Assessment and Treatment of Cognitive Functioning Deficits in Veterans with PTSD

患有 PTSD 的退伍军人认知功能缺陷的评估和治疗

• 批准号: 10348675
• 负责人: Maya Elin O'Neil
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10348675
• 关键词: Address; Area; Attention; Brain Injuries; Characteristics; Chronic; Clinic; Clinical Research; Clinical Trials; Cognition; Cognitive; Cognitive deficits; Data; Development; Educational process of instructing; Effectiveness; Ensure; Etiology; Evidence based intervention; Evidence based treatment; Goals; Health Sciences; Health Services Research; Impaired cognition; Intervention; Language Development; Lead; Learning; Medical Informatics; Medicine; Memory; Mental Depression; Mental Health; Mentors; Meta-Analysis; Methods; Minnesota; Motivation; Nervous System Trauma; Neurobehavioral Manifestations; Neurology; Neuropsychology; Oregon; Outcome; Participant; Patient Self-Report; Performance; Pharmaceutical Preparations; Policy Research; Population; Post-Traumatic Stress Disorders; Preparation; Prevalence; Psychiatry; Psychologist; Psychotherapy; Quality of life; Randomized Controlled Trials; Recording of previous events; Recovery of Function; Rehabilitation Centers; Rehabilitation therapy; Reporting; Research; Research Personnel; Residual state; Resources; Sample Size; Schizophrenia; Services; Severities; Short-Term Memory; Site; Stress; Symptoms; Testing; Training; Training Programs; Traumatic Brain Injury; Universities; Verbal Learning; Veterans; auditory rehabilitation; behavioral clinical trial; career; clinical epidemiology; cognitive function; cognitive rehabilitation; cognitive testing; cognitive training; comorbidity; data resource; data warehouse; effective intervention; effectiveness testing; efficacy evaluation; efficacy study; evidence base; executive function; experience; follow-up; improved; improved functioning; innovation; mid-career faculty; mild traumatic brain injury; military veteran; multitask; pilot test; processing speed; professor; recruit; rehabilitation research; research and development; severe mental illness; side effect; skills; social; stress related disorder; treatment as usual; treatment response; visual learning

CDA Overview: This application proposes a mentored training program supporting Dr. Maya O’Neil’s development into an independent VA Rehabilitation Research & Development (RR&D) investigator with expertise in posttraumatic stress disorder (PTSD), cognitive rehabilitation, and behavioral clinical trial methods. Dr. O’Neil is a licensed psychologist at the Portland VA, Assistant Professor of Psychiatry and Medical Informatics & Clinical Epidemiology at Oregon Health & Science University (OHSU), and recent K scholar. Training: Dr. O’Neil will increase expertise in PTSD and cognitive rehabilitation research, enhance skill in the conduct of behavioral clinical trials, and learn how to use VA resources (e.g., Corporate Data Warehouse, CDW) to support trials. The training plan integrates formal coursework, content trainings, and mentor guidance. Mentors: Dr. Daniel Storzbach, Portland VA Director of Neuropsychology, Associate Professor of Psychiatry and Neurology at OHSU; Dr. Kathleen Carlson, Core Investigator at the RR&D National Center for Rehabilitative Auditory Research (NCRAR) and Health Services Research & Development (HSR&D) Center of Innovation (COIN), PI of the Portland Chronic Effects of Neurotrauma study site; Dr. Elizabeth Twamley, VA rehabilitation researcher, Professor of Psychiatry at UCSD, Director of the Clinical Research Unit of the Center of Excellence for Stress and Mental Health at the San Diego VA, lead author of Compensatory Cognitive Training (CCT); and Dr. Nina Sayer, Associate Director of the HSR&D COIN and PI of the Minneapolis VA EBP4PTSD CREATE, and Associate Professor of Medicine and Psychiatry at University of Minnesota. Project Background: PTSD is associated with deficits in cognitive functioning including memory, learning, processing speed, concentration, attention, and executive functioning. Though many Veterans benefit from evidence-based psychotherapy (EBP) for PTSD, there is little research examining the extent to which cognitive problems are present before and after EBP and are related to change in PTSD symptoms, quality of life, and functioning. Dr. O’Neil’s pilot research suggests that many Veterans have cognitive functioning deficits even after completing EBP for PTSD, though there are no evidence-based treatments for these Veterans. CCT is improves cognitive functioning in Veterans with brain injury history, but is not yet tested in Veterans with PTSD. Project Aims: The proposed studies will (1) determine the types and magnitude of cognitive problems and changes in cognitive functioning following EBP and (2) evaluate feasibility, acceptability, and participant characteristics, and estimate effect sizes, in a pilot test of CCT for Veterans with PTSD-related cognitive problems. Data from these studies will form the basis for a RR&D Merit submission testing the effectiveness of CCT for cognitive problems in Veterans with PTSD in a clinical trial during year 4 of the CDA. Project Methods: We will recruit Veterans from local VA mental health clinics, using the CDW to identify potentially eligible Veterans if needed. For Study 1, we will examine cognitive functioning, mental health symptoms, and quality of life in 150 Veterans before and after EBP for PTSD. In Study 2, we will compare CCT vs. treatment as usual for 36 Veterans with PTSD-related cognitive functioning deficits. We will calculate rates of recruitment, retention, and intervention participation. Statistical significance will be examined, though our focus will be on effect size estimates, score ranges, and variability to plan for a follow-up, fully powered RCT. Anticipated Impact: PTSD-related cognitive functioning deficits are a significant problem for many Veterans. CCT is an effective cognitive rehabilitation intervention for Veterans with a history of brain injury, but VA clinicians need data on its effectiveness for Veterans with PTSD-related cognitive functioning deficits. These studies will provide the data necessary for a larger scale RCT proposal which will be pursued during the fourth year of the CDA if results show that CCT is as promising as expected for Veterans with PTSD.

