Use of the KF Modified Story Memory Technique to Improve New Learning and Memory in Individuals with Mild Cognitive Impairment

项目摘要 60岁以上成年人轻度认知障碍(MCI)的患病率从7%到25%不等， 风险随着年龄的增长而增加。新的学习和记忆(LM)障碍在MCI和 对日常生活的几个方面产生负面影响，包括日常活动和社交活动的独立性 功能正常。尽管老年人和临床医生都对LM治疗有需求，但很少有人认识到 到目前为止，康复(CR)方案得到了I类研究证据的支持，从而将程度限制在 这些潜在有效的治疗方法可以应用于MCI患者。 凯斯勒基金会修改的故事记忆技术(KF-mSMTTM)是一种10会话的手册CR 为治疗受损的LM而设计的方案。在我们中心进行了十多年的研发工作 已经证明KF-mSMT对于改善患有神经疾病的个人的LM是有效的(例如， 跨三个功能领域(客观行为、神经功能和日常生活)， 随着时间的推移，一直保持着改进。这一令人信服的数据提供了I类证据，支持 KF-mSMT用于改善这些人群的LM。此外，我们还积累了强大的试点数据 KF-mSMT在MCI患者中的疗效，突出了KF-mSMT成功应用的可能性 给患有MCI的人。 我们将进行一项多点、双盲、安慰剂对照的随机临床试验(RCT)， 对符合MCI标准的120名参与者进行KF-mSMT。结果将在以下时间立即进行评估 治疗，治疗后6个月以及治疗后18个月检查长期 冲击力。结果将通过3个机制来衡量：(1)神经心理评估(NPE)以检查 治疗后客观认知功能的变化(2)全球功能评定 检查治疗后日常生活中认知的变化和(3)功能磁共振成像(FMRI) 检查治疗前和治疗后大脑激活模式的变化，以支持LM的表现。这个 在这项随机对照研究中，将日常生活活动作为先验终点的检查是建议的 公约与建议委员会的许多专家强调，康复工作是康复文献中的一个重大空白。重要的是， 本研究采用了严谨的研究设计，高度响应了NIA提出的目标 在他们的战略方向(第14页)中，确定个人如何随着年龄的增长保持功能或重新获得功能 由于不能动弹、疾病或创伤而丧失后的功能“，同时也被设计成”通过 哪些常见的干预措施，无论是医学上的还是行为上的，都可以延缓身体和认知能力的下降。

Project Summary Prevalence rates for Mild Cognitive Impairment (MCI) range from 7-25% for adults over the age of 60, with risk increasing with age. Impairments in new learning and memory (LM) are common in persons with MCI and negatively impact several aspects of everyday life, including independence in daily activities and social functioning. Despite the demand for LM treatments by older adults and clinicians alike, few cognitive rehabilitation (CR) protocols to date are supported by Class I research evidence, thereby limiting the degree to which potentially efficacious treatments can be applied to individuals with MCI. The Kessler Foundation modified Story Memory Technique (KF-mSMTTM) is a manualized, 10-session CR protocol designed to treat impaired LM. Over a decade of research and development conducted at our center has demonstrated the KF-mSMT to be effective for improving LM in individuals with neurological conditions (e.g., MS, TBI), across three realms of functioning (objective behavior, neural functioning, and everyday life) with improvements maintained over time. This convincing data provides Class I evidence supporting the efficacy of the KF-mSMT for improving LM in these populations. In addition, we have accumulated strong pilot data on the efficacy of the KF-mSMT in individuals with MCI, highlighting the likely successful application of the KF-mSMT to individuals with MCI. We will conduct a multi-site, double-blind, placebo-controlled randomized clinical trial (RCT), administering the KF-mSMT to 120 participants who meet criteria for MCI. Outcome will be assessed immediately following treatment, 6 months following treatment as well as 18 months following treatment to examine the long-term impact. Outcome will be measured via 3 mechanisms: (1) Neuropsychological Evaluation (NPE) to examine post-treatment changes on objective cognitive performance (2) Assessment of Global Functioning (AGF) to examine post-treatment changes in cognition in daily life and (3) functional magnetic resonance imaging (fMRI) to examine pre to post-treatment changes in patterns of cerebral activation underlying LM performance. The examination of daily life activities as an a priori endpoint in this RCT is a highly innovative aspect of the proposed work, highlighted as a significant gap in the rehabilitation literature by many experts in CR. Importantly, the rigorous research design employed in the current study is highly responsive to the objectives set forth by the NIA in their strategic directions (p.14), to “determine how individuals can maintain function with age or regain that function after loss due to immobility, illness, or trauma”, while also designed to identify the “mechanism through which common interventions, both medical and behavioral, may slow the physical and cognitive decline.”