生活质量（QoL）下降。目前， 20-55%的PD患者患有轻度认知障碍（PD-MCI），高达80%的患者将发展为痴呆（PD-MCI）。 D）。PD-MCI和PD-D的治疗选择有限，可能需要为退伍军人定制治疗 使认知康复成为VA研究的一个重要课题。计算机认知训练（CCT）显示 承诺作为一种有效的认知康复方法，为老年患者群体的认知 下降在帕金森病中，新出现的证据表明，认知训练可以在训练后立即改善认知 对EF测量具有中等至大的效应量。然而，大多数研究仅纳入PD患者， 正常认知（PD-N）;只有一个在家里评估CCT（PD-N参与者）。因此，没有PD研究 评估了在家里，CCT计划改善轻度执行的PD患者的认知能力 功能障碍（PD-MCI-EF）。此外，对于CCT引起的改善是否转移到 日常活动。本SPiRE旨在通过进行一项试点随机对照试验来解决这些差距 (RCT)研究使用现有的 基于网络的EF CCT计划，有或没有前瞻性实施意图策略的培训 （PRIS）在退伍军人与PD-MCI-EF。实施意图策略对阿尔茨海默病有效 在帕金森病患者中也有希望PRIS建立在CCT培训的认知技能基础上， 以病人为中心的自我管理策略为重点的前瞻性记忆训练可能会大大提高 CCT的转移效应。中心假设是，与CCT + PRIS对照或CCT + PRIS对照相比，CCT+ PRIS 控制+PRIS控制，将导致认知表现和日常功能的更大改善。 参与者将被随机分配到CCT（每周4次，每次30分钟）和PRIS（实施 意图）、CCT加PRIS控制（意图的口头排练）或CCT控制（娱乐计算机 游戏）加上PRIS控制。假设CCT+ PRIS计划是可行的，如 参与者方案完成率。关于参与者感觉的补充信息（即享受， 心理刺激）的CCT和PRIS计划将进行定性评估。与会者还将 在基线、终点（8周干预后立即）完成标准化神经认知成套测验 和1个月随访时。假设与其他组相比，CCT+ PRIS将改善 在选定的神经心理学测试组合中对未经训练的认知任务的表现。成果包括 在EF、内存和处理速度任务上的性能。最后，对现实生活功能的近端测量将 与认知表现的变化相关。这个SPiRE提案是创新的，因为它利用了一套 在线训练游戏，针对PD中EF的易感方面，并训练认知益处的转移 为患有PD-MCI-EF的退伍军人提供日常功能。培训在家中进行， 为参与者提供方便和灵活性。由于目前还没有有效的治疗PD-MCI的方法， 由于大多数PD患者将发展为PD-D，因此早期干预以减缓进展为PD-D是至关重要的。然而，在这方面， 考虑到患有PD的退伍军人是老年人群的一部分， 条件和PD-MCI-EF参与者可能在计划和目标设定方面受损， 在家中成功实施认知康复策略的可行性是关键的第一步。这 该项目将产生初步数据，以支持将建立在SPiRE基础上的VA Merit， 不仅是PD康复领域，而且是老年认知康复的一般领域。

More than 100,000 US Veterans living with Parkinson's disease (PD) currently receive PD-related care and services from the VA. In addition to well-defined motor complications, PD is also characterized by progressive cognitive decline, predominantly executive function (EF) deficits. PD-related cognitive decline is clinically significant because it leads to long-term functional impairment and diminished quality of life (QoL). Currently, 20-55% of PD patients have mild cognitive impairment (PD-MCI) and up to 80% will develop dementia (PD- D). Limited treatment options for PD-MCI and PD-D and the possible need to tailor treatments to Veterans makes cognitive rehabilitation an important VA research topic. Computerized cognitive training (CCT) shows promise as an effective cognitive rehabilitation approach for geriatric patient populations with cognitive decline. In PD, emerging evidence reveals cognitive training improves cognition immediately following training with moderate to large effect sizes on measures of EF. However most studies only included PD patients with normal cognition (PD-N); only one assessed at-home CCT (with PD-N participants). Thus, no PD studies have assessed the ability of at-home, CCT programs to improve cognition in PD patients with mild executive dysfunction (PD-MCI-EF). Moreover, there is paucity in understanding if CCT-induced improvements transfer to daily activities. This SPiRE seeks to address these gaps by conducting a pilot randomized controlled trial (RCT) to examine the feasibility of conducting an 8-week at-home cognitive training program using an existing web-based EF CCT program with or without training in prospective implementation intentions strategies (PRIIS) in Veterans with PD-MCI-EF. Implementation intention strategies are effective in Alzheimer's disease and it shows promise in PD patients. PRIIS that builds on cognitive skills trained in CCT and incorporates prospective memory training that focuses on patient-centered self-management strategies may boost far transfer effects of CCT. The central hypothesis is that CCT+PRIIS, compared to CCT+PRIIS control or CCT control+ PRIIS control, will lead to greater improvements in cognitive performance and every day function. Participants will be randomized to either CCT (four 30min sessions/week) plus PRIIS (implementation intentions), CCT plus PRIIS control (verbal rehearsal of intentions) or CCT control (entertaining computer games) plus PRIIS control. The hypothesis is that CCT+PRIIS program will be feasible as indicated by participant protocol completion rates. Additional information on participants' perception (i.e. enjoyment, mental stimulation) of the CCT and PRIIS programs will be qualitatively assessed. Participants will also complete a standardized neurocognitive battery at baseline, endpoint (immediately after 8-week intervention) and at a 1-month follow-up. The hypothesis is that CCT+PRIIS, compared to other groups, will improve performance on untrained cognitive tasks in a selected neuropsychological test battery. Outcomes include performance on EF, memory, and processing speed tasks. Finally, proximal measures of real-life function will be correlated to changes in cognitive performance. This SPiRE proposal is innovative because it utilizes a set of on-line training games that target aspects of EF susceptible in PD and trains the transfer of cognitive benefits to everyday function for Veterans with PD-MCI-EF. Training is conducted at-home which allows for convenience and flexibility for the participant. As there are currently no effective treatments for PD-MCI and since most PD patients will develop PD-D, early intervention to slow progression to PD-D is critical. However, given that Veterans with PD are part of a geriatric population that commonly experience complex chronic conditions, and PD-MCI-EF participants who may be impaired with planning and goal setting, understanding the feasibility to successfully employee cognitive rehabilitation strategies at-home is a critical first step. This project will yield preliminary data to support a VA Merit that will build upon the SPiRE and move forward not only the field of PD rehabilitation but also the general field of geriatric cognitive rehabilitation.