Anxiety, Mild Cognitive Impairment, Alzheimer Disease, Dementia
Conditions
Keywords
Computerized Intervention, Brief Treatment, Psychoeducation, Interoceptive Exposure, Older Adults, Care Partner, Anxiety Sensitivity
Brief summary
The goal of this clinical trial is to test the effectiveness of a computerized anxiety sensitivity treatment (CAST) compared to a health education control (HEC) in older adults with mild cognitive impairment (MCI) or mild Alzheimer's Disease and related dementias (ADRD) and their care partners. The main questions it aims to answer are: 1. Efficacy of CAST in reducing anxiety and related symptoms among those with MCI/mild ADRD 2. Efficacy of CAST in reducing care partner burden among care partners of people living with MCI/mild ADRD 3. Explore treatment mechanisms using a multi-modal assessment battery of anxiety sensitivity and anxiety Participants will complete six in-person visits including a baseline assessment, two intervention sessions, and three follow-up assessments at 1, 3, and 6-months posttreatment. Participants will also complete three weeks of ecological momentary assessments (EMAs) for one week prior to intervention, one week between intervention sessions, and one week after intervention. If there is a comparison group: Researchers will compare CAST to HEC to see if CAST reduces anxiety and related symptoms in older adults with MCI/mild ADRD and care partner burden to a greater degree than HEC.
Detailed description
Participants are dyads consisting of an older adult with MCI/mild ADRD and their care partner. Baseline assessment will include a neuropsychological evaluation to confirm cognitive status for the older adult with MCI/mild ADRD, a series of baseline questionnaires, and introduction to the EMA application. Dyads are randomized to either the CAST or HEC conditions. During CAST sessions, dyads view the CAST presentation and complete interoceptive exposures. An interventionist guides dyads through these sessions. During HEC, dyads view the HEC presentation and complete behavior tracking and goal-setting with the guidance of an interventionist. At both intervention sessions, dyads complete questionnaires including post assessments at the end of intervention session two. For the week prior to intervention session one, the week between the two intervention sessions, and the week after intervention session two, dyads complete daily EMAs about emotional and other factors using an application downloaded on a phone or tablet. At 1, 3, and 6-months follow-up assessments, dyads complete follow-up cognitive testing and outcome questionnaires.
Interventions
Brief computerized treatment for anxiety sensitivity
BEHAVIORALHealth Education Control
Brief computerized presentation on healthy behaviors
Sponsors
Florida State University
Ohio State University
Ohio University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
An independent assessor (blind to treatment condition) will conduct pre-intervention and follow-up assessments. The assessor will have extensive training and experience in conducting the relevant assessments including clinical interviews and neuropsychological evaluations. A separate interventionist will assist in the delivery of the intervention.
Intervention model description
Variable-sized permuted block randomization will be used to allocate participants to treatment condition, stratified by dementia severity (MCI vs. mild ADRD) and gender.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
DYAD * Patient age 60+ * Care partner 18+ * Has care partner who will participate ("someone you have a reciprocal relationship with who provides you with emotional or physical support and helps with decision-making. This could be a spouse or significant other, relative, or close friend whom you spend a significant amount of time with.") * Has smartphone or access to Wi-Fi EITHER * Score of 20 or above on the PROMIS-Anxiety short form (patient only) OR * Score of 5 or above on SSASI (patient only) OR * Score of 31 or above on NIH Toolbox Perceived Stress Scale score (patient only) AND EITHER 1. Participant MoCA score is between 17 to 26 OR 2. Participant Memory Complaint Scale score 3 or greater OR 3. Care partner quick dementia rating scale score between 2 to 12.5
Exclusion criteria
PATIENT * Issues with seeing or hearing that would prevent reading or listening to computer presentations * Medical conditions that would preclude participation in study * Severe mental illness (e.g., schizophrenia, unmedicated bipolar disorder) CARE PARTNER * Issues with seeing or hearing that would prevent reading or listening to computer presentations * Medical conditions that would preclude participation in study * Severe mental illness (e.g., schizophrenia, unmedicated bipolar disorder)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in anxiety sensitivity pre intervention to posttreatment. | Baseline to immediately after the intervention | Anxiety sensitivity will be measured using the Anxiety Sensitivity Index-3 (ASI-3). The ASI-3 is an 18-item self report measure with possible scores ranging from 0 to 72. Higher scores indicate higher anxiety sensitivity. |
