(provided by candidate): This application aims to support the candidate's research training to become an independent investigator in the area of psychotherapy for depressed, cognitively impaired, disabled elders. Depression, cognitive impairment, and disability in the elderly often coexist and lead to suffering and family disruption. Moreover, many depressed, cognitively impaired elders have slow, poor, or unstable response to antidepressant drugs. Despite the need for non-pharmacological interventions, most psychotherapy research focuses on either cognitively intact, """"""""young old"""""""" patients with limited disability or on demented patients with pronounced disability. Thus the available treatments do not fully address the needs of the large number of depressed elders with intermediate cognitive impairment and disability. The candidate decided to devote his career to the care of this population. He proposes to use Problem Solving Therapy (PST) as his treatment framework and integrate in it compensatory strategies enabling patients to circumvent their behavioral limitations and participate in the PST process. The compensatory strategies are """"""""imported"""""""" from literature on other cognitively impaired psychiatric populations after appropriate adaptation. The treatment is administered at the patients'own homes, where disabled patients spend most of their time and experience most of their problems. Family members/caregivers are invited to participate, when needed, utilizing techniques to help patients with problem solving and with increasing the patients'positive interactions and pleasant events. Thus the proposed treatment aims to create an """"""""ecosystem"""""""" that allows the patients'competencies to be brought to bear in solving their own problems. The proposed training aims to strengthen the candidate's skills in compensatory strategies, treatment approaches involving caregivers, manual development, and experimental design and statistics relevant to treatment trials. The current draft of the treatment manual will be upgraded after receiving input from consultants and from treating 10 patients during the first 1.5 year of the award. The resultant treatment will, then, be pilot-tested (N=60) by comparing it with home delivered Supportive Psychotherapy. Preliminary data from a small pilot study, supported from the National Alliance of Research on Schizophrenia and Depression and the Cornell Center for Aging Research and Clinical Care, provides evidence for the feasibility of the proposed study. The participants will be depressed, cognitively impaired, disabled recipients of the Home Delivered Meals Program of the Westchester County Department of Senior Programs and Services, a partner of the Research Network Development Core of the Cornell ACISR.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Interventions Research Review Committee (ITV)
Program Officer
Wynne, Debra K
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Weill Medical College of Cornell University
Schools of Medicine
New York
United States
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Kiosses, Dimitris N; Gross, James J; Banerjee, Samprit et al. (2017) Negative Emotions and Suicidal Ideation during Psychosocial Treatments in Older Adults with Major Depression and Cognitive Impairment. Am J Geriatr Psychiatry 25:620-629
Kiosses, Dimitris N; Rosenberg, Paul B; McGovern, Amanda et al. (2015) Depression and Suicidal Ideation During Two Psychosocial Treatments in Older Adults with Major Depression and Dementia. J Alzheimers Dis 48:453-62
Kiosses, Dimitris N; Ravdin, Lisa D; Gross, James J et al. (2015) Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA Psychiatry 72:22-30
Kiosses, D N; Alexopoulos, G S (2013) The prognostic significance of subsyndromal symptoms emerging after remission of late-life depression. Psychol Med 43:341-50
Kiosses, Dimitris N; Leon, Andrew C; Arean, Patricia A (2011) Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects. Psychiatr Clin North Am 34:377-401, viii
Kiosses, Dimitris N; Teri, Linda; Velligan, Dawn I et al. (2011) A home-delivered intervention for depressed, cognitively impaired, disabled elders. Int J Geriatr Psychiatry 26:256-62
Wilkins, Victoria M; Kiosses, Dimitris; Ravdin, Lisa D (2010) Late-life depression with comorbid cognitive impairment and disability: nonpharmacological interventions. Clin Interv Aging 5:323-31
Kiosses, Dimitris N; Arean, Patricia A (2010) Research on late-life depression and dementia care: across disciplines, across settings. Am J Geriatr Psychiatry 18:457-9
Kiosses, Dimitris N; Arean, Patricia A; Teri, Linda et al. (2010) Home-delivered problem adaptation therapy (PATH) for depressed, cognitively impaired, disabled elders: A preliminary study. Am J Geriatr Psychiatry 18:988-98