Problem Adaptation Therapy for Mild Cognitive Impairment with Depression

摘要 这种合作R 01结合了精神病学系的专业知识，约翰霍普金斯湾景大学 医学中心和威尔康奈尔医学院精神病学系在抑郁症领域的研究 MCI研究。我们建议测试MCI患者的问题适应疗法（PATH-MCI）， 旨在减少MCI患者抑郁的新型心理社会干预，具有更好的认知，功能， 与认知障碍老年人支持疗法（ST-CI）相比， 患有轻度认知障碍（MCI）和重度或轻度抑郁症的成年人。 问题适应疗法（PATH）是一种新颖的心理社会干预，旨在减少抑郁症， 患有重度抑郁症、广泛认知障碍（轻度认知障碍）的老年人的残疾 中度痴呆）和残疾。PATH旨在通过改善情绪调节来减少抑郁症。到 为了达到情绪调节的目标，PATH利用简化的问题解决方法，采用 环境适应，以绕过认知和功能限制，并涉及一个重要的其他时， 适当初步数据显示，PATH显着改善认知、功能和情感 与另一种抑郁症相比，患有重度抑郁症和轻度认知缺陷的老年人的结局 认知障碍老年人支持疗法（ST-CI）我们简化了路径 手动仅关注MCI患者（PATH-MCI），并对其进行修改，以提高其治疗效果， 通过以下方式降低成本：a）提供办公室内而不是在家提供的会议; B）利用个性化技术， 作为MindMe平板电脑应用程序，定制CD或分步书面计划，以帮助患者调节他们的 会议之间的情绪;和c）纳入每月助推器会议。 根据我们的功效分析，我们将随机选择80名患有MCI的老年人（60-85岁）， 抑郁症的15个办公室会议（12个在前12周和3个助推器每月会议之后）的路径- 两个部位的MCI与ST-CI。这两个网站都是主要的学术医疗机构，有证据表明， 招募、随机化、保留和评估程序的可行性。威尔康奈尔大学的研究人员 已经进行了其他NIH和阿尔茨海默氏症协会资助的调查，包括管理 PATH适用于有广泛认知缺陷的老年人（从轻度认知缺陷到中度痴呆）。 将在基线、6（无认知结局）、12、24、36（无认知结局）和 52周，研究助理不知道研究假设和参与者的随机化状态。 在每个研究中心，经认证的心理健康临床医生将管理PATH-MCI和ST-CI。

ABSTRACT This collaborative R01 combines the expertise of the Department of Psychiatry, Johns Hopkins Bayview Medical Center and the Department of Psychiatry at Weill Cornell Medical College in the areas of depression and MCI research. We propose to test whether Problem Adaptation Therapy for MCI patients (PATH-MCI), a novel psychosocial intervention designed to reduce depression in MCI patients, has better cognitive, functional, and affective outcomes compared to Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in older adults with Mild Cognitive Impairment (MCI) and major or minor depression. Problem Adaptation Therapy (PATH) is a novel psychosocial intervention designed to reduce depression and disability in older adults with major depression, wide range of cognitive impairment (from mild cognitive deficits to moderate dementia), and disability. PATH aims to reduce depression by improving emotion regulation. To achieve its goals of emotion regulation, PATH utilizes a simplified problem solving approach, employs environmental adaptations to bypass cognitive and functional limitations, and involves a significant other when appropriate. Preliminary data show that PATH significantly improves cognitive, functional and affective outcomes in older adults with major depression and mild cognitive deficits compared to another depression treatment, Supportive Therapy for Cognitively Impaired Older Adults (ST-CI). We streamlined the PATH manual focusing only on MCI patients (PATH-MCI) and modify it to increase its treatment effects and reduce costs by: a) providing in-office instead of home-delivered sessions; b) utilizing individualized techniques, such as the MindMe tablet app, customized CDs, or step-by-step written plan, to help patients regulate their emotions between sessions; and c) incorporating monthly booster sessions. Based on our power analysis, we will randomize 80 older adults (60-85 years old) with MCI and major or minor depression to 15 in-office sessions (12 in first 12 weeks and 3 booster monthly sessions afterwards) of PATH- MCI vs. ST-CI in both sites. Both sites are major academic medical institutions that have shown evidence of feasibility of recruitment, randomization, retention, and assessment procedures. Weill Cornell researchers have conducted other NIH and Alzheimer's Association funded investigations that include administration of PATH in older adults with wide range of cognitive deficits (from mild cognitive deficits to moderate dementia). Assessments will be performed at baseline, 6 (no cognitive outcomes), 12, 24, 36 (no cognitive outcomes) and 52 weeks by research assistants unaware of the study hypotheses and the participant's randomization status. In each site, certified mental health clinician will administer PATH-MCI and ST-CI.