| Change in anxiety pre intervention to 1-month follow-up. | Baseline to 1-month follow-up | Anxiety will be assessed using the Patient-Reported Outcomes Measurement Information System - Anxiety (PROMIS Anxiety) Short Form 8a self-report measure. The PROMIS Anxiety is an 8-item self report questionnaire with possible scores ranging from 8 to 40. Higher scores indicate more anxiety. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in negative affect pre intervention to 1-month follow-up. | Baseline to 1-month follow-up | Negative affect will be assessed using the Positive and Negative Affect Schedule - Negative Affect (PANAS-NA). PANAS-NA is a 10-item self-report measure with possible scores ranging from 10 to 50. Higher scores indicate more negative affect. |
| Change in stress pre intervention to 1-month follow-up. | Baseline to 1-month follow-up | Stress will be assessed with the NIH Toolbox - Perceived Stress. The NIH Toolbox - Perceived Stress is a 10-item self-report measure with possible scores ranging from 10 to 50. Higher scores indicate more stress. |
| Change in quality of life pre intervention to 1-month follow-up. | Baseline to 1-month follow-up | Quality of life will be assessed with the NIH Toolbox General Life Satisfaction scale. The NIH Toolbox General Life Satisfaction scale is a 5-item self-report measure with possible scores ranging from 5 to 35. Higher scores indicate higher life satisfaction. |
| Change in depression pre intervention to 1-month follow-up. | Baseline to 1-month follow-up | Depression will be assessed using the PROMIS - Depression Short Form 8b. The PROMIS - Depression is an 8-item self-report measure with possible scores ranging from 8 to 40. Higher scores indicate higher level of depression. |
| Change in cognitive functioning pre intervention to 1-month follow-up. | Baseline to 1-month follow-up | Cognitive functioning will be assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RBANS assesses cognitive functioning in the following domains: immediate memory, visuospatial functioning, attention, language, and delayed memory. |
| Stability of anxiety sensitivity from posttreatment to 6-month follow-up. | Immediately after the intervention to 6-month follow-up. | Anxiety sensitivity will be measured using the Anxiety Sensitivity Index-3 (ASI-3). The ASI-3 is an 18-item self report measure with possible scores ranging from 0 to 72. Higher scores indicate higher anxiety sensitivity. |
| Stability of anxiety from 1-month follow-up to 6-month follow-up. | 1-month to 6-month follow-up | Anxiety will be assessed using the Patient-Reported Outcomes Measurement Information System - Anxiety (PROMIS Anxiety) Short Form 8a self-report measure. The PROMIS Anxiety is an 8-item self report questionnaire with possible scores ranging from 8 to 40. Higher scores indicate more anxiety. |
| Stability of depression from 1-month follow-up to 6-month follow-up. | 1-month to 6-month follow-up | Depression will be assessed using the PROMIS - Depression Short Form 8b. The PROMIS - Depression is an 8-item self-report measure with possible scores ranging from 8 to 40. Higher scores indicate higher level of depression. |
| Stability of negative affect from 1-month follow-up to 6-month follow-up. | 1-month to 6-month follow-up | Negative affect will be assessed using the Positive and Negative Affect Schedule - Negative Affect (PANAS-NA). PANAS-NA is a 10-item self-report measure with possible scores ranging from 10 to 50. Higher scores indicate more negative affect. |
| Stability of stress from 1-month follow-up to 6-month follow-up. | 1-month to 6-month follow-up | Stress will be assessed with the NIH Toolbox - Perceived Stress. The NIH Toolbox - Perceived Stress is a 10-item self-report measure with possible scores ranging from 10 to 50. Higher scores indicate more stress. |
| Stability of quality of life from 1-month follow-up to 6-month follow-up. | 1-month to 6-month follow-up | Quality of life will be assessed with the NIH Toolbox General Life Satisfaction scale. The NIH Toolbox General Life Satisfaction scale is a 5-item self-report measure with possible scores ranging from 5 to 35. Higher scores indicate higher life satisfaction. |
| Stability of cognitive functioning from 1-month follow-up to 6-month follow-up. | 1-month to 6-month follow-up | Cognitive functioning will be assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RBANS assesses cognitive functioning in the following domains: immediate memory, visuospatial functioning, attention, language, and delayed memory. |
| Change in care partner burden from pre intervention to 1-month follow-up. | Baseline to 1-month follow-up | Care partner burden will be assessed using the Zarit Burden Interview - Short. The Zarit Burden Interview - Short is a 12-item self-report questionnaire with a possible score range of 0 to 48. Higher scores indicate higher burden levels. |
| Change in objective measure of interoceptive fear conditioning pre to posttreatment | Baseline to immediately after the intervention | Interoceptive fear conditioning will be assessed with a skin conductance response (SCR) during an interoceptive exposure. Higher SCR numbers indicate higher interoceptive fear. |
| Change in Loneliness from pre intervention to 1-month follow up | Baseline through Month 1 follow up | Loneliness will be measured using the 10-item UCLA Loneliness Short form questionnaire. This self-report scale yields scores between 10 to 40 with higher scores indicating more significant loneliness symptoms. |
Countries
United States
Contacts
CONTACTNorman B Schmidt, Ph.D.
CONTACTFrederick T Schubert, B.A.
Outcome results
None listed