Research Project 1: Explicit memory deficits are characteristic of amnestic mild cognitive impairment (aMCl), a condition that often precedes Alzheimer's disease. Although cognitive rehabilitation has Improved memory functioning following other types of neurologic Injury, there is a striking lack of research investigating such methods In aMCl. The proposed project builds directly on the promising results of our ADRC sponsored pilot study that has demonstrated significant behavioral Improvement and increased brain activity as measured by functional magnetic resonance Imaging (fMRI) following training in the use of mnemonic strategies (i.e. explicit memory training). A total of 75 patients with aMCl will be randomly assigned to either 1) explicit memory training 2) rehearsal-based training that relies on preserved implicit memory abilities (spaced retrieval) or 3) an educational control group. Patients will undergo pre- and post-training fMRI while they attempt to learn and remember object-location associations. Between these fMRI sessions, the treatment groups will receive three training sessions that Include both didactics and practice periods (i.e. when patients apply the strategies to associations), or just didactics forthe control group. Long-term retention will be assessed at 1 month. This design will allow us to directly compare the behavioral changes resulting from each Intervention (Specific Aim 1) as well as the neural substrates of these approaches (Specific Aim 2). We will also Identify individual characteristics that affect treatment effectiveness, which could be crucial for the development and selection of appropriate Interventions for future patients (Specific Aim 3).
The Innovative study design may provide substantial insight Into the types of cognitive rehabilitation techniques that are most effective in aMCl. Identification of preserved and/or compensatory neural networks could foster the development of additional techniques that specifically utilize such areas. This line of Investigation could ultimately have significant public health Impact by delaying functional progression to Alzheimer's disease thereby reducing the costs associated with this rapidly growing population.
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