Cognitive Rehabilitation for Veterans with Parkinson's Disease

目前有超过10万名患有帕金森氏病(PD)的美国退伍军人接受PD相关护理和 退伍军人事务部提供的服务。除了明确的运动并发症外，帕金森病的特点也是进行性的 认知功能下降，主要是执行功能(EF)缺陷。帕金森病相关认知功能减退的临床表现 这很重要，因为它会导致长期的功能损害和生活质量(QOL)的下降。目前， 20-55%的PD患者有轻度认知障碍(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量身定做治疗 认知康复成为退伍军人管理局的重要研究课题。计算机化认知训练(CCT)显示 Promise是认知障碍老年患者的一种有效认知康复方法 拒绝。在帕金森病患者中，新的证据显示认知训练在训练后立即改善认知能力 对EF的测量具有中到大的影响大小。然而，大多数研究只包括帕金森病患者 正常认知(PD-N)；只有一人在家中评估CCT(与PD-N参与者一起)。因此，没有PD研究 评估居家CCT计划改善轻度执行帕金森病患者认知功能的能力 功能障碍(PD-MCI-EF)。此外，对于CCT引发的改进是否会转移，目前还缺乏了解 到日常活动。这个尖塔试图通过进行一项试点随机对照试验来解决这些差距 (RCT)研究使用现有的家庭认知培训计划进行为期8周的可行性 基于Web的EF CCT计划，包含或不包含预期实施意向策略培训 (PRIIS)对患有PD-MCI-EF的退伍军人。实施意向策略对阿尔茨海默病有效 它在帕金森病患者中显示出了希望。PRIIS建立在CCT培训的认知技能基础上，并纳入 注重以患者为中心的自我管理策略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+PRIIS对照或CCT相比，CCT+PRIIS 控制+PRIIS控制，将导致认知成绩和日常功能的更大改善。 参与者将被随机分配到CCT(每周四次30分钟的课程)和PRIIS(实施 意图)、CCT+PRIIS控制(意图的口头演练)或CCT控制(娱乐计算机 游戏)加上对PRIIS的控制。假设CCT+PRIIS计划是可行的，如下所示 参与者协议完成率。关于参与者感知的附加信息(即，享受， 将对CCT和PRIIS计划的精神刺激)进行定性评估。参与者还将 在基线、终点(8周干预后立即完成)完成标准化神经认知成套测验 并进行1个月的随访。假设与其他组相比，CCT+PRIIS会有所改善 在选定的神经心理学测试组合中，在未经训练的认知任务上的表现。结果包括 在EF、内存和处理速度任务上的性能。最后，真实生活功能的近距离测量将 与认知表现的变化相关。这个尖顶方案是创新的，因为它利用了一套 在线培训游戏，针对帕金森氏症易患EF的方面，并培训认知利益的转移 对患有PD-MCI-EF的退伍军人的日常功能。培训在家中进行，这使得 为参与者提供便利和灵活性。由于目前尚无有效的治疗PD-MCI和 由于大多数PD患者将发展为PD-D，早期干预以减缓进展为PD-D是至关重要的。然而， 鉴于患有帕金森病的退伍军人是老年人群的一部分，他们通常经历复杂的慢性 条件，以及PD-MCI-EF参与者，他们可能在计划和目标设定、理解方面存在障碍 成功实施员工居家认知康复策略的可行性是关键的第一步。这 项目将产生初步数据来支持退伍军人事务部的优点，该优点将建立在尖顶之上，并向前推进 不仅是帕金森病康复领域，也是一般老年认知康复领域。

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.