The Moderating Influence of Personality on Cognitive Stimulation Outcomes in Pers

描述（由申请人提供）：由痴呆症引起的认知能力下降是对许多老年人健康和福祉的重大威胁。由于其进行性，痴呆症不可避免地导致生活质量的严重下降。以认知为中心的行为干预，其目标是大脑代偿机制，以提高认知表现，已在这一人群中进行了测试，并取得了可喜的结果；研究人员还没有解释为什么有些人比其他人更适合做候选人。该研究将通过调查人格对认知能力加速下降高风险痴呆患者的认知能力干预的调节作用，扩展有关认知能力干预的科学知识。本研究的具体目的如下：1)考察人格特质对认知刺激干预与认知功能（注意、记忆、定向、执行功能和抽象思维）突降期间认知功能改善之间的调节作用；2)检验人格特质对认知能力突然下降期干预中投入的调节作用。本研究将利用目前参与随机临床试验的部分样本来测试个性化认知刺激活动的有效性。研究对象从宾夕法尼亚州的五家疗养院招募，这些疗养院在住院后提供急性期后康复护理服务。那些在两年期间注册的人，或估计总共120名受试者，将被包括在拟议的研究中。所有受试者都要接受轻度至中度痴呆和谵妄的筛查，谵妄是一种以注意力不集中为特征的急性精神错乱状态。在一个认知脆弱的人群中，急性混乱提供了一个观察干预效果的机会模型，包括在康复过程中调节因素的影响。符合条件的受试者被随机分为治疗组和对照组。干预包括各种个性化定制的认知刺激娱乐活动，每天30分钟，持续30天；对照组接受常规护理。拟议研究的主要研究者将使用NEO五因素量表的信息版本收集人格评估数据，这是一种基于人格五因素模型的完善且常用的工具。两组每天都将测量这五个目标领域的认知功能。干预的参与将以完成任务的时间和参与程度来衡量。采用线性混合效应模型进行数据分析。每个人

DESCRIPTION (provided by applicant): Cognitive decline due to dementia is a significant threat to the health and well-being of many older adults. As a consequence of its progressive nature, dementia inevitably leads to devastating declines in quality of life. Cognition- focused behavioral interventions which target compensatory brain mechanisms in order to improve cognitive performance have been tested in this population with promising results; researchers have yet to address why some individuals are better candidates than others. The proposed research will extend scientific knowledge regarding cognition-focused interventions by investigating the moderating effect of personality on a cognition-focused intervention in individuals with dementia at high risk for accelerated cognitive decline. The specific aims of the proposed study are as follows: 1) To test the moderating effect of personality traits on the relationship between a cognitive stimulation intervention and improvement in five domains of cognitive function (attention, memory, orientation, executive functioning, and abstract thinking) during a period of abrupt cognitive decline; and, 2) To test the moderating effect of personality traits on engagement in the intervention during a period of abrupt cognitive decline. This research will utilize a portion of the sample currently participating in a randomized clinical tria testing the effectiveness of individualized cognitively stimulating activities. Subjects are recruied from five nursing homes in Pennsylvania with post-acute care services for rehabilitation following hospitalization. Those enrolled during a two year period, or an estimated 120 total subjects, will be included in the proposed study. All subjects are screened for the presence of mild to moderate dementia as well as the presence of delirium, a state of acute confusion characterized by inattention. Acute confusion in an already cognitively vulnerable population provides an opportunistic model for viewing the effects of the intervention, including the influence of moderating factors, during the course of rehabilitation. Eligible subjects are randomized to treatment and control groups. The intervention consists of a variety of individually tailored cognitively stimulating recreational activities which are delivered for 30 minutes a day for up to 30 days; the control group receives usual care. The Principle Investigator of the proposed study will collect personality assessment data using the informant version of the NEO Five Factor Inventory, a well-established and commonly used instrument based on the five factor model of personality. Cognitive function in the five targeted domains will be measured each day in both groups. Engagement in the intervention will be measured as both time on task and level of participation. A linear mixed-effects model will be applied for data analysis. Each of the five personality traits will be tested independently for a statistically significant moderating effect on each domain of cognitive functioning, as well as separately for a moderating effect on engagement in the intervention. Interactions between multiple personality traits will also be considered within the model. Existing research has not investigated the potential moderating influence of individual characteristics on the treatment effect of cognitive stimulating activitiesin individuals experiencing cognitive decline. The proposed research will address that critical gap and help build a strong foundation for tailored cognition-focused intervention research. PUBLIC HEALTH RELEVANCE: The onset of dementia heralds a downward spiral of cognitive decline that is devastating to those diagnosed as well as to their caregivers and other loved ones. Effective non-drug treatments to improve cognitive functioning in these individuals may promote independence, improve quality of life, reduce caregiver burden, prevent institutionalization, and reduce healthcare costs. This study will examine how personality may help identify individuals who are best candidates for specific non-drug treatments.