Cognitive Rehabilitation and Exposure Therapy for Geriatric Hoarding

老年囤积症的认知康复和暴露疗法

• 批准号: 10591583
• 负责人: Catherine Ayers
• 金额: $ 72.12万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10591583
• 关键词: Acute; Address; Adult; Aftercare; Age; Anxiety; Area; Behavioral; Behavioral Sciences; Case Management; Chronic; Clinical; Clutterings; Cognitive; Communities; Compulsive Hoarding; Dangerousness; Decision Making; Dementia; Demographic Factors; Disease; Distress; Economics; Elderly; Epidemiology; Evaluation; Family; Fire - disasters; Fright; Goals; Healthcare Systems; Home; Homelessness; Individual; Individual Differences; Intervention; Knowledge; Lead; Left; Life; Maintenance; Mediating; Mental Depression; National Institute of Mental Health; Office Visits; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Physiological; Population; Prevalence; Public Health; Randomized, Controlled Trials; Recovery; Reporting; Research Domain Criteria; Severities; Social isolation; Sorting; Symptoms; System; Therapeutic; Treatment Factor; Treatment outcome; Update; active lifestyle; anxiety reduction; clinically significant; cognitive control; cognitive process; cognitive rehabilitation; confirmatory trial; disability; effective therapy; effectiveness trial; executive function; fall risk; follow-up; functional disability; functional improvement; functional outcomes; geriatric mental health; improved; maladaptive behavior; middle age; neuropsychiatry; prevent; primary outcome; reduce symptoms; response; secondary outcome; social; therapy development

Project Summary/Abstract Hoarding disorder (HD) is a chronic, progressive, and debilitating psychiatric condition that leads to devastating personal and community consequences, particularly for older adults. HD is defined by persistent difficulty discarding or parting with possessions due to distress associated with discarding, urges to save, and/or difficulty making decisions about what to keep and what to discard. As a result, clutter accumulates and fills active living areas, preventing the normal use of space and resulting in distress and disability. Community epidemiological reports estimate the prevalence of clinically significant hoarding symptoms at 7% in individuals over age 60 and even higher rates in those over age 70. HD is the only neuropsychiatric condition that progresses in severity and population prevalence with age apart from dementia. Inhibition and cognitive switching have been identified as key deficits in older adults with HD. These executive functioning areas are consistent with the RDoC cognitive control domain and particularly the goal selection, updating, representation, and maintenance subconstruct. Findings suggest that these deficits may contribute to the symptomatic expression of HD, degree of functional impairment, and modest responses to HD treatment. Furthermore, anticipatory and experiential fear and anxiety, consistent with the RDoC constructs of acute and potential threat, lead to sustained problems with discarding items and clutter accumulation. When these constructs are targeted, our group has produced clinically and statistically significant outcomes. Consistent with NIMH strategic goal 3.1, to arrive at effective treatment approaches for unmet therapeutic domains in behavioral science, this project seeks to conduct the first confirmatory efficacy trial for older adults with HD. We propose a RCT comparing CREST to a case management control condition for 150 adults age 50 and older with HD. We are examining age as a moderator and will therefore include both midlife and late life participants. An evaluation of treatment outcome, including hoarding severity and functional outcomes, will be conducted at baseline (0 months), mid-treatment (3 months), end of treatment (6 months), 3-month (9 months) and 6-month follow-up (12 months). Participants will receive 26 weekly 60-minute individual sessions over the course of 32 weeks maximum (6-7.5 months). They will receive 50% in home and 50% office visits. We will examine factors that mediate improvement in CREST (improved inhibition/cognitive switching and reduction in fear/anxiety of discarding items) through physiological, behavioral, self-report, and paradigm assessments. Individual factors (e.g., age and other demographic factors, baseline cognitive control, baseline hoarding severity) and treatment factors (e.g., session attendance) will be evaluated as moderators. The specific aims include determining confirmatory efficacy of CREST, mechanisms of CREST effects, and moderators of CREST. If successful, this project would lead to an effectiveness trial in a real world setting.

项目摘要/摘要 囤积障碍(HD)是一种慢性、进行性和衰弱的精神状态，会导致 对个人和社区造成毁灭性的后果，特别是对老年人。HD由持久化定义 由于与丢弃、拯救的冲动相关的痛苦而难以丢弃或放弃财产， 和/或难以决定要保留什么和丢弃什么。结果，杂乱无章的东西堆积起来 填满了活跃的生活区，阻碍了空间的正常使用，并导致了困境和残疾。社区 流行病学报告估计，临床上有明显囤积症状的个人患病率为7%。 60岁以上的比例更高，70岁以上的比例更高。HD是唯一一种神经精神疾病 除痴呆症外，严重程度和人口患病率随年龄增长的进展。 抑制和认知转换已被确定为患有HD的老年人的关键缺陷。这些 执行功能领域与RDoC认知控制领域一致，尤其是目标 选择、更新、表示和维护子结构。研究结果表明，这些缺陷可能 导致HD的症状性表达、功能损害程度和对HD的适度反应 治疗。此外，预期性和经验性的恐惧和焦虑，与RDoC构建的 严重和潜在的威胁，导致丢弃物品和杂物堆积的持续问题。什么时候 这些结构是有针对性的，我们的团队已经产生了临床和统计上有意义的结果。 与NIMH战略目标3.1一致，为未满足的治疗找到有效的治疗方法 在行为科学领域，这个项目试图为老年人进行第一次验证性疗效试验 采用高清技术。我们建议对150名50岁的成年人进行随机对照试验，比较CREST和病例管理控制条件 高清手机的年龄更大。我们正在研究年龄作为一个调节因素，因此将包括中年和晚年。 参与者。将对治疗结果进行评估，包括囤积严重程度和功能结果 在基线(0个月)、治疗中期(3个月)、治疗结束(6个月)、3个月(9个月)进行 6个月随访(12个月)。参与者将获得26次每周60分钟的个人会议 疗程最长32周(6-7.5个月)。他们将接受50%的家庭访问和50%的办公室访问。我们会 检查调节CREST改善的因素(改善的抑制/认知转换和减少 对丢弃物品的恐惧/焦虑)通过生理、行为、自我报告和范式评估。 个人因素(例如，年龄和其他人口统计因素、基线认知控制、基线囤积 严重程度)和治疗因素(如出席率)将作为主持人进行评估。具体目标 包括确定CREST的确证效力、CREAM效应的机制以及 克雷斯特。如果成功，这个项目将在现实世界中进行有效性试验。