Influence of Strategy Training on Disability for Older Adults with Mild Cognitive Impairment

项目总结/摘要 认知能力丧失导致阿尔茨海默病是渐进性和破坏性的， 残疾人无法回忆起他们的过去老年痴呆症患者的数量预计将 到2050年将增加两倍，但很少有研究检查淀粉样蛋白β（Aβ）沉积，执行功能， 残疾的进展。更不用说研究旨在减缓进展的非药物干预 to disability残疾for these older老adults成年人.我们建议测试一个新的和有前途的非- 药物干预对150例轻度认知功能障碍老年人残疾进展的影响 既往已完成正电子发射断层扫描（PET）成像， 匹兹堡化合物B（PiB）。我们的干预措施是策略培训。战略培训优化了参与 有意义的日常活动，通过产生自我选择的目标，监控日常活动，安排 活动，并解决问题的解决方案，在从事活动时遇到的障碍。职业 治疗师在老年人家中提供策略培训，以增强现实世界的应用。我们完成了 策略训练的初步随机对照试验（N=30），我们发现一个中等的效果大小 （Cohen's d = 0.54），用于6个月时残疾的组间差异。在第二阶段试验中，我们将测试 策略培训与加强家庭护理对老年人残疾变化的影响 MCI，并评估脑成像和神经认知功能在多大程度上改变了 关于残疾变化的战略培训和加强的家庭护理。干预措施，如战略培训， 尽管存在潜在的病理学，但专注于减缓残疾的出现可能会使老年人继续参与 有意义的日常活动尽可能长。这个项目测试了一个新颖的和有前途的非- 药理学干预，并将告知我们对重要效应调节剂-Aβ沉积和 执行功能-认知挑战性日常活动的表现变化。加强我们 了解Aβ沉积，执行功能，残疾，以及一种有前途的非药物 干预可以支持数百万老年人的老龄化，在不久的将来，他们将经历残疾 与MCI有关

PROJECT SUMMARY/ABSTRACT Loss of cognitive abilities leading to Alzheimer's disease is progressive and destructive, leaving older adults disabled and unable to recall their past. The number of older adults with Alzheimer's disease is expected to triple by the year 2050, yet little research examines amyloid beta (Aβ) deposition, executive function, and progression of disability. Even less examines non-pharmacological interventions designed to slow progression to disability for these older adults. We propose to test the influence of a novel and promising non- pharmacological intervention on progression of disability in a sample of 150 older adults with Mild Cognitive Impairment (MCI) who have previously completed Positron Emission Tomography (PET) Imaging with Pittsburgh Compound B (PiB). Our intervention is Strategy Training. Strategy training optimizes engagement in meaningful daily activities through generating self-selected goals, monitoring daily activities, scheduling activities, and problem-solving solutions to barriers experienced when engaging in activities. Occupational therapists deliver Strategy Training in older adults' homes to enhance real-world application. We completed a preliminary randomized controlled trial of Strategy Training (N=30), and we found a moderate effect size (Cohen's d = 0.54) for between-group differences on disability at 6 months. In this Phase II trial, we will test the effect of Strategy Training compared to Enhanced Usual Care on change in disability among older adults with MCI and assess the extent to which brain imaging and neurocognitive function modify the relationship between Strategy Training and Enhanced Usual Care on change in disability. Interventions, such as Strategy Training, focused on slowing emergence of disability despite underlying pathology may keep older adults as engaged in meaningful daily activities for as long as possible. This project tests a novel and promising non- pharmacological intervention and will inform our understanding of important effect modifiers -Aβ deposition and executive function- on change in performance of cognitively challenging daily activities. Enhancing our understanding of Aβ deposition, executive function, disability, and a promising non-pharmacological intervention could support aging for millions of older adults who, in our near future, will experience disability related to MCI.