CDA概述：此申请提出一个支持Maya O'Neil博士的培训计划的问题 发展成为独立的VA康复研究与发展（RR＆D）研究人员 创伤后应激障碍（PTSD），认知康复和行为临床试验方法方面的专业知识。 奥尼尔博士是弗吉尼亚州波特兰的持牌心理学家，精神病学助理教授 俄勒冈州健康与科学大学（OHSU）的信息和临床流行病学以及最近的K科学。 培训：O'Neil博士将提高PTSD和认知康复研究的专业知识，以提高技能 进行行为临床试验，并学习如何使用VA资源（例如，公司数据仓库， CDW）支持试验。培训计划整合了正式的课程，内容培训和心理指导。 导师：丹尼尔·斯托尔兹巴赫（Daniel Storzbach）博士，弗吉尼亚州波特兰神经心理学主任，精神病学副教授 和OHSU的神经病学； RR＆D国家中心的核心调查员Kathleen Carlson博士 康复听觉研究（NCRAR）和卫生服务研究与发展（HSR＆D）中心 创新（硬币），神经曲研究地点的波特兰慢性影响的PI；弗吉尼亚州伊丽莎白·塔姆利博士 UCSD的康复研究员，精神病学教授，该中心临床研究部门主任 弗吉尼亚州圣地亚哥的压力和心理健康卓越，代偿认知的首席作者 培训（CCT）；明尼阿波利斯VA的HSR＆D Coin和PI的副主任Nina Sayer博士 EBP4PTSD创建明尼苏达大学的医学与精神病学副教授。 项目背景：PTSD与认知功能的缺陷有关，包括记忆，学习， 处理速度，集中度，注意力和执行功能。尽管许多退伍军人从中受益 PTSD的循证心理治疗（EBP），几乎没有研究认知的程度 问题存在于EBP之前和之后，与PTSD症状，生活质量和 功能。奥尼尔博士的飞行员研究表明，许多退伍军人具有认知功能，甚至定义 在完成PTSD的EBP之后，尽管没有针对这些退伍军人的证据治疗。 CCT是 改善具有脑损伤病史的退伍军人的认知功能，但尚未在具有PTSD的退伍军人中进行测试。 项目目的：拟议的研究将（1）确定认知问题的类型和大小 EBP和（2）评估可行性，可接受性和参与后认知功能的变化 特征和估计效应大小，在CCT的试点测试中，具有PTSD相关认知的退伍军人 问题。这些研究的数据将构成RR＆D值得提交测试的基础 CCT在CDA的第4年的临床试验中，有PTSD退伍军人的认知问题。 项目方法：我们将使用CDW招募当地VA心理健康诊所的退伍军人 如果需要，可能有资格的退伍军人。对于研究1，我们将检查认知功能，心理健康 PTSD EBP之前和之后的150名退伍军人的症状和生活质量。在研究2中，我们将比较CCT 与往常一样，对于36名与PTSD相关的认知功能缺陷的退伍军人的治疗。我们将计算费率 统计意义将被检查，尽管我们 重点将集中于效果尺寸估计值，得分范围和可变性，以计划后续功能的RCT。 预期的影响：与PTSD相关的认知功能定义了许多退伍军人的重要问题。 CCT是具有脑损伤病史的退伍军人的有效认知康复干预措施，但VA 临床医生需要有关其对具有PTSD相关认知功能缺陷的退伍军人的有效性的数据。这些 研究将提供更大规模的RCT提案所需的数据，该提案将在第四次提出 CDA的年份如果结果表明CCT对具有PTSD的退伍军人的预期是预期的。