Cognitive Rehabilitation for Older Veterans with Mild Cognitive Impairment

患有轻度认知障碍的老年退伍军人的认知康复

• 批准号: 10683711
• 负责人: Maya Elin O'Neil
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-01-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10683711
• 关键词: Abstinence; Activities of Daily Living; Address; Adoption; Adult; Affect; Age; Aging; Alzheimer' s Disease; Attention; Auditory; Behavior Therapy; California; Caring; Clinical Trials; Cognition; Cognitive; Control Groups; Craniocerebral Trauma; Dementia; Diagnosis; Diet; Educational Intervention; Elderly; Enrollment; Equipment and supply inventories; Evaluation; Evidence based treatment; Exclusion Criteria; Exercise; Exhibits; Failure; Frequencies; Future; Goals; Health; Healthcare; Healthcare Systems; Hour; Impaired cognition; Impairment; Independent Living; Individual; Informed Consent; Intervention; Life Style; Manuals; Measures; Mediating; Mediation; Mediator; Memory; Mission; Motivation; Neurodegenerative Disorders; Oregon; Participant; Patient Care; Patients; Performance; Pharmaceutical Preparations; Physical Exercise; Pilot Projects; Population; Post-Traumatic Stress Disorders; Psyche structure; Psychotic Disorders; Publishing; Quality of life; Randomized; Randomized, Controlled Trials; Recording of previous events; Reporting; Research; Research Design; Resources; Risk; Risk Factors; Sampling; Savings; Schizoaffective Disorders; Schizophrenia; Services; Site; Substance Use Disorder; Training; Unconscious State; United States; Veterans; Veterans Health Administration; Vietnam; Visual impairment; Work; acceptability and feasibility; active control group; age related; alternative treatment; care seeking; cognitive performance; cognitive rehabilitation; cognitive training; demographics; effective therapy; efficacy evaluation; eligible participant; evidence base; executive function; follow-up; health administration; health care service; improved; inclusion criteria; medication compliance; mild cognitive impairment; mild traumatic brain injury; motivational enhancement therapy; multimodality; patient oriented; peer; person centered; pharmacologic; prevent; primary endpoint; primary outcome; protective factors; recruit; scale up; secondary endpoint; secondary outcome; substance use; symptom treatment; tool; treatment effect; treatment group; willingness

Due to the aging of the United States population, age-related cognitive problems resulting from Alzheimer’s disease and other causes of dementia are increasingly prevalent. Before individuals are diagnosed with dementia, they typically exhibit a period of “mild cognitive impairment” (MCI). Mild cognitive problems associated with MCI frequently impact an individual’s ability to perform everyday tasks, including working, independent living, and medication adherence. Veterans are at increased risk of cognitive decline, and the Veterans Healthcare Administration (VA) is now providing health care to surging numbers of older Veterans with MCI who report significant cognitive complaints, difficulties with everyday functioning, and concerns about impending dementia. Despite high patient demand, few cognitive rehabilitation interventions exist that specifically address the needs of older Veterans with MCI that are widely accessible, patient-centered, and evidence-based. To our knowledge, no randomized controlled trials have been conducted that evaluate the efficacy of manualized, brief and inexpensive, yet comprehensive (multi-modal) cognitive rehabilitation interventions for older Veterans with MCI. Hence, the primary objective of this study is to evaluate the efficacy of Motivationally Enhanced Compensatory Cognitive Training (ME-CCT), a manualized cognitive rehabilitation group treatment for older Veterans with MCI. The study’s specific aims are to determine whether ME-CCT is effective for: 1) improving objective cognitive performance and functional capacity, 2) improving subjective cognitive complaints, subjective functioning, and collateral measures of everyday function, and 3) increasing modifiable protective factors (e.g., diet, exercise) associated with reduced risk for MCI. We will also explore mediators and moderators of treatment effects. The overall goal is to evaluate a manualized group treatment for the symptoms of MCI that can be readily implemented in VA treatment settings. The study design makes use of the convergent availability of resources at the two participating VA Healthcare Systems in San Diego, California and Portland, Oregon to conduct a randomized controlled trial of ME-CCT. The study will recruit a sample of 216 Veterans (108 at each site) who meet criteria for MCI. Inclusion criteria will be: 1) Veterans 55 years old or older enrolled at one of the participating VAs who are able to provide informed consent, 2) Independently living, 3) Meet criteria for MCI based on previously published criteria (Petersen, 2004; Petersen, 2011), and 4) Willingness to participate in audio-recorded group sessions. Exclusion criteria will be: 1) Current substance use disorder with less than 30 days abstinence, 2) History of schizophrenia, schizoaffective disorder, or other primary psychotic disorder, 3) History of significant head trauma with loss of consciousness >30 minutes, and 4) Auditory or visual impairments that would prevent ability to participate in the cognitive rehabilitation group. Eligible participants will be randomly assigned to either the ME-CCT or an active control group, Goal-focused Supportive Contact (SC). The SC group will provide the same frequency and amount of therapist and peer contact as ME-CCT, but without specific training in cognitive strategies, lifestyle strategies, or motivational enhancement. 10 2-hour long weekly sessions will be delivered in both conditions. Both groups will undergo evaluations at baseline, 5 weeks (midway through the intervention), 10 weeks (immediately following the end of the intervention), and 23 weeks (3 months after completion of the intervention).

