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).

由于美国人口老龄化，阿尔茨海默氏症导致与年龄相关的认知问题 在个体被诊断出患有痴呆症之前，疾病和痴呆症的其他原因越来越普遍。 痴呆症期间，他们通常会表现出一段时期的“轻度认知障碍”（MCI）。 与 MCI 相关的经常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的退伍军人认知能力下降的风险增加。 退伍军人医疗保健管理局 (VA) 现在正在为数量激增的老年退伍军人提供医疗保健 患有 MCI 的人报告了严重的认知问题、日常功能困难以及对 尽管患者需求量很大，但很少有康复干预措施能够满足即将到来的痴呆症的需求。 专门满足患有 MCI 的老年退伍军人的需求，这些需求可广泛获取、以患者为中心，并且 据我们所知，尚未进行评估的随机对照试验。 手动、简短、廉价但全面（多模式）认知康复的功效 因此，本研究的主要目的是评估对患有 MCI 的老年退伍军人的干预措施。 动机增强补偿性认知训练（ME-CCT），一种手动认知康复 该研究的具体目的是确定 ME-CCT 是否有效。 有效：1）提高客观认知表现和功能能力，2）提高主观能力 认知抱怨、主观功能和日常功能的附带测量，以及 3) 增加 我们还将探讨与降低 MCI 风险相关的可改变的保护因素（例如饮食、运动）。 治疗效果的调节因素和调节因素 总体目标是评估手动团体治疗。 该研究设计使得可以在 VA 治疗环境中轻松实施 MCI 的症状。 利用圣地亚哥两个参与的 VA 医疗保健系统的资源聚合可用性， 加利福尼亚州和俄勒冈州波特兰市将开展一项 ME-CCT 随机对照试验，该研究将招募一名受试者。 符合 MCI 标准的 216 名退伍军人（每个地点 108 名）样本将是： 1) 退伍军人 55 名。 年龄或以上在参与的 VA 之一注册并能够提供知情同意书，2) 独立生活，3) 符合基于先前公布的标准的 MCI 标准（Petersen，2004 年；Petersen， 2011），以及 4） 参加录音小组会议的意愿为： 1） 当前。 戒断时间少于 30 天的物质使用障碍，2) 精神分裂症史，分裂情感 障碍，或其他原发性精神障碍，3) 伴有意识丧失的严重头部外伤史 >30 分钟，以及 4) 听觉或视觉障碍会妨碍参与认知活动的能力 符合条件的参与者将被随机分配到 ME-CCT 组或主动对照组。 小组，以目标为中心的支持性联系 (SC) SC 小组将提供相同的频率和数量。 治疗师和同伴接触为 ME-CCT，但没有接受认知策略、生活方式策略、 两组都将进行 10 次每周 2 小时的课程。 将在基线、5周（干预中期）、10周（立即 干预结束后）和23周（干预完成后3个月）。