Meaningful Activity Intervention for Persons with Mild Cognitive Impairment

描述(申请人提供)：轻度认知障碍(MCI)影响多达20%的老年人，他们患阿尔茨海默病(AD)的风险更高。MCI涉及功能衰退，可能包括参与有意义的活动的减少和一个人自己的自信/掌握感，它与抑郁症状、对家庭沟通的不满意以及身体功能下降有关。对MCI患者和照顾者的现有干预措施往往侧重于单一问题，如记忆或体力活动，而没有可用的多方面支持性护理干预措施来满足MCI患者及其照顾者的需求，以防止过早脱离接触和抑郁症状的风险。每日增强有意义活动(DEMA)干预使用基于力量和积极的家庭二元健康方法，该方法建立在现有的二元技能和价值观的基础上，以实现有意义的活动参与，以满足有效干预的优先需求，以防止MCI患者过早脱离接触和抑郁症状。DEMA建立在我们之前的描述性工作和老年学理论、人类职业模型和问题解决疗法的组成部分的基础上。我们的初步调查结果表明，干预和措施是可以接受的，并征求了参与者关于改进分娩的建议。这项初步研究的目的是1)评估修订后的DEMA干预措施的可行性和满意度；2)通过纳入一个对照小组来估计干预措施的效果大小。MCI照顾者二人组(n=36人)将被随机分配到DEMA或信息支持组；每组将接受6次两周一次的会议(2次面对面和4次电话培训)，由训练有素的干预者提供。来自MCI患者和照顾者结果的数据将在干预前、干预后立即(两周)和计划后3个月评估时收集。描述性统计分析将用于对DEMA或信息支持小组的满意度和感知，一般线性混合模型将用于估计干预对近端和远端结果的影响大小。研究结果将为后续R01的设计提供参考：1)在纵向随机临床试验中测试DEMA对MCI患者-护理者双方的疗效；以及2)探索实施的成本/收益。如果发现它是有效的，DEMA有可能减缓从MCI到AD的残疾进展速度，并改善患者和照顾者的生活质量。 公共卫生相关性：轻度认知障碍(MCI)影响五分之一的老年人，他们患阿尔茨海默病(AD)的风险更大，并经历各种困难，降低他们的生活质量。本研究旨在评估修订后的每日强化有意义活动干预(DEMA)的可行性和满意度，并通过纳入对照组来估计干预的效果大小。DEMA使用基于优势的家庭二元健康方法，建立在现有的二元技能和价值观的基础上，以完成有意义的活动参与，以满足有效干预的优先需求，以防止MCI患者过早脱离接触和抑郁症状。

DESCRIPTION (provided by applicant): Mild cognitive impairment (MCI) affects as many as 20% of older adults who are at a greater risk of developing Alzheimer's disease (AD). MCI involves functional decline that may include decrements in engagement in meaningful activities and one's own sense of confidence/mastery, and it is associated with depressive symptoms, poor satisfaction with family communication, and declining physical function. Existing interventions for MCI patients and caregivers often focus on a single problem, such as memory or physical activity and there are no available multi-faceted supportive care interventions to meet the needs of the MCI patients and their caregivers in order to prevent premature disengagement and risk for depressive symptoms. The Daily Enhancement of Meaningful Activity (DEMA) intervention uses a family dyadic, strengths-based, and positive health approach that builds on existing dyadic skills and values to accomplish meaningful activity engagement to address the priority needs for efficacious interventions to prevent premature disengagement and depressive symptoms in MCI patients. The DEMA builds on our previous descriptive work and gerontology theory, the model human occupation, and components of the Problem-Solving Therapy. Our preliminary findings showed that the intervention and measures were acceptable, and suggestions were solicited from the participants for improving delivery. The purpose of this pilot study is to 1) evaluate the feasibility and satisfaction of the revised DEMA intervention; and 2) estimate effect sizes for the intervention through the incorporation of a comparison group. The MCI-caregiver dyads (n = 36 dyads) will be randomized to the DEMA or informational support groups; each group will receive 6 bi-weekly sessions (2 face-to-face and 4-phone delivered) with a trained intervener. The data from MCI patients and caregivers outcomes will be collected at pre-intervention, immediately (two weeks) post-intervention, and 3 months post-program evaluation. Descriptive statistics analysis will be used for satisfaction with and perception of the DEMA or informational support groups and general linear mixed models will be used to estimate the effect sizes of the intervention on the proximal and distal outcomes. Findings will inform the design of a subsequent R01 to: 1) test the efficacy of DEMA for MCI patient-caregiver dyads in a longitudinal randomized clinical trial; and 2) explore the costs/benefits of implementation. If it is found to be efficacious, DEMA has the potential to slow the rate of disability progression from MCI to AD and improve quality of life outcomes for patients and caregivers. PUBLIC HEALTH RELEVANCE: Mild cognitive impairment (MCI) affects one of fifth older adults, who are at a greater risk of developing Alzheimer's disease (AD) and experience various difficulties and decrease their quality of life. This study is to evaluate the feasibility and satisfaction of the revised Daily Enhancement of Meaningful Activity intervention (DEMA); and estimate effect sizes for the intervention through the incorporation of a comparison group. The DEMA uses a family dyadic, strengths-based, positive health approach that builds on existing dyadic skills and values to accomplish meaningful activity engagement to address the priority needs for efficacious interventions to prevent premature disengagement and depressive symptoms in MCI patients.