由于美国人口的老龄化，阿尔茨海默氏症带来的与年龄有关的认知问题 疾病和其他痴呆症原因越来越普遍。在个人被诊断出患有 痴呆症，它们通常表现出“轻度认知障碍”（MCI）的时期。轻度认知问题 与MCI相关的经常会影响个人执行日常任务的能力，包括工作， 独立生活和药物依从性。退伍军人的认知能力下降风险增加，而 退伍军人医疗保健管理局（VA）现在正在为大量退伍军人提供医疗保健 与MCI报告了重大认知投诉，每天运作的困难以及对 即将来临的痴呆症。尽管患者的需求很高，但很少有认知康复干预措施 专门满足与MCI的老年退伍军人的需求，这些需求广泛，以患者为中心，并且 循证。据我们所知，尚未进行随机对照试验来评估 手动，简短且廉价但全面（多模式）认知康复的功效 与MCI老年退伍军人的干预措施。因此，这项研究的主要目的是评估效率 动机增强的补偿性认知训练（ME-CCT），这是一种手动认知康复 MCI老年退伍军人的小组治疗。该研究的具体目的是确定ME-CCT是否是 有效：1）提高客观认知能力和功能能力，2）提高主观 认知投诉，主观功能和每天功能的附带措施，3）增加 可修改的受保护因素（例如，饮食，运动）与MCI风险降低有关。我们还将探索 治疗效果的介体和主持人。总体目标是评估手动的小组治疗 对于可以在VA治疗环境中容易实施的MCI症状。研究设计使 在圣地亚哥的两个参与的VA Healthcare Systems的收敛资源可用性， 加利福尼亚州和俄勒冈州波特兰进行ME-CCT的随机对照试验。该研究将招募 符合MCI标准的216名退伍军人样本（每个地点为108名）。纳入标准将是：1）退伍军人55 年龄或以上的年龄段是能够提供知情同意的参与的VA之一，2） 独立生活，3）根据先前发布的标准符合MCI的标准（Petersen，2004； Petersen， 2011年）和4）愿意参加音频录制的小组会议。排除标准将是：1） 不到30天的禁欲的药物使用障碍，2）精神分裂症的史，具有精神分裂症的病史 疾病或其他原发性精神病，3）严重的头部创伤病史，意识丧失 > 30分钟，4）听觉或视觉障碍将阻止参与认知能力 康复小组。合格的参与者将被随机分配给ME-CCT或主动控制 小组，以目标为中心的支持联系（SC）。 SC组将提供相同的频率和数量 治疗师和同伴接触是ME-CCT，但没有具体的认知策略，生活方式策略的培训， 或激励性的增强。 10 2小时长的每周课程将在两种情况下进行。两组 将在基线时进行评估，5周（干预措施中途），10周（立即 在干预结束后和23周（干预完成后3个月）。