Cognitive Rehabilitation for Individuals with Parkinson's Disease and MCI

帕金森病和轻度认知障碍患者的认知康复

• 批准号: 9057388
• 负责人: Dawn M. Schiehser
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-11-01 至 2019-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9057388
• 关键词: Aftercare; Analysis of Covariance; Attenuated; Blinded; Caring; Cognition; Cognitive; Cognitive deficits; Control Groups; Controlled Study; Data; Dementia; Development; Diagnosis; Foundations; Goals; Health Status; Healthcare Systems; Impaired cognition; Individual; Institutes; Intervention; Investigation; Knowledge; Longevity; Measures; Mediating; Mediator of activation protein; Medical; Memory; Modeling; Moods; Movement Disorders; Neurobehavioral Manifestations; Neuropsychology; Parkinson Disease; Participant; Patients; Pharmacological Treatment; Phase; Phase Transition; Population; Psychosocial Stress; Quality of Care; Quality of life; Randomized; Recruitment Activity; Rehabilitation therapy; Research; Role; Severity of illness; Sleep; Societies; Supportive care; Techniques; Testing; United States Department of Veterans Affairs; Veterans; base; clinical care; cognitive change; cognitive function; cognitive rehabilitation; cognitive skill; disabling symptom; efficacy study; executive function; follow up assessment; follow-up; functional outcomes; group intervention; improved; intervention effect; mild cognitive impairment; motor symptom; neglect; neuropsychiatric symptom; novel; post intervention; prevent; primary outcome; programs; public health relevance; secondary analysis; skills training; symptom management; treatment effect

 DESCRIPTION: Cognitive deficits in Parkinson's disease (PD) are often progressive and frequently represent the most debilitating symptom that result in decreased functional outcome and quality of life (QoL). It is estimated that 20-50% of individuals with PD meet criteria for Mild Cognitive Impairment (PD-MCI), which is characterized as the transitional phase between normal cognition and dementia. Unfortunately, there are few pharmacologic treatment options to help with cognitive impairments associated with PD-MCI. Cognitive rehabilitation based on the development of compensatory strategies represents a non-pharmacological approach to improve cognition in PD-MCI. However, to our knowledge there are no studies examining this approach in PD, which is a critical gap in our knowledge. Moreover, neuropsychiatric symptoms (e.g. sleep difficulty, mood), common in PD, are often neglected in traditional interventions. Thus, the overall aim of this investigation is to determine the efficacy of a novel, manualized compensatory cognitive rehabilitation program to improve cognitive deficits as well as improve neuropsychiatric symptoms and quality of life/health status (QoL/HS) in individuals with PD-MCI. This program, Cognitive Symptom Management and Rehabilitation Therapy for Parkinson's Disease (CogSMART-PD), is a 10-week intervention that provides cognitive skills training and teaches compensatory strategies to help individuals with PD-MCI cope with and adapt to cognitive deficits. Also, the program provides psychosocial and stress-reducing techniques to attenuate common neuropsychiatric symptoms that often negatively impact cognitive functioning and QoL. Our preliminary data demonstrated that CogSMART-PD holds great promise for the treatment of cognitive and neuropsychiatric symptoms in PD-MCI. To our knowledge, this is the first proposed randomized, parallel, controlled study to investigate the efficacy of a compensatory cognitive rehabilitation program adapted specifically for PD. We hypothesize that cognitive functioning, neuropsychiatric symptoms, and quality of life/health status will improve in PD-MCI participants following 10 weeks of the CogSMART-PD, and these improvements will be maintained at 6- and 12-months post-treatment. One hundred ten participants with PD-MCI based on the criteria set forth by the Movement Disorder Society will be recruited for this study. Over-recruitment by 20% will be instituted to account for subject attrition or unusable data. Participants will be randomized into either a 10-week CogSMART-PD intervention group (n = 55) or 10-week supportive care group (n = 55). All participants will be assessed with a battery of tests that measure objective and subjective cognitive function, neuropsychiatric symptoms, disease severity, motor symptoms, and quality of life/health status by an examiner blinded to group assignment. Assessments will be administered at baseline, 10 weeks (post-treatment), and 6- and 12- months (follow-ups). Data will be primarily analyzed using analyses of covariance and linear random effects modeling. Results of this study will provide essential information about a non-pharmacological intervention for individuals with PD-MCI that could improve their cognition, neuropsychiatric symptoms, and quality of life/ health status. Moreover, these results may demonstrate the first evidence of preventing or stabilizing functional cognitive decline in PD and could provide a manualized and systematic program that can be feasibly implemented and disseminated throughout the VA Healthcare System.

 描述： 帕金森氏病（PD）中的认知定义通常是渐进的，并且经常代表最令人衰弱的症状，导致功能结果和生活质量降低（QOL）。据估计，有20％至50％的PD个体符合轻度认知障碍的标准（PD-MCI），其特征在于正常认知和痴呆症之间的过渡阶段。不幸的是，几乎没有药物治疗方案可以帮助与PD-MCI相关的认知障碍。基于补偿性策略的发展，认知康复代表了一种改善PD-MCI认知的非药理学方法。但是，据我们所知，没有研究在PD中检查这种方法，这在我们的知识上是一个关键的差距。此外，在传统干预措施中通常会忽略神经精神症状（例如睡眠困难，情绪）。这是这项研究的总体目的是确定一种新型的，手动的补偿性认知康复计划的有效性，以改善认知缺陷以及改善PD-MCI患者的神经精神症状和生活质量/健康状况（QOL/HS）的改善。该计划是帕金森氏病（COGSMART-PD）的认知症状管理和康复疗法，是一项为期10周的干预措施，提供认知技能培训，并教授补偿性策略，以帮助PD-MCI患者应对并适应认知缺陷。此外，该计划还提供了心理和减轻压力的技术来减轻常见的神经精神症状，这些症状通常会对认知功能和QOL产生负面影响。我们的初步数据表明，COGSMART-PD在PD-MCI中治疗认知和神经精神症状具有巨大的希望。据我们所知，这是第一个提出的随机，平行，对照研究，用于研究专门针对PD的补偿性认知康复计划的效率。我们假设认知功能，神经精神症状和生活质量/健康状况将有所改善 COGSMART-PD 10周后，PD-MCI参与者将在治疗后6个月和12个月保持这些改进。根据运动障碍协会规定的标准，将招募有PD-MCI的十名参与者。招聘过度降低20％，以说明主题属性或无法使用的数据。参与者将被随机分为10周的COGSMART-PD干预组（n = 55）或10周的支持护理组（n = 55）。所有参与者将通过一系列测试来评估，以衡量客观和受试者的认知功能，神经精神症状，疾病严重程度，运动症状以及生活质量/健康状况的审查员对小组分配的审查员。评估将在基线，10周（治疗后）以及6个月和12个月（随访）进行管理。数据将使用协方差和线性随机效应建模分析对数据进行分析。这项研究的结果将为PD-MCI患者提供有关非药物干预的基本信息，这些信息可以改善其认知，神经精神症状和生活质量/健康状况。此外，这些结果可能证明了预防或稳定PD功能认知能力下降的第一个证据，并且可以提供手动和系统的程序，可以在整个VA医疗保健系统中可行地实施和传播。